Risk Management 1 Identify the four stages of

Risk Management

1. Identify the four stages of risk management for infection prevention and control. 2. Develop a system for setting priorities for action based on risk management. December 1, 2013 Objectives 2

• 40 minutes December 1, 2013 Time involved 3

• Risk is defined as ‘possibility of incurring misfortune and loss’ • Primary aim of risk management is December 1, 2013 Risk Management • Proactive • Reduction of risks to the lowest level that is “reasonably practicable” • Ongoing process 4

• By applying concepts of risk management, the Infection Control Team can help healthcare facilities set priorities • Aim is to December 1, 2013 Risk Management • Identify unsafe and hazardous practices • Recommend cost effective preventive measures 5

This approach can also be used for hazards or risks that arise from the environment or equipment, as well as patient-related risks December 1, 2013 Risk Management 6

1. 2. 3. 4. Risk identification Risk analysis Risk control Risk monitoring December 1, 2013 Four Stages of Risk Management 7

• • • Identify tasks and activities that put patients, healthcare workers & visitors at risk Identify the infectious agent(s) involved Identify the mode of transmission December 1, 2013 Risk Identification 8

• Why are infections happening? • How frequently they are happening? • What are the likely consequences if the appropriate action is not taken? • How much they are likely to cost to prevent it? December 1, 2013 Risk Analysis 9

• Compare level of risk found during the analysis process with previously established risk criteria • Using statistical analysis December 1, 2013 Evaluating risks • Type III 10

• Sources of performance deficit • These occur due to an act of omission Example: failure to comply with current professionally accepted practice December 1, 2013 Why Are They Happening? - Type I Error • Could be due to: • Lack of knowledge • Inadequate provision of education, training and supervision • Lack of communication • Lack of availability/regular supply of goods 11

• Sources of performance deficit • These occur due to an act of commission • an act should not have been committed December 1, 2013 Why Are They Happening? Type II Error • Could be due to: • Lack of commitment • Lack of consideration for others This is more complex and may also require management reinforcement 12

• Occurs when we fail to understand the true nature of the problem • Real solutions are adopted to deal with the wrong problems, rather than incorrect solutions to real problems • Often due to lack of communication or misinterpretation of information December 1, 2013 Why Are They Happening? – Type III Error 13

• This is quantitative information • Can be achieved by on-going surveillance or by prevalence study December 1, 2013 How frequently are they happening? • Frequency can be measured as the percentage or rate of persons who developed infection • If there are no infection data, probability can be used instead 14

Rating Probability Comments 4 1: 10 Almost certain or very likely to occur 3 1: 100 Highly probable that they will occur. 2 1: 1000 It is possible that they may occasionally occur 1 ≥ 1: 10000 They are rare and do not believe/expect to occur December 1, 2013 Risk Probability - Frequency 15

• Consequences are expressed by severity • Severity is measured by morbidity/mortality of infection involved December 1, 2013 What are the likely consequences? 16

Rating Description Consequence/Impact Comments 20 -30 High or major Major impact on patient which may lead to death or long term consequences Urgent action is required 10 -19 Moderate impact which may lead to short term consequences Action required 1 -9 Low risk or minor Minimum impact with no or minor consequences Keep under review December 1, 2013 Risk Probability - Severity 17

December 1, 2013 Prioritising Risks 18

Risk Factor = Frequency (Probability) X Consequence (Impact) Surveillance data provides probability or frequency of infection from a task or a procedure Risk assessment provides impact or consequence to patient as a result of a task or a procedure December 1, 2013 Calculating Risk 19

• Estimated cost is important as it helps to target IP&C resources to specific procedure December 1, 2013 How much does it cost to prevent ? • where risk was identified • where they will deliver the greatest advantage in terms of preventing harm for patients • Often it is not possible to have exact cost estimated cost is acceptable 20

• Once all information on the severity, frequency of occurrence and cost of prevention are available • Priorities for action can be calculating as follows: December 1, 2013 Priorities for action RISK RATING = SEVERITY x FREQUENCY 21

December 1, 2013 Priority for Action 22

• Put an agreed risk reduction plan in place in the problem area • Eliminate risk, if possible • Reduce risk to acceptable level, if needed • Transfer risk to a third party • May need to accept risk in short term December 1, 2013 Risk Control - 1 23

December 1, 2013 Risk Control - 2 Identify Risks ↓ Analyse (Evaluate & Rank) ↓ Control Avoid Prevent Transfer Accept Risk Control : Think possible solutions ! n n How they can be avoided eg minimize/avoid use of sharps How they can be prevented eg use aseptic techniques Can it be transferred eg outsource waste management Can you accept it eg low risk/high cost intervention 24

• Feedback and reporting • To ensure that risk reduction plans are followed • Performed by December 1, 2013 Risk Monitoring • regular audit • process surveillance • outcome surveillance • Feedback provided to relevant staff and senior management 25

• Audit process can identify infection risks • When risk reduction plan in process, audit can • identify new risks • analyse risk against evidence-based practice • identify any gaps in practice December 1, 2013 The audit process • Key elements of the audit process • communication • consultation • timely feedback 26

December 1, 2013 Summary: Risk Management 27

1. 2. 3. Roberts G. Risk Management in Healthcare. 2 nd ed. London: Witherby & Co. 2002 Australian Standard: Risk management. AS/N 2 S 4360: 2004. http: //www. mwds. com/AS 4 me_files/ASNZS%2043602004%20 Risk%20 Management. pdf Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010) http: //www. nhmrc. gov. au/book/australianguidelines-prevention-and-control-infectionhealthcare-2010/a 2 -1 -risk-management-bas December 1, 2013 References 28

1. Risk management is a retroactive approach and its aim is to minimise harm. T/F 2. In setting priorities for action, which of these is needed? a. b. c. d. December 1, 2013 Quiz Severity or consequences Frequency Cost of implementing plans All of the above 29

• IFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe. • The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise. • For more information go to http: //theific. org/ December 1, 2013 International Federation of Infection Control 30