Risk Assessment

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Risk Assessment Management Plans

• Sue Templeton
• Michael Arthur

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Definition

• Risk assessment is the systematic process by
  which factors which might lead a person/situation
  to a certain outcome are defined and rated
• Risk assessment occurs in many areas including
  health care and industry
• To be effective risk assessment must be linked to
  actions and evaluation

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In wound management

• In wound management risk assessment can include
• Manual handling
• Infection control
• Pressure ulcers
• Should be a proactive process
• Good risk assessment can avert danger, harm or
  negligence

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In pressure ulcers

• Used to determine whether or not a person is at
  risk of pressure ulcers
• Determines the degree of risk
• Risk assessment scales identify the presence of
  extrinsic and intrinsic factors that are known to
  increase an individuals susceptibility to
  pressure damage and to quantify this through a
  numerical score

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Scales in perspective

• Any risk assessment scale should be used in
  conjunction with a comprehensive assessment of
  the individual client.
• Risk assessment scales are not (and should not
  be) a definitive indicator of whether an
  individual will or will not develop a pressure
  ulcer .

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Tools in use

• There are many available tools
• Need for high inter-rater reliability
• Consistency is critical
• Extensive training, education and follow up may
  be required
• Suitable tool for the setting
• Valid and reliable
• Useful as an adjunct to comprehensive clinical
  assessment

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Scales in practice

• Risk assessment scales must be used regularly,
  systematically and as the persons condition
  changes
• To be effective, interventions must be
  implemented according to the results
• Consider individual risk/s in addition to the
  overall score

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Management

• Good management will only occur if sound risk
  assessment has taken place
• Management must be
• Individualised and realistic
• Based on best practice
• Documented in a systematic manner
• Able to be easily compared to interventions
• Regularly evaluated

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Case study

• 56 year old woman
• Paraplegia for a number of years due to
  radiotherapy for a spinal tumour
• Developed a stage IV sacral pressure ulcer

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The facts of the case

• Bone excised from wound
• Further exposed bone in wound
• Thick, sero-purulent exudate
• Obese
• Incontinent
• Hospital bed with innerspring mattress
• Has carers for ADL assistance and transfers

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Risks

• Osteomyelitis
• Infection
• Poor nutritional status but obese
• Excessive moisture
• Ongoing pressure (Waterlow) score
• Bed chair
• Poor wound healing
• Ongoing care requirements

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Management plan

• Need for hospitalisation
• Multi-disciplinary team management
• Coordination with home care agencies
• Discharge planning
• Collaborative learning and participation in care

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Management interventions

• Diagnosis and treatment of probable osteomyelitis
• Wound management Monitoring, debridement,
  dressings
• Dietician
• Continence assessment and management
• Pressure redistributing mattress
• Transfer techniques, equipment review

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Summary

• Risk assessment is multi-factorial
• Risk must be assessed, documented, communicated
  and acted upon
• Individualised, evidence based management plans
  must be devised and implemented to reduce risk
• Risk should be continually reassessed