Archived Content from National Patient Safety Week #5

Seven Step Risk Assessment
Assessing risk every day to ensure patient safety 

1. Q:  What is the first step in conducting the risk assessment?
   
   A:  To clearly define the issue that could potentially cause harm to patients, visitors, or staff members.
   
   
   
2. Q:  How should you document the risk assessment process?
   
   A:  Submission of the risk assessment to a multidisciplinary committee provides appropriate documentation of the process. The risk assessment documentation and committee discussion should appear in the multidisciplinary committee's minutes.

Risk assessment is a process that, when done objectively, provides direction and assurance that supports the pursuit of new processes and practices. This risk assessment process allows organizations to evaluate practices in a structured and reasonable format and effectively manage risk.

There is no single way to conduct a risk assessment. Regardless of the process the user chooses, it is critical to document the process and include a mechanism to confirm that the conclusion is the "right" conclusion.

To assist organizations in this process, the Joint Commission has developed a seven-step risk assessment process:

1. Identify the issue(s). The first step in conducting the risk assessment is to clearly define the issue that could potentially cause harm to patients, visitors, or staff members. The issue defined becomes the focus of the risk assessment. Avoid combining several issues.
2. Develop arguments in support of the issue. Once the issue is clearly defined, develop arguments that support the proposed process or issue. It may be helpful to create a list of questions, with response columns for advantages and disadvantages. These questions for advantages might include how the issue affects the following:
1. Patient care delivery
2. Staff
3. Work environment
4. Any visitors or volunteers
5. Public safety
6. Organizational finances
7. The physical structure, including buildings; departments, units, or other areas; and the exterior environment (that is, access, exit from buildings, grounds)
8. Equipment (including its use, function, or serviceability)
9. Internal physical systems
3. Develop arguments against the issue. Once the issue is clearly defined, develop arguments that disagree with the issue. These may be perceived concerns or situations that may pose a potential risk or affect a situation negatively. It may be helpful to create a list of questions similar to those in step 2, with a response column for disadvantages. Consider using the same questions in step 2 with this perspective.
4. Objectively evaluate both arguments. It is crucial that an organization conducts an impartial comparison of the advantages and the disadvantages associated with the issue.
5. Reach a conclusion and decide whether any action is needed, based on the risk assessment. Once the conclusion is determined, it is advisable to submit the risk assessment to a multidisciplinary committee-such as the Environment of Care Standard for Proactive Risk Assessments: EC.1.10, EP 4 (The hospital conducts proactive risk assessments that evaluate the potential adverse impact of buildings, grounds, equipment, occupants, and internal physical systems on the safety and health of patients, staff, and other people coming to the hospital's facilities).
6. Document the process. Submission of the risk assessment to a multidisciplinary committee provides appropriate documentation of the process. The risk assessment documentation and committee discussion should appear in the multidisciplinary committee's minutes.
7. Monitor and reassess the conclusion to ensure that it is the best decision. A monitoring strategy should be included in the risk assessment document that is submitted to the multidisciplinary committee. This strategy should include a specific date to reassess the conclusion drawn by the risk assessment. If the reassessment determines that an incorrect conclusion was reached, the issue should be submitted to the multidisciplinary committee for reassessment. However, if the evaluation confirms the conclusion, then document the confirmation and decide if further monitoring would be beneficial.