Trust Board Febuary 2010 - Sandwell & West Birmingham Hospitals

Risk Register
APPENDIX 7 Version 1 new format November 2009
Sandwell and West Birmingham NHS Trust Clinical Risks for Medium Term Options
J Dunn redesign Director,G GAdd-service
redesign Manager,E Newell Head of Midwifery, P
Bosio Lead Clinician, S Murray Divisional
Manager
SWBTB (2/10) 045 (c)
Risk Area Risk Assessment Risk Owner
Risk Management
OPTION Category Description Impact Likelihood Overall Risk Level Organisation Officer Advisor Indicators for Crystallisation Action to Mitigate
NO CHANGE TO CURRENT SERVICE
MODEL
0a 1 Risk of continuing to practice under the
4 2 8 medium inappropriate medical intervention including All midwives to receive normality training
present medical model
induction of labour and caesarian section with programme as established by regional leads.
associated risks. Lack of choice for place of Designated rooms within the labour suite for low
birth. Lack of facility for midwifery led care risk birth. Continued review of activity and poor
outcomes.
0b 1 Inability to work towards 60hr Consultant
Labour ward cover for 4000 births at City
Hospital as defined by NHSLA
0c 1 Inability to change entrenched cultures and
responsiveness of maternity services across
the two sites
3 4 12 high women receive substandard or delayed out of
hours consultant care resulting in poor clinical
outcomes
Business cases submitted for additional
consultants - unlikely to be supported
Risk Commentary
4 4 16 high difficulty in promoting continuity of care and Site based in service matrons, working in close
generic standards across both maternity units. collaboration to ensure consistency in standards
Lack of leadership and willingness to change
practice
and communication across sites. Joint meetings
such as Risk and educational meetings promotes
consistency in case management and shared
learning. Lead obstetrician appointed for
Sandwell who will work closely with CD / Lead
obstetrician for City site
Post Mitigation Risk Assessment
Date for
Review Notes Impact Likelihood Overall Risk Level
3 2 6 medium
3 4 12 high
3 3 9 medium
0d 1 Lack of continued presence across two sites
of Head of Midwifery and Lead Clinician
0e 1 Inability to promote choice for midwifery led
care due to lack of facilities
3 4 12 high difficulty in promoting continuity of care and
generic standards across both maternity units.
Lack of leadership and willingness to change
practice
as above 3 3 9 medium
2 2 4 low Risk of continuing to practice under the as above 2 2 4 low
present medical model
0f 1 Destabilisation of City site (High Risk) service
with on-going mitigation at Sandwell
0g 1 Public confidence in clinical care for maternity
services will remain low due to perceived lack
of change
0h 1 Continued difficulty with recruitment of staff
due to poor reputation and lack of facilities/
career development opportunities
0i 1 Inadequate provision of care for women with
complex clinical conditions
4 3 12 RED Increase inn Adverse Clinical Outcomes Medium term review of services being
undertaken
3 4 12 high Women will choose a medical model of care
and be at risk of increased intervention.
Continued loss of reputation for service with
potential loss of income
Work with Comms team to raise profile of
service / promotion of positive developments as
they occur.
3 5 15 high Lack of highly skilled staff. Inability to provide Continued high profile recruitment campaigns
strong clinical leadership.Difficulty in retaining have been undertaken over recent months with
high calibre staff.
some success
4 4 16 high Continiuity of care for high risk women is Provision of a limited number of specialised
reduced. Some complex care servces may not clinics on 1 site.
be provided due to resource constraints
4 3 12 red
3 2 6 medium
3 4 12 high
4 3 12 high
0j 1 Unplanned urgent transfer of high risk
women in labour remains high
0k 1 Delivery and urgent transfer of baby at under
34 weeks gestation
0l 1 Skills and competencies can not be
maximised across two sites
OPTION 1= NO BIRTHS OR INPATIENT
CARE AT SANDWELL. ALL BIRTHS AND
CONSULTANT LED CLINICS AT CITY
3 4 12 high women and babies receive substandard or
delayed care. Continuity of care is
compromised for high risk women
4 2 8 medium women and babies receive substandard or
delayed care. Continuity of care is
compromised for high risk women
3 4 12 high ineffective use of skills competences and
resources. Inability to provide optimum
standards of care
Trust guidelines and transfer policy in place.Cant
mitigate this any more than we currently do
Trust guidelines and transfer policy in place.Cant
mitigate this any more than we currently do
Implement rotation of staff across sites in order
to maximise exposure to all aspects of care.
(Note this may adversely impact on recruitment
and retention)
3 4 12 high
4 2 8 medium
3 3 9 medium
1a
Increased DNAs for hospital appointments
resulting in lack of appropriate antenatal
assessment
2 3 6 medium Poor continuity of care. Lack of appropriate
assessent and booking for delivery.
Careful planning with local transport networks to
ensure that appropriate transport links in place.
Positive promotion of service reconfiguration to
ensure women are aware of benefits of service.
Clear information provided to women (all
languages) regarding services available.
Promotion of community based midwifery
services
2 1 2 low
1b
1c
Sandwell women may percieve there is a lack
of choice and delay accessing appropriate
antenatal care
Women may arrive at Sandwell in labour and
2 2 4 low Lack of appropriate antenatal assessment.
Increased number of high risk women not
identified early in pregnancy
as above 2 2 4 low
2 3 6 medium Women receive delayed or substandard care as above 2 2 4 low
need urgent transfer to City
1d Increased numbers of birth before arrival 3 3 9 medium Babies delivered in an inappropriate
As above. Ensure local ambulance Trust
environment with lack of appropriate support. engaged in consultation. Ensure robust BBA
policy
1e
Loss of staff who do not wish to transfer
to|City
3 3 9 medium Midwife to birth ratio is reduced. Difficulty in
providing continuity of care. Need to recruit
midwives
1f Inappropriate home births 3 2 6 medium Women refuse to be booked for City Hospital
delivery
Ensure staff fully engaged in consultation
process. Regular staff updates re planning of
any service changes. Introduce rotation
programme so that staff are familiarised with
environment. Maintain transport service
between sites for staff redeployed. Set up early
discussions with HR and staff side
representatives. Establish proactive recruitment
strategy
Consult with users extensively and prepare
patient information which promotes maternity
services at City site. Engage community
midwives in planning in order that they are able
to effectively inform women.
2 1 3 low
3 2 6 medium
3 1 3 low
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Risk Register