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Risk management is defined in the Intravenous Nursing Standards of Practice as a "process that centers on identification, analysis, treatment and evaluation of renal and potential hazards." Just what type of risk do these hazards pose and what types of "real and potential hazards" are there? The first question is the easiest to answer.
AIM: This study sets out to investigate the theories and practices of risk assessment and management in the context of contemporary mental health practice. BACKGROUND: Although risk assessment and management policies are well established for those working in the field of community mental health care, there are noticeable anomalies and regional variations, in the criteria, procedures and decision-making strategies used. METHODS: Focus group taped interviews were conducted with over 100 mental health professionals in one NHS Trust. These were compared with an extensive literature review on the topic. FINDINGS: The main theme to emerge was lack of resources, which included time and staff in the context of a changing and increasing workload. Another important theme was the lack of access to centralized and accurate information about mental health service provision. CONCLUSION: It is essential that professionals, clients, their families and the public feel confident in professional judgements and practices to avoid a 'back to the asylum' lobby, for the care and treatment of seriously mentally ill individuals.
The Health Insurance Portability and Accountability Act (HIPAA) security standard requires a formal security management process that includes risk management. Risk management is a detailed process used to identify and assess risk, identify and accept mediation for risk, and maintain an acceptable level of risk. This chapter explains the risk management methodology developed by Providence Health System for HIPAA compliance. Providence risk management methodology includes risk analysis and assessment for both hard and soft assets.
Risk management is the process by which choices are made between alternative actions or policies according to the likelihood of beneficial or adverse outcomes. It entails an assessment of the potential risks and benefits associated with each possible option, and the application of value judgements to decide which option should be chosen. Informal risk management for chemicals, a distinction is made between hazard (a potential adverse effect of the substance) and risk (the probability that that a hazard will be realised given the circumstances and extent of exposure to the substance). Where there is uncertainty about the existence of a hazard or about the level of risk associated with an exposure, this must also be taken into account. Of the various measures of risk, the two that are most relevant to risk management are the individual attributable risk and the population attributable risk. Assessment of risk entails the identification and characterisation of hazards, and estimation of the risks associated with the exposure circumstances that will follow from different policy options. Examples are given of the way in which epidemiology can contribute to this process, and also to checking that the outcomes of decisions in risk management accord with what was predicted by underpinning risk assessments. The strengths and limitations of epidemiology as a tool in risk management are discussed.
The transmissible spongiform encephalopathies (TSEs) represent an emerging group of diseases that have been labeled as "prion diseases" because of the recent characterization of the infectious agent. TSEs are caused by prions, which induce neurodegenerative fatal diseases in humans and animals. Some TSEs (scrapie and kuru), have existed in both animals and humans for a very long time, whereas others such as bovine spongiform encephalopathy and variant Creutzfeld-Jakob disease have either recently emerged or are more thoroughly described and recognized. It is obvious that the medical community will be forced to consider these diseases in humans and animals for the future. This article offers a short review of the TSEs of immediate concern to zoo and wildlife veterinarians and wildlife biologists and suggests risk management strategies for the prevention of these diseases, with special focus on chronic wasting disease of cervids in North America.
Research on "risk behaviour" in the time of AIDS has emphasised how social relationships influence individuals' responses to risk. Yet the social relationship remains an under-utilised unit of analysis in risk behaviour research. Drawing on qualitative research with illicit drug users in London, this paper illustrates how drug users' sexual relationships act as key sites of risk management in individuals' drug use and everyday lifestyles. First, while recent research has almost exclusively focused on the dangers of disease transmission, our findings show that drug users perceived their sexual relationships as influencing a variety of risks associated with heroin and other opioid drugs. Here, two types of relationships--"gear" and "straight" relationships--were perceived to be particularly important. Second, while research has tended to focus on drug and health risks as an outcome of relationships, drug users' accounts emphasise that managing risks to their relationships is an important facet of everyday risk management made complicated by drug use. It is argued that risk is a product of social interactions, and that the sexual relationship is an important site of risk management in this process. Future interventions should target drug users' sexual relationships as agents of risk management and behaviour change.
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Environmental risk assessment has matured into a powerful analytical tool, which is finding ever-wider applications in the arena of policy making and regulation. However, the principal focus of its development to date has been on the technical challenges of characterising and modelling the environmental behaviour and biological action of chemicals, whereas issues concerning its broader socio-political context have been generally neglected. Problem definition, risk analysis and decision making have, therefore, tended to be dominated by experts and by expert opinion. Fresh insights from the social sciences advocate a pluralistic, inclusive approach, with experts participating alongside other stakeholders in a consensual decision making process. Adoption of this paradigm has far reaching consequences for the form and conduct of risk assessment and risk management.
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Application of Law 626/94 in the health care area is still only partial and in many respects practically in the initial stages. This is due to a number of causes, including the special features of this sector and the extreme variability and diffusion of the risk factors involved. Assessment of risk, especially the newest ones (from manual patient handling to biological agents) involves considerable difficulties, also because the usual methods cannot be applied. The process of assessment and especially the management of risks in this sector is an extremely complex problem, and to address it requires the creation of an organized structure within the hospital consisting of a general manager, or a person delegated by the same, the medical director, the administrative director, the certified occupational physician, the director of prevention and protection. This management team must be flexible in character, draw up strategic plans according to priority criteria, periodically assess the state of advancement of the plans that will be carried out in phases. It is also necessary to ensure the active cooperation of worker safety representatives and of other experts who may be involved in the various topics addressed from time to time. The authors propose a method used in a three-year project, still under way, for the assessment of risk due to manual patient handling in a major Italian hospital; the data obtained from an assessment made in 58 wards were the following: about 60% of the wards showed a medium-high exposure level, 24% negligible exposure levels and 13.8% zero exposure due to the absence of disabled patients. On the basis of the initial data obtained from health surveillance programmes on a group of 431 exposed subjects, about 10% were judged fit with limitations due to spinal disorders. The main problems that have arisen (management, organisation, training, transfer of workers with limited job fitness, accreditation) are discussed. The method proposed for management of risk due to manual handling of patients is considered suitable for other risk factors, within the framework of a more far reaching programme for application of Law 626/94, as a means of permanent management of risk in a particularly complex working environment such as that of a hospital.
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Risk management continues to define itself as an integral element in quality dental care. Issues reviewed range from periodontal record keeping to assessment of temporomandibular joint dysfunction and from cosmetic patients to after-hours emergency care. Two common denominators emerge throughout the articles reviewed. First, thorough and accurate documentation of all phases of patient contact and treatment remains at the heart of risk management. Communication, as a system of relationships between physician, staff, and patients, ensures understanding and agreement toward a common goal. Risk management remains a unifying principle that joins legal responsibilities with sound clinical practice.
Risk management is worthwhile, and should be given high priority by health professionals. There is a direct payoff for practitioners. The past decade has witnessed organizational trappings of risk management. However, until practitioners appreciate the personal payoff of risk management, and that treatment will be more effective at the same time, more lip service than results will be the norm.
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Baptist Healthcare Corporation in Pensacola, FL, has found that attention to details in risk management can lower costs and reduce liability exposure at the same time. Baptist's partner, MMI Companies, explains how it's done.