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9.1.6 Service User Risk Assessment Guidance

This chapter was added to the manual in October 2015.


Contents

  1. Approach to Risk: Governing Principles & Purpose of Risk Assessment
  2. Basic Principles of Risk Assessment
  3. Service User Risk Assessment Checklist
  4. Full Risk Assessment
  5. Flowchart


1. Approach to Risk: Governing Principles & Purpose of Risk Assessment

Approach to Risk - Governing Principle

The governing principle behind good approaches to choice and risk is that people have the right to live their lives to the full as long as that does not stop others from doing the same. Fear of supporting people to take reasonable risks in their daily lives can prevent them from doing the things that most people take for granted. What needs to be considered is the consequence of an action and the likelihood of any harm from it. By taking account of the benefits in terms of independence, well-being and choice, it should be possible for a person to have a support plan which enables them to manage identified risks and to live their lives in ways which best suit them.”

(Independence, choice and risk: a guide to best practice in supported decision making DoH 2007).

Purpose of Risk Assessment

The purpose of a risk assessment is to manage risks to protect the person and others, with the least infringement of their rights as possible. The least restrictive ways of managing risk should always be considered.

Weighing up the ‘benefits and burdens’ (pros and cons) of risk taking is needed. The process of undertaking the risk assessment should assist this.


2. Basic Principles of Risk Assessment

  • Use the procedure to stop and think about any potential risk (it will help to balance the need to avoid being inadvertently risk averse whilst fulfilling our duty of care);
  • Is there really a risk?
    How do we know?
    Have there been previous incidents?
    What has happened as a result of the risks? Is it a high/med/low risk?
    What is the frequency of risk?

    Think About ABC’s - what leads up to the risk/in what situations does the risk occur? Is the behaviour risky behaviour. What has happened as a result of the risks taken? How was it managed previously and are these controls working?
  • Involve the Service User, relatives/ representatives as appropriate
    What is important to the service user? How would they like the risk to be managed? What is the relevant information about the persons’ abilities and insight? Consider Capacity issues. Use the Mental Capacity Act principles. Help the person understand the risks and decide.

    Communicate in a way the person can understand. What about an advocate?(remember to evidence the persons’ involvement/ decision making process around this).
  • Risk Assess together
    Ensure risks are managed with the least impact on the persons’ rights and chosen lifestyle. Apply least restrictive minimum time principles.
    Check with other professionals (multi-disciplinary as appropriate) for ideas about the best ways to manage the risk that respects the persons’ choices.

    Ensure risk management actions are chosen by the person/ in the persons’ ‘best interests’, & involve relatives/ representatives as appropriate;
  • Document
    The decision making process,
    How it is agreed the risk will be managed in the persons’ care support plan;
  • Have appropriate level of sign off;
  • Review dates must be specific to each risk assessment.


3. Service User Risk Assessment Checklist

The risk assessment checklist has come about from the need to ensure a robust process in is place to identify any needs and risks for the service users we support and how these needs will be met. This includes signposting to any restrictive practises that have been agreed for the individual. The section below helps to explain to staff and managers how to undertake the checklist.

  1. Undertake the checklist with service users (involve carer/ referrer if possible / appropriate). Is risk thought to be identified for any of the sections on the checklist, or any other areas?
    • NO - no further action. Service user and assessor both to sign the checklist and file;
    • YES - for any of the sections on the list. Complete steps 2 onwards.
  2. Estimate the level of the risk High, Medium or Low (H/M/L) for each concern before actions have been put in place. Think through and collate information on:
    • The number and dates of occurrences of concerns or incidents;
    • What has happened as a result of incidents?
    • Relevant information about the service user’s wishes, abilities, insight and capacity;
    • Whether it is likely to still be a risk while the person is in receipt of your service.
  3. If the risk level is lower/ non contentious and the service user is in agreement with how it will be managed, you can just indicate where the actions to manage the risk are covered in the care plan. The usual process of agreeing the care plan with the person/ their representatives (as appropriate) will apply;
  4. There may be another specialised risk assessment in place already e.g. a Waterlow risk assessment for pressure areas, a MUST tool for nutrition and hydration, or a RIRA form relating to risks around behaviour. If so, you can indicate on the checklist where this is to be found. Make sure that agreed actions needed to manage the risk are clear on the relevant section of the care plan;
  5. If the risk is medium or higher level, complex, or may need managing with a restrictive practice and there is no specialised risk assessment, you will need to complete the full risk assessment form. Write that you have completed it on the checklist form;
  6. The checklist should be signed off by the service user, the assessor and a senior staff member (unless the assessor is a senior member of staff. The level of seniority should be proportionate to the level of risk).


4. Full Risk Assessment

Where there are risks identified that are medium, contentious or high and are not covered by a specialist risk assessment, these will need to be described on the full risk assessment form. The section below helps to explain to staff and managers how to complete the risk assessment.

  1. Consider who needs to be involved in discussions to complete and agree the risk assessment e.g. service user, service user’s relatives, key worker, other professionals, level of management, advocates etc. Ensure their involvement is documented;
  2. Although you need to assume Capacity, the person’s insight and mental capacity for making decisions related to particular risks should be considered (especially if their mental capacity is in doubt). This might prompt a mental capacity assessment. If a mental capacity assessment has been undertaken indicate the outcome, where the assessment is and what other procedures have been invoked as a result; for example restrictive practices or Deprivation of Liberty Safeguards;
  3. In the column ‘Description of the Hazard', describe the risk area that is of concern and give a brief summary of the history and analysis around the risk:
    • Have any incidents occurred?
    • How often they have happened?
    • What triggered them?
    • What has happened as a result.

    (You may want to just summarise and cross reference to more detailed recording/ analysis elsewhere).

  4. In the next column ‘Consequence of Hazard’ – write the potential harm that could occur if the risk is unmanaged;
  5. Complete ‘Persons at Risk’ column (i.e. is it a risk just for the service user concerned, or are others likely to be at risk?);
  6. In the ‘Action/Support Needed’ column put the agreed actions which will be in place to manage the risk. (Remember the person has the right to take considered risks, so we may not be able to eradicate risk completely.) It is critical to take full account of:
    • What is important to the service user; and also to;
    • Find the least restrictive way to manage the risk.

If a restrictive practice (see definition below) is being proposed to manage the risk then the restrictive practice procedure should be followed.

  1. The main points from the Action/Support Needed column should be taken into the relevant section of the care plan, as this is the essential guidance for staff on how to manage the risk;
  2. Risk Rating’ column – this describes the amount of risk that is considered to be left after the agreed actions have been put in place. Estimate the likelihood of the event happening (1-5) and the impact if it does (1-5). Multiply the two scores together and include that total in the final column. This will give you either a high, medium and low score (Use the table at the top of the form for guidance). If the score remains at a high level it is important that everyone involved understands this, and senior management are aware of it;
  3. Service User sign-off - Service users/appropriate representative/ and an appropriate level manager to sign completed assessment to confirm their agreement/ or indicate how they have been involved and any comments;
  4. A Planned Review of the Risk Assessment should be booked at the time of completion. The review date should be put on the top left of the form in the relevant section. The review date should be decided according to the issues/level of risk, but should never be more than 1 year. Additional reviews can be held if circumstances change or whenever needed;
  5. Complete the ‘Review’ section of the form. Remember to alter any aspect of the care plan or risk assessment to ensure they remain accurate in response to the review.
Definition of Restrictive Practice….
Restrictive Practice: Any practice, which could be construed as potentially restricting a person's rights of choice, self-determination, privacy, freedom or freedom of movement must be considered within this procedure. This includes anything introduced to prevent harm to a person, other people, or property, or to manage the risk of this.


5. Flowchart

Click here to view the flowchart.

See also:

Service User Risk Assessment Form

Service User Risk Assessment Checklist.

End