HEALTH & SAF E T Y
of 10 as the risk is high that a staff member, or patient could get injured if this failure mode occurred. The cause of failure is that it falls and could spill. The occurrence scores moderately low. It happens infrequently and, as long as the temporary closure is shut, the risk is low. However, if it did spill, the detection of the danger is ‘uncertain’ as there is no guarantee that all spilled needles would be found, exposing an injury risk, so 9 is scored. Once the total scores are made, the risk priority number is determined which, in this example, is 360. Then the team can begin to work on priority actions. The benefit of taking this approach is that you can start to look at ways to prevent the risk of exposure by using equipment design solutions. The severity of getting a needle injury will never change from 10. A needle that becomes exposed at any point after disposal in the end-to-end process will always pose an injury risk. However, the occurrence, or likelihood that it happens can be designed out. The same goes for detection. If by better design we can prevent the spill, we manage the risk more effectively.
Safety organisations such as HSE publish hierarchy of risk guidance, and we can look to this information for how to manage risk most effectively by elimination. See the example in Fig 4. The hierarchy model demonstrates the effectiveness of dealing with risk. Prevention is significantly more effective and less costly than any other means. Training staff and developing their skills and competences is critical, but it is unfair and inefficient to rely solely on human controls to manage the exposure to such significant injuries as needle sticks. This guidance is telling us to prevent risks happening in the first place and equipment design is the way to do this. In our example, the team have looked at a number of ways to address the risks of 17b and made some proposals. The first is to secure the sharps bin to the stabiliser or wall bracket. The risk can then be re-evaluated to assess the effectiveness of this proposal, but you can see that the occurrence is improved only slightly with a score of 3. If it did spill, perhaps while it was being removed from the wall bracket, then it will still spill the contents. It is just that the likelihood is less frequent. So, an improvement could be achieved, but the risk is not significantly reduced. In the second example, the recommendation is to use a container with no spill feature. This equipment design solution doesn’t rely on the actions of the user for its safety. If it falls, it will not spill so the likelihood of injury is dramatically reduced, so the team scored 1.
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