Version: / 2
Author: / Eithne Ni Dhomhnaill, Nursing Matters & Associates
Issue Date: / January 2016
Review date: / January 2019 or sooner if required.
Authorised by:
1.0Policy Statement:
Risk management will be incorporated into all aspects of care and service delivery atthe centre. This means that all staff have an active role in the identification, assessment and management of hazards and risks in accordance with their roles and as outlined in this policy.
2.0Purpose of this Policy.
To ensure that the centre has a robust system of risk management that is integrated into all care and service delivery and underpinned by a culture of continuous learning.
3.0Objectives.
3.1To ensure that all staff are aware of their roles and responsibilities regarding risk management in the centre.
3.2To promote a culture of safety for residents, staff and visitors of the centre.
3.3To create an effective approach to the reporting, investigation, analysis and monitoring of incidents and adverse events.
4.0Scope of the Policy.
In residential services, risks may include corporate risks, which are risks to the
service itself, such as risks to its financial viability, reputation or risks associated with
service change and transition, risks to staff and visitors and direct risks to service
users, such as the risk of abuse, falls or medication errors (HIQA, 2014).Theprinciples of risk management outlined in this policy apply to the categories of risks outlined below associated with care and service delivery in the centre.
4.1Corporate Risks.
These are risks to the centre itself, such as risks to its financial viability, reputation or risks associated with service change and transition arising from, for example poor governance and management of the home; poor information governance; insufficient workforce planning or staff performance.
4.2Clinical Risks:
Clinical risks are those arising from treatments, care and therapeutic interventions provided to residents. Clinical risks that fall within the scope of this policy include (but are not limited to):
- Medication errors and adverse events
- Resident falls
- Abuse of residents.
- Documentation errors.
- Incidents resulting from the use of restraints.
- Nursing home acquired infections
- Needle stick/sharps injuries
- Therapeutic equipment failure
- Pressure ulcers of grade 2 and greater.
- Self-Harm and suicide.
- Violent and Aggressive behaviour.
4.3Individual Resident Specific Risks.
These are risks arising from the care needs and condition of individual residents, such as poor mobility leading to risk of falling; impaired swallowing leading to a risk of choking or immobility leading to a risk of pressure ulcer development.
4.4Non Clinical Risks:
Non clinical risks are those associated with environmental hazards; occupational hazards and complaints management. These may include those arising from:
- poor housekeeping
- poor maintenance
- wet or oily surfaces
- occasional spills
- unsuitable flooring types
- damaged surfaces
- trailing cables or pipes
- overcrowding and clutter on walkways
- poor lighting
- poorly made or maintained stairs
- poorly maintained ladders or other means of access
(Health and Safety Authority, 2001).
5.0Definitions.
5.1Risk management.
5.2Risk management is a means of identifying, assessing, prioritizing and controlling risks across an organization, with a coordinatedand cost-effective application of resources to minimize, monitor, and control theprobability and/or impact of adverse events or to maximize the realization of opportunities (World Health Organisation, 2013 cited in Health Information and Quality Authority, 2014). It is a process of clearly defined steps which support better decision making by providing a greater insight into risks and their impacts. Risk management is a continuous process and has two key components. It is:
Proactive (Preventative - uses information to prevent harm or loss)
Responsive (Reactive – action is taken following an adverse event, incident or near miss).
(Health Information and Quality Authority, 2014).
5.3Hazard.
Something that has the potential to cause harm, which is workplace generated (Health and Safety Authority, 2005 and 2012).This policy refers to hazards, which are reasonable to expect could result in significant harm under the conditions in a nursing home and can be categorized into physical, chemical, biological and psychosocial hazards.
5.4Physical hazards.
According to the Health and Safety Authority (2012), physical hazards include:
■Manual handling activities involving heavy, awkward or hard to reach loads where there is a risk of injury;
■Vehicle movement, whether in the workplace or on the road, which can cause serious injury or death to people who come in contact with them;
■Slipping and tripping hazards such as wet or poorly maintained floors.
5.5Chemical hazard.
Chemical hazards include hazardous cleaning, disinfecting or sterilising agents (HSA, 2012).
5.6Biological hazards.
These include any virus and/or bacteria that can cause infection, allergies or toxic effects: for example, harmful exposure to blood and body fluids, or exposure to airborne pathogens such as tuberculosis and Legionnaires’ disease (HSA, 2012).
5.7Psychosocial hazards.
Psychosocial hazards include bullying at work and dealing with aggressive behaviour, which can affect psychological health and result in work related stress (HSA, 2012).
This policy must be read in conjunction with the following documents:
The centre’s Clinical Governance Policy.
The centre’s Health and Safety Statement.
5.8Risk.
Thelikelihood, great or small that someone will be harmed by the hazard, together with the severity of harm suffered and the number of people exposed to the hazard. (Health and Safety Authority, 2012).
5.9 Incident.
An incident is an event or circumstance resulting from healthcare which could have, or did lead to unintended harm to a person, loss or damage, and/or a complaint (WHO,2009 and DOHc 2010, HSE Quality and Risk Taxonomy)where ‘person’ in this policy includes a resident, staff member or visitor.
5.10Near Miss Incident.
A near miss incident is a situation in which an event or omission or a sequence of events fails to develop further, thus preventing harm to residents, staff, or visitors (Adapted from NHS Professionals, 2006).
5.11Root Cause Analysis (RCA).
Root Cause Analysis is an evidenced based, structuredinvestigation process which utilisestools and techniques to identify the true causes of an incident or problem, by understanding what, why and how a system failed (NPSA, 2009)
5.12Root Cause.
Root Causes / Causal Factors refer to the prime reason(s) why an incident occurred. A root cause is a fundamental contributory factor. Removal of these will either prevent, or reduce the chances of a similar type of incident from happening in similar circumstances in the future (NPSA, 2009).
5.13Contributory cause.
A cause/s which contributes to the incident but which by itself would not cause the incident.Generally speaking the removal of the influence may not always prevent incident recurrence but will generally improve the safety of the care system; whereas removal of causal factors or ‘root causes’ will be expected to prevent or significantly reduce the chances of recurrence (NPSA, 2009).
6.0Responsibilities.(Adapt as required for your own centre based on the local management structure).
6.1Registered Provider.
The nominated provider for the centre is (specify).He /shehas overall responsibility for ensuring that structures and processes for risk management are in place. This includes ensuring that policies and procedures for risk management and health and safety are developed and implemented in the nursing home and that the required resources are provided for the effective implementation of risk management at the centre. He/she is also responsible for ensuring that an effective health and safety management system is in place for the centre that complies with statutory requirements. He/she is also responsible for ensuring a healthy and safe environment for residents, staff and visitors to the centre.
6.2The Person in Charge.
The person in charge in the Centre is responsible for ensuring that there is a record kept of all incidents that occur in the Centre and for timely notification of the Chief Inspector in accordance with National Regulations.He/sheis responsible for overseeing the operational management of health and safety and clinical risk at the centre. This includes ensuring that a risk register is maintained and will be actively involved in risk management decisions. He/shehas responsibility for ensuring that all nursing and clinical staff are aware of the structures and processes for risk management and health and safety in the centre and the implementation of policies, procedures and action plans for risk management and health and safety. He/shealso has the following additional responsibilities that include: (These can be allocated to other personnel in accordance with local management and staffing structures)
■Ensuring that planned preventative maintenance of the building and premises is carried out and that a record of same is kept.
■Developing the checking and maintenance schedules for equipment used for fire and non-clinical emergencies in the unit.
■Keeping records for checking and maintenance of all equipment used in the centre.
■Conducting scheduled checks of equipment in the centre.
■Arranging a schedule for health and safety walkabouts/audits of health and safety structures and processes.
■Ensuring that all environmental hazards identified are risk assessed and appropriate actions taken.
■Ensuring staff are familiar with all emergency plans
■Maintenance of the risk register for the centre in collaboration with the clinical governance committee.
■Ensuring all staff have attended fire safety training and simulated daytime and night-time fire drills.
■Ensuring all staff have attended health and safety training including training in chemicals, people handling, infection control etc.
■Maintenance of the centre’s fire register.
■Developing the checking and maintenance schedules for clinical equipment used for care delivery and clinical emergencies in the centre.
■Keeping records for checking and maintenance of all clinical equipment used in the centre.
■Delegating responsibility for conducting scheduled checks of clinical and clinical emergency equipment.
■Ensuring that all clinical and occupational hazards identified are risk assessed and appropriate actions taken.
■Ensuring staff are aware of the policy and procedures for incident management and reporting;
■Identifying and addressing specific training needs of all nursing and non-nursing staff for health and safety;
■Coordination of occupational health processes and maintenance of records for same.
■Ensuring that training needs analyses are carried out at least annually, and that staff training programmes are developed so that all staff have access to education and training specific to their roles. This includes induction and mandatory training programmes.
■Ensuring that statutory notifications are forwarded to the chief inspector as outlined in the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013).
■Ensuring that resident specific risks are identified, risk assessed and addressed within the system for assessment and care planning in the centre.
6.3Each Managerhas responsibility for the operationalmanagement of clinical risk management in their area. She/he ensures that staff are familiar with all risks to staff, residents and visitors resulting from activities in their area. Additionally each managerwill ensure that staff in their area are familiar with and comply with all policies and procedures for risk management and health and safety relevant to their roles. Managers must also ensure that a copy of all risk assessments is given to the health and safety officer and person in charge.
Specific Managers, eg Maintenance, ADON and CNMs may have specific roles at local level. These should be added in here.
6.4The Health and Safety Officer (HSO) This should reflect the responsibilities outlined in the centre’s Health and Safety Statement.
6.5The Health and Safety Representative: The safety representative is nominated by staff and has a responsibility for representing staff views and concerns to the health and safety committee. The safety representative sits on the health and safety committee and provides feedback to staff on issues affecting them or concerns raised at meetings. Again, as per Health and Safety Statement.
6.6The Risk Management /Clinical Governance Committee: The risk management committee has responsibility for the developing and monitoring procedures for clinical risk identification; reporting; assessment; analysis and action planning for risk management. This includes maintenance of the risk register. The risk management committee will meet on a scheduled basis to review all risks, incidents and adverse events and conduct root cause analysis within 48 hours of the occurrence of any serious incidents. The committee will disseminate information / updates on risk management activities or alerts to all staff appropriate to their roles. Additionally the committee will liaise with the HSO the person in charge and the registered provider in the creation and maintenance of a risk register for the centre and advise on training needs for staff. All meetings must have a documented agenda and minutes must be recorded by a nominated member of the committee.
6.7The Health and Safety Committee:The health and safety committee is responsible for the development of systems and procedures for all aspects of health and safety in the nursing home under the direction of the HSO. The health and safety committee will meet on a scheduled basis and review all non- clinical risks, incidents and adverse events. The committee will disseminate information / updates on health and safety activities or alerts to all staff appropriate to their roles. The health and safety committee will assist the HSO in updating the risk register as non- clinical risks are identified. All health and safety meetings must have a documented agenda and minutes recorded by a nominated member of the committee.
6.8All Staff: All staff are responsible for compliance with all policies and procedures relating to risk management in the centre. Staff should familiarize themselves with health and safety statements in their department. Staff should be aware of and comply with any control measures identified to address risks in their work environment. Staff must report any hazard / risk observed to their line manager for assessment.
6.8.1All staff have responsibility to report to his/her line manager without unreasonable delay, any defects in plant, equipment, place of work or system of work, which might endanger the safety, health or welfare, of residents, staff or visitors.
6.8.2All staff are obliged to take reasonable care for his own safety, health and welfare and that of any otherperson who may be affected by his acts or omissions while at work.
6.9Risk management Process.
6.10Risk Identification.
Hazards and risks will be identified through the following activities:
■Identification of hazards and risks by staff in the course of their work, which are then reported to the relevant manager.
■Scheduled daily walkabouts of the premises and buildings carried out by the accommodation manager.
■Formal health and safety audits.
■Trending and analysis of incidents, accidents and complaints.
■Clinical audits.
■ Inspections carried out by statutory bodies.
■Investigation of incidents and complaints.
■Risk assessment of new equipment and changes in work practice.
■Assessment and care planning for individual residents.
6.11Risk assessments will be conducted by the clinical governance committee for new equipment; change to work practices or changes to the environment where it is reasonable to foresee that risks are present.
6.12Risk Assessments.
Risk assessments will be based on answering the following questions for each risk:
■Who might be harmed?
■How might they be harmed?
6.12.1The list of who might be harmed might include:
Residents
Staff
Visitors
Contractors
Other people sharing the workplace
Volunteers
Members of the public
The list should include those persons / groups of people who may be particularly vulnerable such as:
Staff with disabilities
Inexperienced staff
Lone workers
Night workers.
Children on the premises
(Health, Safety and Welfare Act 1989, 2005)
6.13Risk Evaluation
6.13.1Each risk will be evaluated based on the centre’srisk matrix and include:
■The hazard or risk identified.
■The likelihood /probability of the risk occurring.
■The potential consequences of the risk.
■Category of risk and risk score.
■Control Measures to manage the risk.
6.14Risk Control.
Risk control at the centreis underpinned by the Principles of Prevention set out in Schedule 3 of the Safety Health and Welfare at Work Act 2005. These are outlined in FIG 1: Hierarchy of Risk Controls.
Fig1 Hierarchy of Risk Controls.
Control Strategy Element / Control strategy DetailElimination / Where the hazard is removed from the workplace
Substitution / Where the hazard is replaced with a less hazardous substance
Changing work methods/patterns / Where the method of work is changed to reduce the risk
Reduced or limited time exposure / Where the time the employee is exposed to the hazard during the working day is reduced
Engineering controls (e.g. isolation, insulation and ventilation) / Where risk are isolated and people are segregated from the hazard by means of engineering design rather than a reliance on preventative actions by the employee
Good housekeeping / Where good housekeeping is an effective way of controlling risks
Safe systems of work / Where the system of work describes the safe method of performing the job or activity
Training and information / Where employees acquire skills and knowledge and attitudes to make them competent in the health and safety aspects of their work and where risks involved in the task are in writing and communicated in a training session
Personal protective equipment(PPE) / Where risk cannot reasonably be reduced further by any of the above means, PPE will be used to protect individuals as a last resort.
Welfare / Where such facilities as prescribed by law are in place to ensure a place of safety
Monitoring and supervision / Where all risk control measures whether they rely on engineered or behavioural control measures must be monitored for their effectiveness by a competent person
Review / Where periodic review or work processes have changed to minimise risk and ensure continual improvement
6.15Control Measures.