Risk and Risk Assessment Dr Maggie Robertson March

Risk and Risk Assessment Dr Maggie Robertson March 2011 abridged

Defining Risk “The likelihood of an event happening with potentially harmful or beneficial outcomes for self and others. (Possible behaviours include suicide, self-harm, neglect, aggressions and violence; with an additional range of other positive or negative client/ patient experiences)” “Risk is dynamic, constantly changing in response to altered circumstances. Risk can be minimised but not eliminated. Assessment Group 2005) (The Joint Risk

Some words underpinning the risk concept • Hazard –something that may cause harm or increases the chances of future harm. • Strength –something that reduces the chances of future harm. • Danger –a feared outcome of a hazard. • Vulnerability –capable of being wounded or susceptible to danger.

Elements of Risk Goes beyond mere probability of injury or death Uncertainty is a broader term than probability or likelihood. lack of knowledge (information) about situation. • Novelty • ambiguity about situation. • lack of control • lack of time; time pressure

Types of risk What risk assessment is: “A risk assessment is a systematic method of looking at work activities, considering what could go wrong and deciding on suitable control measures to prevent loss, damage or injury in the workplace. The assessment should include the controls required to eliminate, reduce or minimise the risks. ” (NHS Health Scotland 2008)

Why we assess risk. Proactively reducing/ managing risk Because we have to (the law says!) Protecting patient/ service user, self and others from harm • Providing a focus for nursing care & care planning –helps prioritisation Can mitigate against litigation • May reduce health care costs (economic & social)

Assessing Risk Five steps for assessing risk in the workplace (HSE: 2006) Step 1: Identify the hazards Step 2: Decide who might be harmed and how Step 3: Evaluate the risks and decide on precautions Step 4: Record your findings and implement them Step 5: Review your assessment and update if necessary

Risk Analysis Describe a range of future scenarios: worst case, best case, most probable. How: Mechanisms of possible future harm. When: Describe the short, medium and long term. Where: Describe places of possible future harm. What: Describe the possible future harms Who: Who is exposed to the possibility of harm Why: Describe a range of retrospective scenarios (hypotheses as to how the situation came to be)

Risk and Decision Making Risk assessment (How much harm is incurred or expected? ) judgment of the likelihood and severity of the threat or undesirable outcome -made about a situation at a particular point in time. Future oriented, prediction about the future.

Who should assess risk? Qualified healthcare staff Trained risk assessors Generally –anybody can use principles and be proactive Person ‘at risk’

Documenting Risk Follow NMC guidelines –jargon-free, accurate, sufficiently detailed, factual, with patient/ service user if possible, etc. Follow local policies Set review date Inform relevant others Documentation is seldom enough –need to plan action.

Relevant legislation, policy and guidance Go to Quality Improvement Scotland Scottish Government SIGN NHS Highland/ Grampian NHS Scotland (SHOW) Health Scotland (Scotland’s health improvement agency) ◦ Health and Safety Executive ◦ ◦ ◦

Conclusion Risk is an elusive concept. It is multidimensional. It has a number of components like uncertainty, harm or loss, danger, exposure to harm, control, how avoidable. These components are multifaceted too. The word is often used interchangeably with any of its components.

continued Risk assessment involves more than tools (but tools can be useful) Be careful of defensive risk management Balance in all things Accurate and timely documentation Share and act on information

Refs & Further Info Department of Health (2007) Best practice in managing risk. Department of Health, London Health and Safety Executive (2006) Five steps to risk assessment. HSE, Sudbury. Joint Risk Assessment Group (2005) The single shared assessment of needs and risks. NHS Argyll and Clyde NHS Health Scotland (2008) Risk assessment. [online] http: //www. healthyworkinglives. com/advice/minimising-workplacerisks/risk- assessment. aspx Accessed 30 th September 2008. NHS Quality Improvement Scotland (2005) Clinical governance & risk management: achieving safe, effective, patient-focused care and services. QIS, Edinburgh and Glasgow.