Risk Assessments
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Transcript of Risk Assessments
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Environment of CareEmergency Management
Life Safety
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“Courtemanche & Associates Healthcare Synergists is an Approved Provider of continuing nursing education by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.”
Continuing Education Contact Hours will be awarded upon full attendance of the program and receipt of the participant course evaluations.
There are no influencing financial relationships or commercial support relating to this activity.
Participation in an accredited activity does not imply endorsement by the provider or NCNA of any commercial products displayed in conjunction with this activity.
Courtemanche & Associates does not discuss any products for use for a purpose other than that for which they were approved by the Food and Drug Association.
Disclosure Slide
www.courtemanche-assocs.com 2
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Why Perform?
Improve Patient and Staff Safety Improve Efficiency Identify Training Issues Evaluate when answers unclear Justify a Need
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TJC Risk Assessments
Safety Hazardous materials and Waste Security Hazard Vulnerability Analysis (HVA) Statement of Conditions and ILSM Medical Equipment Utility Proactive Infection Control (PICRA)
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Risk Assessment Cycle
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Document
No particular form required by TJCSpreadsheetsPRO/CON listingRating System
Organizations will be held to the documentation requirements that are in their own policies.
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Internal and External Data
Data can be used as part of the Risk Assessment:
PI Data Staff, Patient and Family Feedback Environmental Tracers Root Cause Analysis JC publications
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Simplifying ProActive Risk Assessment Identify Issues Develop arguments that support a process Develop arguments that disagree with a
process Evaluate both arguments Reach a Conclusion Document the process Monitor and Reassess
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How to Conduct a Risk AssessmentCreate a Multidisciplinary Team to include:
Subject Matter Experts
Departments Directly Effected
An Administrative representative
Individual critical to implementation
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Environment of Care Risk Assessments
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Safety Risk Assessments
Review Data:Incident ReportsIC DataPI DataPatient SatisfactionComplaints LiteraturePrevious Assessments
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Targeted Attention
New Construction
Renovations
Environmental Tours
Worker Safety – Job Hazard Analysis
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Environmental Tours
Ongoing Environmental Tours Identify hazardous conditions Observe Safety Practices Observe Behavior Eliminate potential hazards Monitor Staff Knowledge
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Formalize Tour Process
Establish a schedule Conduct annually in non-patient areas and
semiannually in patient care areas Create a form or checklist Respond to information Collected Train others in departments to conduct their
own mini-tours
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Job Hazards Analysis
Assessments that examine the safety risks associated with specific job tasks.
NOT required by TJC but required by the Occupational Safety and Health Administration (OSHA).
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Conducting a JHA
Review history of accidents, workers comp, work loss days occupational illnesses
Conduct job reviews/observations Correct any immediate danger situations Rank jobs: risks posed, likelihood of
occurrence and severity of consequences
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Suicide Safety Risk Assessment
Environment plays a key role in prevention of suicide.
Deficiencies in the Evironment can contribute to suicide events.
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Identification of Suicide Risks
Conduct Walk throughs Create Behavioral Checklist:
Hanging RisksSuffocating RisksWeapon RisksElopement/Jumping Risks
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Behavioral Tours Ideas
Wall protrusions such as fire sprinkler heads, air vent grills – cover with small holed screens
Secure lay-in ceiling tiles Removed exposed wires, blind cords,
telephone cords, tubings and lines Install anti-suicide doors Remove plastic trash can liners
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Behavioral Tours Ideas
Cont.
Use flushed cloth shower curtains attached to above threshold or breakaway rods
Use heavy furniture that cannot be easily liftedInstall shatterproof glass in windowsRemove hangers and closet rodsUse sloping hardwareUse convex mirrors to prevent blindspots
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Smoking Risk Assessments
Although many Organizations and their campuses are smoke free, there are conditions where smoking is allowed.Define clearly exceptions to the no smoking
policyInsure that practice and policy are the sameMonitor policyDevelop and implemented strategies to eliminate
smoking violations
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Hazardous Materials and Waste Risks
Assessments
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What are Hazardous Materials?
Materials whose handling, use and storage are guided or regulated by local, state or federal directives.
Examples: radioactive waste, hazardous vapors, bloodborne pathogens
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Conducting the Hazardous Risk Assessment Easy! Easy! Easy!
Annual inventory hazardous chemicals○ Identifiy those used○ How stored○ Monitoring○ Disposal
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Conducting the Inventory
Department managers should conduct their own inventory
Define for Department Managers what materials should be included
Create a standardized Form Key Department to spearhead project:
Material Department Create a database
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Using the Inventory to Lower Future Risk Identify safer alternatives to hazardous
chemicals where possible. Identify better storage practices for
chemicals Identify additional security methods when
needed. Facilitate the elimination of unneeded or
outdated chemicals.
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Using Inventory
Verify appropriate MSDS. Monitor hazardous gases and vapors
associated with dangerous chemicals. Submit the organization’s inventory to the
appropriate local, state and federal government agencies.
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Security Risk AssessmentsSecurity Risk Assessments
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Why perform a Security Risk Assessment? Improve patient and staff safety Improve Health Improve Satisfaction
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Data for Security Assessment
Number and severity of security incidents in an area or department
Level of access to area Security hardware present in the area Degree of public traffic through and in an
area Potential degree of loss associated with a
security issue taking place (i.e. abduction of baby, loss goods)
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Data for Security Assessment
Cont.
Risks present in the community Security needs of particular patient population Risks associated with times of day. Risks associated with security sensitive
departments
Involve managers, various departments, local police when gather information about the environment.
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Workplace Violence Considerations Likelihood of Community members to carry a
weapon Presence of gangs and gang activity Presence of drugs and money in Facility Facility Shift changes and the times of day Lighting of campus Landscaping of campus Accessibility of panic/alert systems
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Special Patient Population Considerations Infant and Pediatrics Behavioral Health Alzheimer patients Forensic Patients
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Emergency ManagementEmergency Management
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What does an EM plan do for an organization The Plan defines for the Organization a
comprehensive approach to identifying risks in order to mobilize an effective response within the organization as well as in collaboration and coordination with essential response partners in the community.
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Defining Emergencies
Human made Terrorist made Mother Nature made Events that escalate
Assessing risks allows the Organization to plan and act during emergencies. The best way is through the Hazard Vulnerability Assessment.
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Emergency Management Hazard Vulnerability Analysis Planned Structured Flexible Scalable
The HVA is a method for evaluating the Organization’s vulnerability to specific hazards.
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A Big Difference
Community Planning and Involvement!
This assessment requires community involvement for coordination and
prioritization within the HVA. Match perspectives of the Organization with the
perspectives of the Community.
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All Hazards Approach
List possible disasters List possible emergencies List pandemics List terrorist event
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Categorize Hazards
Natural hazards Technical hazards Human events Hazardous materials
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Assess Impact
Determine Probability of event occurring Evaluate extent of the impact
Rank the event
Assess current ability to respond
Remember: Events never experienced does not mean zero potential for the event. Be objective in evaluation.
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Considerations during Prioritization Short Term Effects Long Term Effects Influx of Patients/Community Changing/ Shifting Probability of Events
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Responding to the Threats Identified Design activities to reduce the risk of
potential damage due to the emergency Plan activities to mobilize essential
resources and organize efforts Test plans Develop recovery strategies
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HVA Uses
Effective HVA’s are linked to the Emergency Operations Plan (EOP).Focuses preparedness efforts
Drive the Emergency Drills and Tabletop Exercises
Identify Vulnerable populations (dialysis, nursing home, etc.)
Accurately understand self-sustainability
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Fire Safety RisksFire Safety RisksThe Life Safety (LS) The Life Safety (LS)
AssessmentAssessment
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Statement of Conditions
What is it?
A proactive tool helping the Organization perform a critical self-assessment of its fire safety risks and current level of compliance with the Life Safety Codes.
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SOC Value
Identifies areas for fire safety focus efforts Assist in developing Plans for Improvement
(PFI) Creates timelines and focus for activities Educate staff on the Life Safety Code
requirements
Remember: All Organizations are required to complete an electronic SOC and BBI.
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Conducting a Life Safety Assessment Lead by Competent Individual(s)
Knowledgeable about the building, fire protection features occupancy types and construction type of the building
Start at the top of the building and work down
Verify each feature of fire protectionExamine fire and smoke barrier above the ceiling
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Conducting a LSA
Include inspection process as part of hazard surveillance rounds
Through engineers and maintenance staff who are making repairs and rounds
Construction/Renovation sites daily inspections
Follow-up on Contractor’s jobs Findings during fire drills and/or fire events
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Medical EquipmentMedical Equipment
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Medical Equipment
Assessing and Managing Medical Equipment Risks
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What is Medical Equipment?
Life Support: anesthesia machines, ventilators
Monitoring: bedside monitors, telemetry momitors
Diagnostic: laboratory analyzers, radiology equipment
Patient Support: hospital beds, specialty beds, lifts
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Where are the risks for Equipment? Selection Use Maintenance
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Equipment Selection
Establish a process for selection and acquisitionIdentify a review process for each request, to
include clinical engineeringIdentify space and special utilities req’dUser training
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Create a Risk Based Inventory
Criteria to use:What is the function of the equipment?What are the physical risks associated with
equipment use?What are the maintenance requirements?What is the incident history?
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Maintenance is Risk Based
No longer requires PM inspections of all equipment.
PM inspections should be based on proactive risk assessment, sound professional
judgement, and organizational experience.
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Multidisciplinary Approach
Joint Effort between clinical care, clinical engineers and clinical staff
Include all departments and vendors as necessary
Equipment treated the same without regard to ownership
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Utility Systems
Creating a Risk-Based inventory, consider utilities impact on:Life Support SystemsInfection Control SystemsEnvironmental Support SystemsEquipment Support SystemsCommunication Systems
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Utility System Examples
Electrical Emergency power Elevators and Escalators Heating, Ventilating and airconditioning (HVAC) Plumbing Boiler and steam Piped gases Communication
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Addressing Risk
Assessing and monitoring the operational reliability
Identify/Rate the potential of failure Create Contingency Plans Test Contingency Plans Include Utilities in Emergency Management
Exercise
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Infection ControlInfection ControlProactive Risk AssessmentProactive Risk Assessment
PICRAPICRA
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PICRA
Manages Safety during construction process by conducting proactive risk assessments as part of the planning phase of building construction and renovation.
Identifies hazards that may compromise patient care
Determines the extent and nature of the risk
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PICRA Criteria for Consideration Air Quality Infection Control Utility requirements or interruptions Noise Vibration Emergency procedures
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Construction Issues to Assess
Disruption to essential services Relocation of patients Barriers to control airborne contaminants,
reduce noise and vibrations Debris cleanup and removal Traffic Flow
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CDC Suggested Considerations
Design and Function of the new area Risk of Airborne disease transmission Preventive measures to contain dust and
moisture
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Performing PICRA
Individual or Team depending on the scope, size and complexity of project
Identify type of construction Conduct regular meetings till project
completed
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Summary of Concerns
Nature of Project Patients affected Risks Involved Mold Fungi Hazard Material Noise and Vibration Emergency procedures Utility Disruption Hygiene Storage
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Objectives
Identify Risks Mitigate Risks Recover/Respond to Risks
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Other Risk Assessments
Construction Risks Building Projects Risks
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Conclusion
Nothing is an exact science. Conduct risk assessments to prevent or reduce dangers to patients, family and staff. Design the process and form to work for you and always follow your own policies.
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