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Step C involves assessing the consequence × the likelihood and applying a risk grading score.

Step A: consequence score

The most appropriate domain for the identified risk is chosen from the left-hand side of the table. Then the individual works along the columns in the same row to assess the severity of the risk on the scale of 1 to 5 to determine the consequence score, which is the number given at the top of the column.

Step B: likelihood score (L)

This involves assessing the likelihood of the consequence occurring.

Step C: risk scoring = consequence × likelihood (C × L)

This involves multiplying the consequence score by the likelihood score to come up with a risk level.

The risk scores are not intended to be precise mathematical measures of risk but the system allows healthcare professionals and managers to arrive at a consistent risk evaluation score and subsequent risk level. Risks can then be prioritized and action taken accordingly. Within each range of risk, there is a range of scores that will further help the process of prioritization. These levels can be simplified into the following format.

In summary, where a risk is adequately addressed by existing controls or can be resolved by some immediate action, it will be the responsibility of all staff to ensure that the control is implemented in their ward or area and that any necessary action is taken. In cases where the risk cannot be immediately resolved, it is the responsibility of the manager to escalate the risk through the trust risk management structures so that the risk may be reviewed by senior management and placed on a document know as the risk register.

A risk register is a log of risks which have been evaluated but not yet fully controlled; these are therefore risks that may impact upon patient safety or the trust’s objectives.

The risk register includes details of the nature of the risk, the severity, likelihood and overall rating, the service which owns the risk, the controls currently in place, the forum where progress in mitigating the risk is monitored, and progress achieved.

Stage 5 – risk treatment

Where risks have been identified, action must be taken to control these risks by reducing the potential impact or likelihood to an acceptable level. The overall purpose of risk treatment is to determine what will be done to mitigate the risk and who will be responsible for the treatment action(s). Risks are more likely to be acted upon if responsibility is allocated to an individual. Risk treatment options are evaluated in terms of feasibility, cost and benefits with the aim of choosing the most appropriate and practical way of reducing risk to a tolerable level. Risk action plans may seek to reduce the likelihood of occurrence, minimize the consequences, transfer or share the risk, or retain the risk.

The following list of risk reduction approaches can be used.

Avoid the risk: for example, by deciding not to proceed with the activity likely to generate risk (where this is practicable); for example, withdrawing equipment from use or terminating activity.

Reduce the likelihood of the risk materializing: audit and compliance programmes, policies and procedures, preventive maintenance, supervision and training.

Reduce the potential impact if the risk does materialize: for example, through contingency planning, minimizing exposure to the risk.

Transfer of risk: this involves another party bearing or sharing some part of the risk. Mechanisms include the use of contracts, insurance arrangements and organizational structures such as partnership and joint ventures.

Stage 6 – monitoring and reviewing risks

Continuous monitoring and review of risks ensure that new risks are detected and managed, action plans are implemented and managers and stakeholders kept informed. The availability of regular information on risks can assist in identifying trends like trouble spots or other changes that have arisen. It is essential that this information is accurate, complete and based on the most recently