Outcome of clinical risk management in the Gloucester rehabilitation service

Abstract

Aims and MethodTo assess the impact of a clinical risk assessment and management policy introduced in a tertiary rehabilitation service, in response to UK government statute. The study assessed the effect of a formal risk management approach for high-risk cases over a year, in terms of changes in risk-associated behaviour and perceived levels of risk, and in achievement of clinical risk management goals.ResultsInitially 35 of 107 patients were rated as high risk, mostly of neglect or of harm to others, and were subjected to formal risk management. At follow-up only 16 patients were still rated as high risk, most reduction occurring in risk of neglect. Half of the 112 risk management goals established were fully achieved, 58 partially and 18 not achieved. Total Social Behaviour Schedule ratings were significantly lower at follow-up.Clinical ImplicationsRisk management appeared to be successful in terms of reducing overall levels of risk, the achievement of risk management goals and the reduction of risk-associated behaviours. The lack of a control group and blindness limits the validity of these findings. However, organised risk management procedures may help to support and promote good general clinical management.

Goal attainment scaling (GAS) in rehabilitation: a practical guide

“…The literature encompasses a range of different approaches to scaling and measuring the achievement of goals, ranging from simple recording of goals achieved, partially achieved or not achieved 16 to rating scales of up to seven points. 17 The procedure described below is based on that used in the context of upper limb spasticity by Ashford and Turner-Stokes.…”

Root cause analysis applied to the investigation of serious untoward incidents in mental health services

“…The value and the ethics of risk assessment and management in reducing suicides and homicides is a topic of contemporary debate (Kennedy, 2001;Szmukler, 2001Szmukler, , 2003Maden, 2003). Methods of risk reduction such as the care programme approach and clinic risk assessment/ management do not yet have good quality evidence derived from randomised controlled trials to establish their effectiveness in preventing suicides or homicides, despite their introduction as official health policy (Marshall et al, 1997;Macpherson et al, 2002). Therefore, categorical statements that failure to implement these processes correctly led to a particular serious incident are debatable, and RCA will not provide the answers to this issue.…”

Involving mental health service users considered to pose a risk to other people in risk assessment

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