The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [118]
The language of risk is often confusing to healthcare professionals so before looking further into risk management, it is important to understand the basic definitions.
Hazard: a situation, object, property, substance, phenomenon or activity with the potential to cause harm (HSE 2010).
Adverse event: any event or circumstances leading to unintentional harm or suffering relating to treatment. Adverse events may be preventable or non-preventable (WHO 2005).
Risk: the likelihood that something will occur that will have an impact on the achievement of aims and objectives (Standards Australia and Standards New Zealand 2009) or the probability that a specific adverse event (or patient safety incident) will occur in a specific time period or as the result of a specific situation (NPSA 2007).
Clinical risk: the chance of an adverse outcome resulting from clinical investigation, treatment or patient care (NPSA 2007).
Inherent clinical risk: the permanent or currently unavoidable clinical risk that is associated with a particular clinical investigation or treatment (NPSA 2007).
Clinical risk management: the use of techniques to minimize the occurrence of near misses, errors and incidents in the processes of clinical activity and thereby reducing unwanted outcomes (NPSA 2009, Standards Australia and Standards New Zealand 2009).
Patient safety incident: any unintended or unexpected incident which could have or did lead to harm for one or more patients receiving healthcare.
A patient safety incident is an umbrella term used to describe a single incident or a series of incidents that occur over time. Terms such as adverse, error or mistake suggest individual causality and blame and can often prevent the development of full understanding and learning from the incident.
The main categories of patient safety incidents as defined by the National Patient Safety Agency in 2009 were:
medication incident
consent incident
surgical incident
anaesthetic incident
medical device incident
medical records/clinical information, breaches in confidentiality
radiotherapy and systemic isotope incidents
diagnostic radiology
pathology.
(NPSA 2009)
Patient safety incidents may include:
incidents that staff are involved in
incidents that staff may have witnessed
incidents that caused no harm or minimal harm
incidents with more serious outcomes
prevented patient safety incidents (also known as near misses).
A medicine could be described as a hazard if it has the potential to cause harm. However, the risk of that harm may be very small provided effective controls/measures are in place. If the patient could suffer harm as a result of taking the medication, the adverse event may be described as a clinical risk, and a patient safety incident if the harm occurred unexpectedly or unintentionally.
If the hazard is considered as selecting the wrong drug because of look-alike packaging, there is a clinical risk to the patient, a risk to the members of staff involved and a risk to the organization. If the organization identified the hazard and changed the packaging, this could be defined as successful clinical risk management. If a healthcare professional still administered the wrong drug following the mitigating action, this would be described as a patient safety incident (NPSA 2009).
Accident
An unplanned, undesired non-clinical event that could have or did lead to the injury or death of any person affected by the organization’s activities. This definition therefore includes injuries to staff, visitors and contractors. It also applies to any incident involving a patient that is not directly related to their clinical care; for example, a patient fall would be included as an accident.
Non-clinical incident
An incident which is not related to the clinical area of patients but which could have or did lead to harm to an individual