Risk Assessment
Core concepts
Risk assessment estimates the likelihood and impact of harm so that resources can be targeted. Distinguish screening (brief identification of who needs further evaluation) from comprehensive assessment (identifying causes and mitigation). Common CNL risk areas include falls, pressure injury, venous thromboembolism, medication errors, infection, suicide, readmission, and environmental hazards. A score is a prompt, not a diagnosis. Reassess after changes in condition, setting, or medication. Mitigation should match the identified contributors and be documented with escalation criteria.
Traps
Questions may treat a high score as proof of harm or a low score as permission to stop preventive care. Other traps: not reassessing after transfer or new sedating medication, ignoring patient-specific factors, and screening without acting. Sensitivity and specificity matter: a tool can over-flag or under-flag. Avoid documenting “fall precautions” without specifying which precautions and who checks them.
Worked example
An older adult scores high on a fall screen after starting a sedating medication. The CNL assesses contributors (medication, urgency, footwear, environment), initiates a tailored bundle, reviews medications with the prescriber, and reassesses after the change.
Rule of thumb
Screen, assess contributors, act, and reassess. If the risk is high, the plan must name the specific mitigation, the responsible person, and the trigger for escalation.