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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