Risk Assessment & Risk Assessment & Management PlansManagement Plans

Sue TempletonSue Templeton

Michael ArthurMichael Arthur

DefinitionDefinition

Risk assessment is the systematic Risk assessment is the systematic process by which factors which might process by which factors which might lead a person/situation to a certain lead a person/situation to a certain outcome are defined and ratedoutcome are defined and rated

Risk assessment occurs in many Risk assessment occurs in many areas including health care and areas including health care and industryindustry

To be effective risk assessment must To be effective risk assessment must be linked to actions and evaluationbe linked to actions and evaluation

In wound managementIn wound management

In wound management risk In wound management risk assessment can include:assessment can include:– Manual handlingManual handling– Infection controlInfection control– Pressure ulcersPressure ulcers

Should be a proactive processShould be a proactive process Good risk assessment can avert Good risk assessment can avert

danger, harm or negligencedanger, harm or negligence

In pressure ulcersIn pressure ulcers

Used to determine whether or not a Used to determine whether or not a person is at risk of pressure ulcersperson is at risk of pressure ulcers

Determines the degree of riskDetermines the degree of risk

Risk assessment scales identify the Risk assessment scales identify the presence of extrinsic and intrinsic presence of extrinsic and intrinsic factors that are known to increase an factors that are known to increase an individual’s susceptibility to pressure individual’s susceptibility to pressure damage and to quantify this through a damage and to quantify this through a numerical score numerical score

Scales in perspectiveScales in perspective

Any risk assessment scale should be Any risk assessment scale should be used in conjunction with a used in conjunction with a comprehensive assessment of the comprehensive assessment of the individual client.individual client.

Risk assessment scales are not (and Risk assessment scales are not (and should not be) a definitive indicator should not be) a definitive indicator of whether an individual will or will of whether an individual will or will not develop a pressure ulcer .not develop a pressure ulcer .

Tools in useTools in use

There are many available toolsThere are many available tools Need for high inter-rater reliabilityNeed for high inter-rater reliability

– Consistency is criticalConsistency is critical– Extensive training, education and follow Extensive training, education and follow

up may be requiredup may be required Suitable tool for the settingSuitable tool for the setting Valid and reliableValid and reliable Useful as an adjunct to comprehensive Useful as an adjunct to comprehensive

clinical assessmentclinical assessment

Scales in practiceScales in practice

Risk assessment scales must be Risk assessment scales must be used regularly, systematically and used regularly, systematically and as the person’s condition changesas the person’s condition changes

To be effective, interventions To be effective, interventions must be implemented according must be implemented according to the resultsto the results

Consider individual risk/s in Consider individual risk/s in addition to the overall scoreaddition to the overall score

Management Management

Good management will only occur if Good management will only occur if sound risk assessment has taken placesound risk assessment has taken place

Management must be:Management must be:– Individualised and realisticIndividualised and realistic– Based on best practiceBased on best practice– Documented in a systematic mannerDocumented in a systematic manner– Able to be easily compared to interventionsAble to be easily compared to interventions– Regularly evaluatedRegularly evaluated

Case studyCase study

56 year old 56 year old womanwoman

Paraplegia for a Paraplegia for a number of years number of years due to due to radiotherapy for a radiotherapy for a spinal tumourspinal tumour

Developed a stage Developed a stage IV sacral pressure IV sacral pressure ulcerulcer

The facts of the caseThe facts of the case

Bone excised from woundBone excised from wound Further exposed bone in woundFurther exposed bone in wound Thick, sero-purulent exudateThick, sero-purulent exudate ObeseObese IncontinentIncontinent Hospital bed with innerspring mattressHospital bed with innerspring mattress Has carers for ADL assistance and Has carers for ADL assistance and

transferstransfers

RisksRisks

OsteomyelitisOsteomyelitis InfectionInfection Poor nutritional status but obesePoor nutritional status but obese Excessive moistureExcessive moisture Ongoing pressure (Waterlow) score: Ongoing pressure (Waterlow) score:

– Bed & chairBed & chair Poor wound healingPoor wound healing Ongoing care requirementsOngoing care requirements

Management planManagement plan

Need for hospitalisationNeed for hospitalisation Multi-disciplinary team Multi-disciplinary team

managementmanagement Coordination with home care Coordination with home care

agencies agencies Discharge planningDischarge planning Collaborative learning and Collaborative learning and

participation in careparticipation in care

Management Management interventionsinterventions Diagnosis and treatment of probable Diagnosis and treatment of probable

osteomyelitisosteomyelitis Wound management: Monitoring, Wound management: Monitoring,

debridement, dressingsdebridement, dressings DieticianDietician Continence assessment and Continence assessment and

managementmanagement Pressure redistributing mattressPressure redistributing mattress Transfer techniques, equipment reviewTransfer techniques, equipment review

SummarySummary

Risk assessment is multi-factorialRisk assessment is multi-factorial Risk must be assessed, documented, Risk must be assessed, documented,

communicated and acted uponcommunicated and acted upon Individualised, evidence based Individualised, evidence based

management plans must be devised management plans must be devised and implemented to reduce riskand implemented to reduce risk

Risk should be continually reassessed Risk should be continually reassessed