1. Risk Assessment & Management Plans Sue Templeton Michael Arthur

2. 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 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 Risk assessment occurs in many areas including health care and industry To be effective risk assessment must be linked to actions and evaluation To be effective risk assessment must be linked to actions and evaluation

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

4. In pressure ulcers Used to determine whether or not a person is at risk of pressure ulcers Used to determine whether or not a person is at risk of pressure ulcers Determines the degree of risk 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 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

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

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

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

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

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

10. The facts of the case Bone excised from wound Bone excised from wound Further exposed bone in wound Further exposed bone in wound Thick, sero-purulent exudate Thick, sero-purulent exudate Obese Obese Incontinent Incontinent Hospital bed with innerspring mattress Hospital bed with innerspring mattress Has carers for ADL assistance and transfers Has carers for ADL assistance and transfers

12. Risks Osteomyelitis Osteomyelitis Infection Infection Poor nutritional status but obese Poor nutritional status but obese Excessive moisture Excessive moisture Ongoing pressure (Waterlow) score: Ongoing pressure (Waterlow) score: –Bed & chair Poor wound healing Poor wound healing Ongoing care requirements Ongoing care requirements

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

14. Management interventions Diagnosis and treatment of probable osteomyelitis Diagnosis and treatment of probable osteomyelitis Wound management: Monitoring, debridement, dressings Wound management: Monitoring, debridement, dressings Dietician Dietician Continence assessment and management Continence assessment and management Pressure redistributing mattress Pressure redistributing mattress Transfer techniques, equipment review Transfer techniques, equipment review

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