risk assessment handout · risk assessment – handout training 2 care (uk) ltd, 3 media house,...

Risk Assessment – HANDOUT

Training 2 CARE (UK) Ltd, 3 Media House, Threshelfords Business Park, Feering, CO5 9SE. www.training2care.co.uk. Tel: 01376 573999

Introduction

For care managers and care professionals risk assessments can be a daunting procedure

By following some basic rules and applying the principles of the care value base the task can be made a lot simpler

The Law

Health and Safety at Work Act 1974 o It shall be the duty of every employer to ensure (so far as is

reasonably practicable) the health, safety and welfare at work of all employees

Management of Health and Safety at Work Regulations 1999 o Every employer shall make a suitable and sufficient assessment of the

risks to the health and safety of his employees to which they are exposed whilst they are at work

What is a Risk Assessment?

A risk assessment is “the procedure which examines a care setting for potential risks and hazards to service users and their carers. Following this the areas of concern are recorded and addressed” (Richards, 2003)

Risk management o “involves identifying health and safety hazards in order to

implement strategies to eliminate and prevent such risks” (Richards, 2003)

Involves: o Recognising a risk o Weighing up the extent of the risk o Implementing methods and strategies to control the risk o Where necessary making finances available for alterations to

premises and purchase of equipment Duty of Care

Care professionals have duty of care to their clients in all matters, including assessment of risks

Ethical perspectives have to be taken into consideration

The relationship between client and the care professional should remain equal

A clients’ potential vulnerability should not affect their right to empowerment

Ensuring that the desires/needs of the client are at the heart of the process (not just physical needs)



Client participation in the procedure

A clear understanding of all the risks

A thorough weighing up of the pros and cons for a particular course of action

Documenting the pros and cons

Documenting conclusions/decisions

Discussing and agreeing review dates

Documenting review dates Risk Assessments

Identify any hazards - these are things with the potential to cause harm

Assess the risk - the likelihood that a hazard will actually cause harm and to whom it can cause harm

Control measures - actions or items that remove or reduce the risk

Train and inform - train, inform and supervise the personnel involved

Monitor - monitor, review and reassess the situation regularly Health and Safety at Work Act 1974

There must be a written policy and procedures document identifying all areas of risk and how they are to be controlled

Staffing Issues

New employees must have access to: o Health and Safety Policies/Procedures o Care Plans o Completed Risk Assessments

They must also have received appropriate induction and training and be supervised (where appropriate)

Summary

A risk assessment should be undertaken for each individual client

Staff should be trained, competent and regularly updated (and supervised where necessary)

Risk assessments should keep the client at the centre – their needs and desires must be balanced with those of the care professional



What is a Risk Assessment?

A risk assessment is a systematic examination of work situations to identify:

Potential risks to the health, safety and security of

o Workers, service users and the visiting public

A risk assessment puts in place risk control measures

o To minimise, eliminate or contain ‘risks’

They are a legal requirement of the Health and Safety at Work Act 1974

The Risk Assessment Process

The risk assessment process is a continual process

Nothing can ever be ‘safe’ and must be continually monitored and reviewed

In care settings there are very many working areas and practice issues

representing hazards

o Moving and handling

o Hazardous chemicals

o Medicines

o Infection control

o Food preparation and handling

o Road safety

o Outings

o Security breaches

o Missing persons

o Accidents and emergencies

o Fire or gas leak

o First aid

o Challenging behaviour



Something for You to Think About

General statistics on some areas requiring a risk assessment

Moving and Handling – Source Health and Safety Executive (HSE)

Key Statistics for 2010/2011

o 7.6 million working days were lost due to musculoskeletal disorders

o 26.4 million working days lost due to work-related illness and

workplace injury

o 1.2 million working people suffered from a work-related illness

Health and social care:

The second most common kind of major injuries are those sustained while

handling, lifting or carrying

o This accounts for 40% of work-related sickness absence

o Around 5000 injuries are reported each year in health services and

around 2000 in social care

“Moving and handling is a key part of the working day for most employees;

from moving of equipment, laundry, catering, supplies or waste to assisting

residents in moving. Over 50% of injuries arise from the moving and

handling of people.” (Source: HSE)

Hazardous Chemicals – Source Health Protection Agency (HPA)

Between 1st October and 31st December 2005 (3 months!) there were 221

acute chemical incidents reported:

o 1% from primary care trusts

o 4% from local authorities

o 4% from hospitals

o 8% from the ambulance service

o 30% - origin not described



Medicines – Source National Patient Safety Agency (NPSA)

The most commonly reported categories of errors involving medication is:

o Wrong dose

o Omitted or delayed medicines

o Wrong medicine

April 2007 to March 2009

o 60 deaths in health and social care settings resulted from medication

errors

Infection Control

Providers of health and social care are required to report MRSA bloodstream

infections and cases of clostridium difficile infection

Reported cases March 2011 to March 2012

o MRSA - 1225 cases (MRSA Action UK)

o Clostridium difficile (c diff) – 19649

Deaths involving MRSA fell by 38 per cent between 2009 and 2010 from 781

to 485 (Office for National Statistics)

There were 337 reported cases of tuberculosis in 2005, an increase from 271

reports in 2004

The greatest number of incidents in both years occurred in health care

settings of which 103 incidents in 2005 involved tuberculosis in a health

care worker

Health care settings include hospitals, nursing homes, other medical/health

centres and the community

There have been seven cases of hepatitis B reported to the Health

Protection Agency since 2004 from care and residential homes following the

incorrect use of lancing devices

In 2006 /07 there were 914 incidents where healthcare workers were put at

risk



o Most occupational exposures involved nursing professionals (48% )

A recent report by the Royal College of Nursing reported that one third of

nurses feel at risk of contracting diseases such as HIV and hepatitis C

"Many incidents of occupational exposure can be prevented if there is

proper adherence to standard precautions for the safe handling and

disposal of clinical waste”

Gastrointestinal infections (2005)

o In South West London alone there were 1,966 notifications of food

poisoning

o The majority of these were seen in schools and care homes

Food Preparation and Handling – Source Food Standards Agency (FSA)

In 2007 The Food Standard Agency found that the highest number of

infringements in establishments providing a meal service involved general

hygiene, i.e.:

o Handling procedures, equipment and the conditions of premises

The second highest number of infringements involved the hygiene of staff

These are the latest figures available but these reasons remain the top 2

reasons every year



Introduction

For most of us taking risks is an accepted part of life

However people requiring health or social care services are often discouraged from taking risks

Because of their perceived limitations, or

Fear that they or others might be harmed Personalisation

A risk assessment should focus more on enhancing people’s abilities rather than concentrating on their frailties

Personalisation means working towards providing choices rather than services

Risk Assessments

Risk assessments are not a tick box exercise

They require an understanding of the special vulnerabilities of people

Some risk assessments (e.g. infection control) involve the implementation of standard procedures

Other types of risk assessment are never straightforward and always multi-faceted

The Care Environment

Service users are vulnerable people

Care staff must do all they can to protect clients, themselves, other employees and the public

All care settings should:

Provide a healthy, safe and secure environment

Promote optimum health and well-being for service users and staff Risk Assessment

The care environment:

Risk assessments must be balanced

Risk enablement v responsibilities:

For example:

Safeguarding

Care standards

Health and safety legislation



Accountability and Responsibility

These terms have different meanings: o Responsibility (for) can be defined as:

A set of tasks or functions that an employer, professional body, court of law or some other recognised body can legitimately demand

o Accountability (to) describes: The relationship between the practitioner and the

organisation/setting

Accountability describes the process by which failure to exercise responsibility can produce sanctions

For example: o Warnings, disciplining, suspension, criminal prosecution,

deregistration from professional status

Accountability : o Being able to justify your actions o Keeping up to date with policies and procedures o Acting in a professional manner

Responsibility: o Working to the best of your ability o Carrying out your duties fully

Accountability and Responsibility

Noticing or become aware of someone else’s wrong practice: o Staff are duty bound to:

Do something about it, and Report it

o Otherwise – they too can be held responsible for allowing the situation to continue unchecked

Where does accountability and responsibility fit into risk assessment? o Care staff and managers have individual responsibility for the tasks

they perform o In accordance with the guidance provided by those to whom they are

accountable o Appropriate to their capabilities

Skills of team members must match the needs of the clients Vulnerability and Risk

So that service users can exercise self-determination and choice:

Risk assessment and risk management are an integral part of the needs assessment and care planning process

Service users' vulnerabilities need to be taken into account when assessing risk



Service users should be included in that process Duty of Care

Care services have a duty of care to all their service users when assessing risk

There are potential legal implications (negligence)

There should always be written records showing: o Issues and solutions considered o Clear and justified grounds for risk management decisions

Who is Vulnerable?

In addition to individual vulnerabilities some ‘groups’ have common vulnerabilities

Vulnerable groups: o Children o Teenagers o People with special needs o Older people

Vulnerable Groups

Children, teenagers, people with special needs, older people

These groups are potentially more vulnerable to harm because of the age, stage or nature of their life experience

Children: o Reliant on others for all needs o May be too young to express needs or ask for help o Body not yet developed full strength/dexterity o Lack of experience o Less fear of danger o Strong instinct to explore the world around them o Young children unable to read instructions o Judgement for vehicle distance and speed not yet developed o More vulnerable to infection

Teenagers: o Partially reliant on others for some needs o May resent needing help, so avoid asking for it o Less aware of limitations o At a stage where authority is challenged and convention defied o Less likely to consider consequences o Desire to experiment o More susceptible to peer pressure o May think it ‘uncool’ to read instructions o More likely to take risks and seek thrills



o More vulnerable to some infections

People with special needs: o May be reliant on others for basic needs o May be unable to express needs or ask for help o May have physical or mental deficits o People with special needs: o May be over-trusting o A lack of specialised facilities for people with disabilities makes the

attempt to carry out some activities more risky o May be more vulnerable to infection

Older people: o May be reliant on others for basic needs o Maybe unable or unwilling to express needs or ask for help o May have physical deficits plus wear and tear deterioration of

hearing, sight, mobility o May have memory loss or confusion o May be unaware of, or in denial of physical/mental deficits o May overlook instructions o Judgement for vehicle distance and speed reduced o Less efficient immune system o Lowered ability to heal

Vulnerability and Risk

Older people: o Contemporary literature and guidance stresses the need for: o “People to have choice and opportunities to take risks towards

maintaining their independence and self-determination” o Risk assessment should not focus on a member of staff’s

interpretation of events Person Centred Approaches

This is where care focuses on the person

Delivered in ways that promote: o Independence o Autonomy o Choice

Risk Assessment

A risk assessment requires a comprehensive holistic person centred needs assessment

Which should: o Support independence



o Assess all risks (including abuse, failure to protect, harm to self and others)

o The management of risk is always multifactorial and effective communication is key

Risks, Risk Events and Outcomes

Risk o The possibility that an event will occur with harmful outcomes

Risk events o Can have harmful outcomes because of certain associated risks

Outcomes o Depend on the person, their relationships with others and the

circumstances o Are different for each individual person

Associated Risks

Impairment or disability

Health or mental health problems

Risks linked to everyday activities (affected by impairment or disability)

Medication

Drugs/alcohol misuse

Behaviours causing injury, neglect, abuse, exploitation

Self-harm, neglect, thoughts of suicide

Aggression and violence

Poor planning or service management Managing Risk Positively

Weighing up the potential benefits and harms of exercising one choice of action over another

Identifying the potential risks involved

Developing plans and actions that reflect the positive potential and stated priorities of the service user

Using available resources and support to: o Achieve the desired outcomes o Minimise the potential harmful outcomes

It involves using available resources and support to: o Achieve the desired outcomes o Minimise the potential harmful outcomes

Information Sharing

Information gathering and sharing is:



o Central to identifying risks o Essential to risk assessment and management o The use and sharing of information must respect the principles of the

Data Protection Act 1998 Data Protection Act 1998

The Act is designed to: o Protect personal data about living people o Place obligations on organisations that process personal data o It regulates the processing and disclosure of information and provides

people with rights of access to the information Information Sharing

When collecting information, it is important to tell the service user: o The reason why it is being collected o With whom it will be shared

Information must only be shared in accordance with relevant information sharing protocols

Gathering Information

From: o Access to past records o Self-reports during assessment or reviews o Observing discrepancies between verbal and non-verbal cues o Rating scales/ predictive indicators o Clinical judgement based on evidence based practice o Gathering Information o Reports from significant others: o Carers, relatives or friends o Other team members/teams o Advocates o Other statutory or voluntary agencies or the police o Probation services or courts

Gathering Information

Whilst identifying, assessing and managing risk: o Ensure information shared or gathered is properly recorded o Formulate a logical, informed opinion as to the severity of risk o Arrange discussions with the service user, their family and any

health, social care, advocacy or independent sector professional involved

Include the service user (and others where appropriate) in decision making

Identify any conflicting opinions and interests



Clarify lines of accountability

Justify actions In Conclusion

A balanced approach - looking at what is and is not an acceptable risk

Based on the wishes of the service user (and others)

Aiming to support the service user

Not every situation or activity will entail a risk that needs to be assessed or managed

Risk assessment is an on-going process

Managing risk positively sometimes needs to distinguish between short-term and long-term

It involves managing relevant information in meaningful ways

Service users should not be regarded as the source of the risk

The focus should be on their strengths



GENERAL INDICATORS OF RISK

What could be the source of the infection?

Is it from within the host (endogenous)? Is it from outside the host (exogenous)?

How could it be spread?

Direct contact (person to person) Indirect contact (contaminated items to person) Lack of personal hygiene practices

Airborne Droplets Not using personal protective equipment Incorrect clinical waste disposal Contaminated intrusive devices Contaminated Food

Are there additional risk factors?

MRSA carrier (staff/service user) Inadequate cleaning



What is the service user’s general mental and physical

state?

Age of service user History of chest infections etc Existing open sores/abrasions Weakened immune system

Are other service users or staff at risk?

Based on previously listed indicators

What staffing facilities are there?

Are staffing levels sufficient? Are there adequate laundering facilities? (e.g.)

What could be contaminated?

Everything

risk assessment handout · risk assessment – handout training 2 care (uk) ltd, 3 media house,...

Documents