Risk Assessment and Management in the Home

CPD
7m

Published: 09 September 2020

Most injuries are preventable, but despite this, there were 532 500 injury hospitalisations in Australia in 2017-18 (AIHW 2020).

Alarmingly, the most likely location for accidents resulting in injury to occur is in the home (RoSPA 2020).

As a home care worker, you must be vigilant when working in client residences in order to minimise the risk of injury or harm to yourself and others. Consider that:

  • 45% of home care workers have experienced an injury in the workplace;
  • More than half of emergency department presentations of older adults over 65 are for accidents that occur in the home;
  • More than half of fall hospitalisations for older adults over 65 are for accidents that occur in the home; and
  • About 15% of fall-related injuries in older adults over 65 are caused by household objects (e.g. beds, chairs, stairs).

(Skatssoon 2019; PropertySafe 2017; Liotta 2019)

An essential component of home care is conducting risk assessments. You must know how to identify potential hazards, assess the risks they pose and implement appropriate control measures (QLD Gov 2018).

This will help ensure that you, your clients, your clients’ carers and other workers are safe in home environments (QLD Gov 2018).

older adult falling in bathroom
The most likely location for accidents resulting in injury to occur is in the home.

What is Risk Management?

Risk management is the process of identifying, assessing and controlling risks. It should be a proactive, planned and systematic process that addresses all potential hazards and risks in the workplace. Risk assessment is not a once-off task; it should be an ongoing process that responds to changes in the workplace and allows for continuous improvement. It should also be performed before undertaking any hazardous work activities (Safe Work Australia 2018).

The Risk Management Process

There are four steps in the risk management process:

  1. Identify hazards.
  2. Assess risks.
  3. Control risks.
  4. Review control measures.

(Safe Work Australia 2018)

Risk management should be conducted together with the client, and any control measures should be implemented as part of their care or service plan (QLD Gov 2018).

1. Identify Hazards

Hazards are any objects or situations that have the potential to cause harm. In home care settings, hazards might arise from the client’s physical home environment; the equipment, materials and substances being used; or the work activities you are performing. Some hazards may be an inevitable part of your work, but others may be the result of accidents or failures (Safe Work Australia 2018).

The following table outlines some examples of hazards you might encounter in home care settings:

Type of Hazard Examples Potential harm
Gravity
(hazards that cause a person to fall or have something fall onto them)
  • Stairs and steps
  • Poor lighting
  • Slippery floor surfaces
  • Cluttered walkways
  • Loose mats or tiles
  • Uneven flooring
  • Furniture
  • Space limitations
  • Fractures
  • Bruises
  • Lacerations
  • Dislocations
  • Concussions
  • Death
Chemical and biological
  • Cleaning substances
  • Pets
  • You, the client or others present having an infectious illness
  • Blood and bodily fluids
  • Contaminated or soiled objects
  • Unsafe food handling or storage
  • Sharps and clinical waste
  • Hazardous chemicals in the home
  • Illness or disease
  • Injury
  • Explosion or fire
  • Corrosion
  • Poisoning
Energy sources
  • Powerboards
  • Electrical appliances
  • Switches and plugs
  • Electrical leads and extension cords
  • Gas cylinders
  • Shock
  • Burns
  • Damage to organs and nerves
  • Death
Extreme temperatures
  • Windows
  • Ventilation
  • Water temperature
  • Stove
  • Heater
  • Injury
  • Heat stroke
  • Fatigue
  • Hypothermia
  • Frostbite
Machinery and equipment
  • Food preparation equipment
  • Household appliances and equipment
  • Fractures
  • Bruises
  • Lacerations
  • Dislocations
  • Death

(WorkSafe VIC 2017; NDS 2016; Safe Work Australia 2018; QLD Gov 2018)

2. Assess Risks

carer conducting risk assessment
Risk assessment will help you to determine the overall severity of the risk and whether further action needs to be taken.

Once a hazard has been identified, the next step is to conduct a risk assessment. This will help you to determine the overall severity of the risk, whether existing control measures are effective, whether you need to take any further action, and how urgently further actions should be taken (Safe Work Australia 2018).

Note: If the particular risk is already well-known, with established control measures, a formal risk assessment may not be necessary (Safe Work Australia 2018).

Ask the following three questions:

1. How severe would the potential harm be?

  • What harm could occur as a result of the hazard? (e.g. injury, illness, death);
  • Are there any other factors that could influence the severity of potential harm? (e.g. the distance of a fall);
  • How many people could be harmed?
  • Are there any situations that could increase the severity of an accident?

2. How could harm occur?

  • What sequence of events could lead to harm occurring?
  • Can one or more of the events in the sequence be stopped or changed?

3. What is the likelihood of harm occurring?

  • Is it certain, very likely, likely, unlikely or rare?
  • How often does the hazard have the potential to cause harm?
  • How effective are current control measures (if any) in reducing the risk?
  • Could differences in operating conditions increase the risk?
  • Does the working environment increase the risk?
  • If harm occurs, how long would people be exposed to it for?
  • Could the likelihood be affected by the way people act or behave?
  • Does the likelihood depend on the people involved?

(WorkSafe VIC 2017)

3. Control Risks

The next step is to determine appropriate control measures for addressing the risk. Generally, the best way to control a risk is to eliminate it as much as reasonably practicable. However, this is not always possible, as certain risks are inevitable (WorkSafe VIC 2017).

For example, the risk of you passing an infectious disease on to a client can not be completely eliminated, as you being able to physically visit their home is an essential component of the service you are providing.

In these cases, the next best option is to minimise the risk as much as reasonably practicable (WorkSafe VIC 2017).

The process of determining appropriate control measures involves:

  1. Identifying the appropriate options for control measures.
  2. Deciding the option(s) most suitable for eliminating or reducing the risk effectively.
  3. Implementing the chosen control measure(s).

(WorkSafe VIC 2017)

The Hierarchy of Control Measures

hierarchy of control measures diagram
The hierarchy of control measures.

The hierarchy of control measures lists different types of control measures from most to least reliable. You should always aim for elimination, as it offers the highest level of protection and is most effective in reducing the risk of harm. However, if elimination is not feasible, you should work your way down the hierarchy until you find the next best option (Safe Work Australia 2018).

Keep in mind that the lower levels of the hierarchy are less effective because without eliminating the hazard, there is no way to completely eliminate the risk. Even if you are able to minimise the risk, it will still exist in some capacity (Safe Work Australia 2018).

As a general rule:

  • Eliminating the risk is most effective.
  • Changing the risk to minimise it is less effective.
  • Changing how people behave and expose themselves to the risk is least effective.

(WorkSafe VIC 2017)

Elimination

Elimination involves completely removing the hazard and its associated risks.

This can be achieved through:

  • Not introducing the hazard in the first place; and
  • Removing the hazard (e.g. disposing of a hazardous object, refraining from going to a hazardous place).

(Safe Work Australia 2018)

Substitution, Isolation or Engineering Controls

The next best option is to either:

  • Substitute the hazard with a safer alternative;
  • Physically isolate the hazard from people; or
  • Implement an engineering control (mechanical device or process) to reduce the risk (e.g. a trolley to move heavy objects).

(Safe Work Australia 2018)

Administrative Controls

Administrative controls are work methods or procedures that aim to minimise exposure to the hazard and provide appropriate information, training and instruction to staff. Examples include implementing new policies or using signs to warn people about a hazard (Safe Work Australia 2018).

Personal Protective Equipment (PPE)

PPE should be used to reduce any remaining risks. It must be used and worn correctly in order to be effective (Safe Work Australia 2018).

4. Review Control Measures

The final stage of the risk management process is to regularly check that control measures are working effectively. Control measures should be reviewed:

  • When they are not working effectively;
  • Before changes that may cause new or different risks to arise;
  • When new hazards or risks emerge; and
  • When a review is indicated or requested.

(Safe Work Australia 2018)

The Risk Management Process in Practice

slipping hazard caused by leaking shower

Scenario: You are a home carer for Greta, a 78-year-old woman who lives alone. During one of your visits, you notice that the shower in Greta’s bathroom is leaking, causing the bathroom floor to become wet and slippery.

1. Identify Hazard

In this case, the hazard has been identified as the shower leak.

2. Assess Risk

In order to assess the risk, you now need to ask the following questions:

How severe would the potential harm be?
  • Fractures, bruises, lacerations, dislocations, concussion or even death could occur if someone slips.
  • Any person who uses the bathroom (you, Greta or other visitors) could be harmed.
How could harm occur?
  1. The shower leaks, causing the floor to become wet and slippery.
  2. Someone enters the bathroom.
  3. They slip on the wet floor.
  4. They fall and injure themselves.
What is the likelihood of harm occurring?
  • Harm could occur whenever there is some amount of water on the floor.
  • If the water is not cleaned, the floor will get more slippery and the risk will increase.
  • Greta is more likely to fall due to her age.
  • Greta is more likely to seriously injure herself due to being frail.

3. Control Risk

Using the hierarchy of control, you should now determine your options for controlling the risk.
Elimination This is not possible, as Greta needs a shower in her home.
  • Substitution
  • Isolation
  • Engineering controls
  • Greta could have the shower repaired. The shower will still be there, but it will be safer. Arrange a portable commode chair with breaks and situate it in another area of the house until the leak is repaired.
  • Instead of the usual bathroom, Greta could use the guest bathroom.
  • Greta could have handrails installed in the bathroom.
Administrative Controls You could put a wet floor sign in Greta’s bathroom whenever you notice that the shower has leaked.
PPE Greta could wear slip-resistant footwear in the bathroom.

The best option here appears to be substituting the hazard with a safer alternative by having the shower repaired. While the shower cannot be eliminated completely, fixing it will hopefully ensure that there is no more water leakage onto the floor.

4. Review Control Measures

Once the shower has been repaired, you should check the bathroom floor during your visits to ensure that there is no more leakage.

Additional Resources


References

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Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile

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