Safe Practice

Managing Risk

'Risk management in healthcare includes the whole spectrum of things that could and can go wrong. It includes slips, trips and falls involving staff, patients/clients and the public, administrative errors that impact on patient/client care and clinical incidents that have a direct effect on the outcome of patient/client care. It will also include the management of the business risks associated with running a NHS Board or hospital including financial, ethical and information technology risks.'

Managing risk

Find out more about clinical governance and managing risk by completing the following activity.

The Healthcare Improvement Scotland website contains a series of Clinical Governance & Risk Management Local Reports for Health Boards in Scotland.

  • read the report for your Health Board area and identify aspects of it that apply to your work setting and role.

Consider what you have found that applies to your work:

  • how is this put into practice in your workplace?
  • have you identified situations where you think there could be improvement?
  • If there are situations where you think there could be improvement, what action can you take to help make this happen?

Discuss what you have found with your mentor/manager and make a portfolio entry about what you have learned and how this will influence your practice.

Reviewing your knowledge

Your student experience and corporate induction into NHSScotland will have provided you with some information on Health & Safety at Work issues. However, there may be some issues that, in your role, you need to know more about…

For example, one of the key issues for all healthcare staff is Healthcare Associated Infections. If you have identified specific learning needs around HAI, you may find the NES HAI online short courses useful.

There are many other risks for patients/clients and staff e.g. environmental hazards, hazards posed by equipment and its use, other people or their activities or treatments.

You should now try to relate your knowledge to your current healthcare setting.  With the help of your mentor, identify potential hazards/risks in your healthcare setting. A useful tool to help you with this activity is available from NHS Direct.

Reflect on your role in managing these risks, in line with departmental guidelines and record your reflections for your portfolio.

Key questions about risk

Healthcare Improvement Scotland provides information

Read the information available through the link above and apply questions such as:

  • what could happen?
  • when and where could it happen?
  • how and why could it happen
  • how can we prevent or minimise risk of this happening?

to a situation or activity in your workplace. They asks for less detail than the risk assessment tool in the previous activity and you may find this useful in dealing with less serious risks, or where you are trying to decide if there is a need to a more in-depth assessment.

Capacity and consent

This activity also appears in the Clinical Skills unit - if you have completed it in that unit you may want to take some time to review what you learned from a risk perspective here.

This activity requires you to critically examine the issues for your profession around capacity and consent:

1.  In relation to your practice (using information from your professional regulator)

and

2.  Using the interactive learning resource 'Think Capacity, Think Consent'.

As this will take around an hour and a half, you may want to complete it in stages.

1.  What your regulator says

Take time to review your professional responsibilities in relation to consent.

It is essential that patients/clients understand the implications and risks of the care and treatment they receive. You have a significant role in ensuring that they understand what is proposed, are aware of the potential benefits and risks and agree to the treatment or care taking place.

NMC: Consent

HCPC: standards of conduct, performance and ethics (p12 of the document/ p14 of the PDF)

2. 'Think Capacity, Think Consent'

Now that you know what your professional regulator expects of you, you need ensure that you can assess patient's/client's capacity to consent to treatment.

'Assessment of capacity to consent to treatment is an important legal and ethical issue for staff working in acute general hospitals. It is estimated that between 30% and 52% of people admitted to hospital will lack capacity to consent to treatment'.

This quote is from the NHSScotland 'Think Capacity, Think Consent' interactive learning resource. It is recommended that all NHSScotland staff who provide care and treatment complete the learning activities in this resource.

Knowing your limits

We all have experiences in providing healthcare that challenge us, no matter how much experience we have acquired. As a newly qualified practitioner you will almost certainly feel out of your depth at times and in this situation patient/client safety can be compromised. Knowing when to ask for help and guidance is a pre-requisite for safe and effective care.

Identify a clinical situation where you began to feel close to the limits of your knowledge, capability and confidence:

  • who was available for support and advice?
  • how easy did you find it to ask for guidance?
  • what have you learned that will help you deal with a similar situation?

You should link this activity with the activities in the Accountability section of this unit.

In discussion with your mentor and other colleagues, explore other challenging situations that could arise in your work setting and devise strategies to deal with them.

Information in the Reflective Practice section can be useful in helping you analyse the situation, including how it links to your future safe and effective practice.

Dealing with errors

Errors can occur in relation to any aspect of the work that you do e.g. medication administration, documentation, treatments. So it is vital that errors near misses and risks are appropriately dealt with.

Lawton et al (2012) highlight how errors are complicated, and often many factors are involved. They categorise them in the following way:

  • active failures e.g. individual performance or behaviour
  • situational failures e.g. team factors
  • local working conditions e.g. workload
  • latent/organisational factors e.g. policies and procedures
  • latent/external factors e.g. design of equipment

Access the full text of this article and the view the full information about these sources of errors (Figure 2). Identify the potential for these sources of error in your work setting and:

  • discuss what you have identified with your mentor.
  • reflect on your understanding or your role and responsibilities should a near miss or error occur.
  • thinking specifically about the process that leads to a near miss, what were the factors that caused the hazardous situation to occur and what contributed to it being a miss?
  • record what have you learnt from this reflection and discussion for your portfolio.

The Swiss Cheese model

'Not all errors lead to serious harm. In fact, it usually requires a string of errors to result in harm to patients. Professor James Reason illustrated this concept through his well-known 'Swiss cheese model'.

In this model, the slices of cheese represent the various system defences between hazards and adverse events and the holes represent active and latent (system) errors. The slices of cheese are in constant motion. The holes generally do not form a straight line, with at least one slice blocking hazards from reaching patients (Fig 1).

Most incidents of harm occur when the holes in the slices of cheese (the active and system errors) temporarily align, allowing hazards to reach patients.' (NES QI Hub)

Read about this in more detail in the Quality Improvement Hub.

Identify where active and latent errors can occur in your work setting, and explore the strategies used to mitigate them. What are the implications of this for the care you and your team provide?

Discuss what you have found with your mentor and make an entry in your portfolio reflecting what you have found and your discussions with your mentor. Include any changes in your practice that you want to put into action as a result of this activity.

How do you deal with near misses and errors?

It is important to report and take the appropriate action when a near miss or error happens. Find out more about the Health Board policies and procedures that you need to follow if there is a near miss or an error.

Ensure that you know what you need to do including:

  • what immediate action to take
  • who needs to be informed
  • the reporting systems that need to be followed e.g. Datix

Critically reflect on what you have learned and make and entry in your portfolio.

Avoiding drug calculation errors

If your role involves calculating medication dosages, it is essential that you ensure your skills are accurate and up to date.

Consider the drugs that you administer in your setting and the potential consequences of any errors. List 3 or 4 and review the medicines information about this drug using the BNF or one of the Evidence into Practice's drug information links.

Portfolio activity

Make a portfolio entry which summarises what you have learned about Managing Risk. Include what you have already recorded in this section, sharing best practice, your learning needs and how what you have learned so far has changed aspects of your practice. Make sure you discuss this with your mentor/supervisor and/or NHS KSF reviewer and that your future learning needs are reflected in your Personal Development Plan.

Add an alert to your Flying Start NHS® portfolio and /or make a date in your diary to revisit Managing Risk.