Top 4 Most Common Patient Safety Risk Assessment Categories

Conducting an annual patient safety risk assessment is a proactive process that identifies risks and provides suggestions to improve patient safety.

That’s why LHA Trust Funds conducts complimentary assessments for member facilities each year.

Our patient safety risk assessments are designed to evaluate your organization’s current policies and practices, comparing them to industry-leading best practices that support high-reliability values consistent with safe critical processes and systems.

We analyzed the results of our 2022 patient safety risk assessments, and four categories stood out as the most challenging for our members. Here are those four categories and how your facility can advance performance improvement in healthcare.

1. Emergency Preparedness

Being prepared for emergencies goes beyond having a plan in place to respond to a hurricane, tornado, or other natural disaster. It also consists of simple internal factors that we often overlook in our physical environment.

Some common concerns identified during our risk assessments include:

• Cluttered emergency supply carts with expired contents. How can we be prepared for a medical emergency if the emergency cart is piled high with boxes and expired equipment? Emergency supply carts should be readily available for use — meaning the cart is clean from clutter and dust with easily accessible, up-to-date equipment.
  
  Pay special attention to defibrillators with date and time stamps because they don’t update automatically and must be reset manually for bi-annual time changes like daylight savings time. Check the accuracy of the defibrillator’s date and time stamp by running the rhythm strip. Add a reminder to the emergency supply cart checklist for staff members to ensure that updating essential equipment isn’t overlooked.

• Emergency pull cord cleanliness and accessibility. Patient safety assessments frequently find pull cords laying on the floor instead of the regulation 4-6” from the floor. Cords lying on the floor result in dirty cords that pose an infection control risk, get tangled around grab bars and are inaccessible to the patient.

• Items blocking emergency shut-off valves, electrical panels, fire safety pulls, and fire extinguishers. Frequently, different items block these panels or extinguishers on the wall. There’s typically a great need for storage space in healthcare organizations. However, blocking access to these critical safety devices can impact the quality and performance of care by limiting accessibility to them during an emergency — resulting in a delayed emergency response. Consider incorporating these suggestions into the routine safety rounds checklist conducted by the risk manager or safety director. By adding them to your checklist, your team can better manage these emergency preparedness concerns.

2. Behavioral Health & Violence Prevention

Evaluating a facility’s behavioral health and violence prevention strategy is a significant portion of the LHA Trust Funds Patient Safety Risk Assessment. Since Louisiana passed legislation addressing workplace violence in healthcare settings in 2022, we anticipate that performance in this category will improve next year.

Here are some opportunities for improvement in this category:

• Evaluate your workplace violence program for effectiveness. Healthcare organizations often have some type of workplace violence program or process in place to handle violent incidents. However, these plans are not always evaluated for effectiveness or revised to reflect identified improvement opportunities.
  
  Your organization should evaluate its current workplace violence plan at least annually to ensure its effectiveness. LHA Trust Funds offers a Security & Threat Risk Assessment to members to evaluate your existing program and assist in identifying potential risks to your organization.

• Establish a method for staff to report workplace violence. Workplace violence has not been routinely reported in the past, but it is a helpful way to track and trend the types of violent events within your organization to develop interventions for prevention. Violence should not be tolerated in your organization. Reporting these events helps your organization better understand the approach to take for prevention.
• Remove ligatures and educate sitters about behavioral health patients. Patients with behavioral health issues are commonplace in emergency departments (ED).
  
  Unfortunately, the environment of care in the ED is not set up with these patients in mind. A safe environment must be created for them when they arrive, including the removal of anything that can be used as a ligature. In addition, appropriate monitoring must be established and may require the use of a sitter.
  
  Since ligatures are tricky, examine the patient’s room to determine items that could possibly be used by a patient to harm themselves or others. This isn’t always as easy as it sounds. It’s helpful to develop a checklist of items that should be removed to help staff consistently create a safe patient environment.
  
  Most organizations have processes in place to determine the appropriate level of monitoring for a patient. Often, clinical staff are not available to do the job and sitters must assist.
  
  Sitters are appropriate in many settings. However, sitters need to understand their purpose — precisely what they are being asked to do or not do, the significance of the job, and be capable of documenting their observations appropriately. Developing a training program with a multidisciplinary team in mind would be beneficial to your organization.

• Train all staff in the identification and de-escalation of violence. The level of staff training should be determined based on the area where staff works. For example, more high-risk or volatile patient care areas — especially ED and Maternal Health areas — should have extensive training whereas the Nutritional Services staff may only need a basic level of training. Nevertheless, all staff should have some training upon hire and at least annually.

There are many factors to consider when addressing the behavioral health population and violence in healthcare. Our Violence Prevention Toolkit features a variety of resources that address these issues in-depth.

3. Hazardous Materials & Waste Management

Unsecured environmental service (EVS) carts and unsecured hazardous chemicals — especially cleaning supplies — are other common findings in our patient safety risk assessments.

These tips can help your organization improve the security of hazardous materials and waste management:

• EVS carts should be locked or within the line of vision of the EVS staff member when in use.
• Chemicals should not be readily available for patients or visitors to access since most are poisonous or caustic. They should always be secured.

4. Clinical Monitoring

The clinical monitoring portion of our risk assessment evaluates many critical processes that should be in place to ensure patient safety. Some opportunities for process improvement include:

• Follow-up on critical test results. Documentation should be in the medical record to indicate that any test deemed “critical” by the organization is communicated to the patient care provider. The timeliness of this communication should be specified in a policy and documented accordingly.
• Alarm safety. Alarms can be heard throughout the halls of healthcare organizations. The constant sounds of alarms going off can often lead to alarm fatigue — resulting in harm to a patient because a real patient event is missed.
  
  Each patient care department should evaluate all the possible alarms in their area and take care to make sure important alarms are not missed. Access our Clinical Alarms Toolkit for more helpful resources.
• Handoff communications. Many changes in patients occur during a hospital stay. Passing off care from one healthcare provider to another is a critical point during patient admission. A standard process should be in place for staff to follow when handing off care.
  
  Our High Reliability and Culture of Safety Toolkit features several tools that can be used to standardize the admissions and handoff process.
• Preventative maintenance of biomedical equipment. Equipment used in patient care should be checked on a regular basis by the Biomedical (Biomed) Engineer at the organization.
  
  Regular inspections ensure that the equipment is calibrated correctly and in proper working condition. Biomed should place a sticker on the equipment to indicate that it has been checked within the past year. When equipment that has expired is encountered, contact Biomed as the equipment may need to be taken out of service until it can be inspected.

Improve Your Healthcare Performance

COVID-19 took a toll on the Louisiana healthcare community, and the overall benchmarking report results for our member organizations across all categories were impressive — especially considering the challenges faced since 2020.

At LHA Trust Funds, we are very proud of the hard work accomplished in patient safety every day. Examining our 2022 patient safety risk assessments isn’t intended to be a criticism of those efforts. Instead, they give us valuable information that allows our risk managers to share fresh approaches and identify solutions to common patient safety issues experienced by many members.

Learn more about our Patient Safety Risk Assessments by contacting our Vice President of Patient Safety and Risk Safety Jenkins.

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Want more patient safety tips? Sign up for our 2023 Patient Safety in Healthcare webinar on April 12 at 10 a.m. featuring hot topics in patient safety influencing healthcare nationwide.