Risk Assessment includes absconding, missing persons and pass-plans, admission, discharge and follow-up procedures, live risk assessment, training, timings and review with involvement. It is the systematic process of identifying risks and evaluating their potential likelihood and consequences. Risk is the likelihood, high or low, that somebody will be harmed by an unwanted event or incident, multiplied by the severity of the potential harm. Risks are measured in terms of their likelihood and consequences.
A risk assessment should be kept up to date and relevant to the patient and the service throughout admission. It provides valuable information for the multi-disciplinary team (MDT), which is shared, for example, during safety briefings, huddles and MDT meetings. It should also be linked to goal setting to allow risks to be taken into account during recovery.
To maintain a ‘live’ risk assessment:
- complete for all new referrals,
- review per shift as a minimum, as well as immediately prior to times of transition e.g. pass, transfer or discharge, or at times of significant change (escalation or decrease of symptoms),
- take a consistent approach to collating information including current and historic triggers,
- have a team approach to assessment and communication,
- revise the risk assessment management plan, sometimes known as the safety plan,
- include input from the patient, carer and family,
- include the appropriate referral,
- include medication and observation levels, and
- include any changes to the patients legal status.
Absconding, missing persons and pass-plans
The operational definition of unscheduled absence is when a patient has left the ward without medical advice, without informing staff or when a patient agreed time. When any compulsory patient does so this is absconding. A missing person is anyone whose whereabouts are unknown and; where the circumstances are out of character; this suggests the person may be subject to crime; or the person is at risk of harm to themselves or others. A pass-plan is when a patient has a scheduled pass for extended leave from the ward for an activity, appointment or is out with visitors.
There is a partnership agreement between Police Scotland and NHS Scotland when patients go missing. A Framework was developed and it sets out a methodology for effective partnership working when people do go missing.
When someone does go missing from a hospital or a similar establishment the response should be effective, proportionate, timely and co-ordinated between all the organisations concerned.
NHS boards have signed off partnership agreements with Police Scotland. These agreements will shape front line practice across Scotland to meet the objectives of the National Missing Framework for Scotland.
Admission, discharge and follow-up procedures
Evidence and feedback from service users and carers has identified issues around both NHS board admissions and discharge processes into and from hospitals and services. Examples of these issues include; a lack of information about what happens next; difficulty in identifying staff and their roles – nurses, assistants, students or other visitors and admissions as much as possible. (Carers Trust December 2014)
NHS boards will have a person-centred patient and carer friendly admission and discharge procedure to ensure smooth transitions.
Training, timings and review with patient involvement
Risk assessment training and refresher training should be available to all staff and include how to undertake risk assessments correctly.
Risk assessment should be completed for all new referrals and then repeated annually as a minimum or at times of significant change; such as escalation or decrease of symptoms. Other significant changes can include and at all interfaces within the Mental Health Services i.e. transfer of care, pass and discharge. Risk Assessment should provide a helpful structure for practitioners to record their professional judgement, including observations, discussions, formulation and management planning, when carrying out assessments with patients. It is vital for staff to use their professional training, knowledge and interpersonal skills to tactfully draw out required information directly from the patient.