The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [125]
Stage 7 – communication and consultation
At every stage of the risk management process, it is important that healthcare professionals, ward and departmental teams, managers and the risk management team communicate and consult both which each other and with key stakeholders, which may include the patient and their family. Key decisions regarding risk issues need to be made collaboratively in order for the whole process to remain open and transparent. Essential to nurses being successful and confident in managing risk is their understanding of their own and others’ contribution to the risk management process and maintaining effective communication throughout the organization.
The two scenarios below demonstrate the way in which the risk management process can be put into practice in the ward setting. The first scenario demonstrates the ‘procedure’ for undertaking proactive risk assessment of a situation, and the second outlines the procedure for managing risk following a patient safety incident.
Scenario One
Mrs M is a 75-year-old woman admitted for a course of chemotherapy. She lives with her daughter who is her main carer. On admission she is appears to be a very thin, frail woman who is slightly unsteady on her feet. She walks with the aid of a walking frame but requires supervision. Mrs M’s daughter also cares for her mother-in-law so is unable to stay with her mother in hospital.
Risk management stages Action
1 Establish the context As part of the induction process to any clinical area, you should ensure that you fully understand the risk management procedures for the organization, including the documentation required to ensure that a full assessment of the patient is undertaken.
Prior to the patient arriving on the ward, ensure you have the appropriate documentation available, including any risk assessment you may require, for example falls risk assessment.
Introduce yourself to the patient and her daughter and explain the admission assessment process.
Show the patient and her daughter around the ward, explain the ward values and routines and introduce her to her ‘neighbours’, if appropriate.
2 Risk identification Undertake a full patient admission assessment, including risk assessments such as a falls assessment, pressure ulcer risk assessment (see Chapter 15), venous thrombosis assessment (VTE), nutritional assessment (see Chapter 8). Include the patient’s daughter in the risk assessments to gain a full picture of the patient’s needs.
3/4 Risk analysis and evaluation Formulate an action/care plan based on the assessment of risk above and agree the plan with the patient and her daughter, especially concerning discharge planning.
5 Risk treatment Communicate the results of the risk assessment and implement the actions required to the rest of the multiprofessional ward team and make referrals to other professionals as required.
6 Monitoring and reviewing risk Ensure the patient’s risk treatment/care plans are reviewed regularly throughout her stay. Her risk status may change as she progresses through her treatment pathway and risk assessments may need to be repeated.
7 Communication and consultation Ensure multidisciplinary meetings, ward handovers and ward rounds include regular discussions regarding the patient’s risk treatment/care plan.
1–7 Prior to discharge, meet once again with the patient and her daughter to assess the potential risks on discharge and the actions that the patient and her daughter are able to undertake to mitigate those risks, together with any support they may need to manage them. This may include referral to community services, home care teams, local authority support. Depending on the level of risk identified, a full multiprofessional team risk assessment may need to be undertaken.