Mac’s Safety Space: Managing Risks—How Do You PCRA?

Recently, I was queried about the efficacy of having a single individual be responsible for the pre-construction risk assessment (PCRA) process based on anecdotal evidence of others doing the same. Personally, I am not familiar with any organizations (and I’m familiar with a fair number of them, though, unlike Johnny Cash, I haven’t been everywhere … yet!) who task this process to a single individual. That said, the amount of latitude with which to entrust to a smaller group in making the risk assessments depends on the level of experience and competence of the persons who are completing the assessments. In my experience, it is quite unusual for this process to reside solely in the hands of a single individual, partially for the same reasons one would not have a single incident commander—there’s literally no back-up if that person is unavailable for whatever reason. (You can plan for vacations, but sick days, etc., not so much). As there are no regulatory requirements beyond the actual performance of the pre-project (construction, renovation, maintenance) risk assessment, there are certainly ways  to modify the process in order to accommodate the volume of projects across an organization, including building minimum risk strategies into the work order or project designation.

For example, one could establish a dividing line for projects between patient and nonpatient areas that automatically triggers a specific set of protective measures. So, in this scenario, you could establish that work in (or immediately adjacent to) a patient area automatically receives a risk level of 3 and above, which would require further assessment by the infection control risk assessment (ICRA) team. You could certainly set up a hierarchy of protective controls based on the elements as identified in the ICRA form (this is particularly useful when it comes to “regular” maintenance activities, more on those in a moment) that don’t require convening the entire team. Over time, as the team becomes comfortable with the elements of the ICRA algorithm and, accordingly, there is less discussion about what does or doesn’t need to be done—everyone tends to have their “pet rock” when it comes to identifying risks, which, I think, is the most compelling reason for going with a group—you get more “looks,” more interpretation, which generally leads to a more all-inclusive assessment.

When it comes to regular maintenance activities, start by making a list of the types of activities that are performed and pre-assign a risk level and applicable protection measures. For example, activities involving patching and painting would likely be considered a greater risk than changing a fluorescent lamp in a light fixture. So, the pre-assigned risk level and applicable protection measures could be embedded in the work order (I suppose that would depend on how sophisticated the work order system might be). Plumbing repairs might merit a score of X, while mounting a hand sanitizer dispenser in a utility room might merit a score of Y. The algorithm used in the ICRA form is designed to remove at least some of the subjectivity from the assessment process and, admittedly, this would require a fair amount of work on the front end as you establish the various protective measures as a function of the tasks/projects. But I think it would be worth it in the long run as you can clearly establish the expectations of the folks working in the field and ensure that those expectations are clearly communicated as part of the process in which tasks/projects are assigned.

As always, as we approach the turn of the year, there is much for which to be thankful, and I wish each of you—and your family—a most delightful Thanksgiving! We’ll be right back at it next week!

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at stevemacsafetyspace@gmail.com.