Risk Assessment and Management of Deterioration
Framing the domain
This domain asks: can you identify the person at risk before they deteriorate, and do you act on it? Know the early warning system used in your setting, the concept of the afferent limb (recognition and calling for help), the efferent limb (the response), and the barriers to escalation such as hierarchy, task focus and normalisation of deviance.
Concepts to know
Track-and-trigger observations and escalation triggers; falls risk and prevention; pressure injury risk assessment and prevention; VTE risk; delirium risk; choking and aspiration risk; suicide and self-harm risk; restrictive practice minimisation; and the recognition of the deteriorating patient using the ABCDE approach with early senior review. Understand the difference between a risk assessment score and a clinical judgement - the score supports, not replaces, your decision to escalate.
Common traps
- Documenting a high score and not acting on it.
- Deferring escalation because a senior clinician is busy or dismissive; use the next level in the chain.
- Relying on a score in the "normal" range when the person looks unwell.
- Failing to reassess after an intervention or to set a review time.
- Ignoring cumulative risk (falls plus anticoagulation plus delirium) that multiplies harm.
Rule of thumb and worked example
Rule of thumb: if you are worried, escalate - and if you are still worried after escalating, escalate again using the next link in the chain.
Worked example: An older patient on anticoagulation has a falls score in the moderate range, new confusion, and a urinary catheter. Correct reasoning: the combination of anticoagulation, delirium and a device creates high cumulative harm risk even though no single score is extreme. Action: escalate for medical review of the confusion, remove the catheter if no longer indicated, implement close supervision and environmental measures, and document the plan and review time.