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Healthcare risk assessment

Cardiac Care Support Risk Assessment: Deterioration, Medication, Equipment and Information Controls

A worked example of how a cardiac care support service finds, scores and controls risks to patients, staff, equipment and records, from missed deterioration and medication errors to privacy, handovers and escalation.

Updated November 2026 8 hazards assessed Review every 6 months Highest risk: Critical to Medium
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Executive summary

This assessment shows how a cardiac care support service can find, rate and control the risks that matter most to patients, staff and records. Eight hazards were chosen because they are plausible in daily support work. Missed deterioration is the highest inherent risk because a delay can cause serious harm. Medication errors, equipment failure, infection lapses and handover gaps follow closely. Each risk is scored before controls and again after existing and added controls. Most fall to Medium or Low once controls are in place, but deterioration and medication stay at Medium because their impact stays serious. The first actions are a shared early warning tool, a daily monitor check, a standard handover checklist and a tested downtime procedure. Clinical decisions remain with licensed staff, and specialist review is needed before any local change.

Focus area
Cardiac care support in a hospital ward or community cardiology service
Setting
Non-clinical and support duties alongside clinical cardiac care in a hospital or community setting with a multidisciplinary team
Method
Five by five likelihood and impact risk register

Scope

This assessment covers the support work that surrounds cardiac care, including monitoring equipment, observations, medication support, infection control, documentation, patient information, handovers and escalation. It does not give clinical instructions or replace local protocols. Health system, jurisdiction, ward layout and record systems are not specified, so they are treated as assumptions for teaching only.

Context

The service supports patients with heart conditions who may be admitted for monitoring, recovering from procedures or managed at home with periodic review. Support staff use observation charts, electronic records, telemetry and infusion equipment, and they hand over information between shifts and to other teams. Each hazard is scored before controls to show its natural level, then again after existing controls and the additional controls that should be added. Clinical decisions remain with licensed clinicians, and any specific clinical question should go to them.

Objectives, assets and stakeholders

The objective is to support safe, timely and respectful cardiac care, avoid preventable harm, protect patient information and keep staff working within their competence. The assets in scope are patients and their wellbeing, monitoring and infusion equipment, medicines and fluids, the electronic record, consent documents, staff skills and the reputation of the service. Stakeholders include patients and families, nurses and support workers, clinical leads, pharmacists, biomedical engineers, infection prevention staff, information governance staff, managers and regulators. Every risk has one owner role, and the clinical lead for cardiac care reviews the register each quarter with the ward manager and the information governance lead.

Risk matrix: before and after controls

Each cell shows hazard numbers placed by likelihood and impact. Compare the two grids to see how controls move each hazard.

Before controls

Inherent risk

Risk before controls: rows are likelihood from almost certain to rare, columns are impact from insignificant to catastrophic. Cells list hazard numbers.
1
Insignificant		 2
Minor		 3
Moderate		 4
Major		 5
Catastrophic
5 Almost certain
4 Likely Likelihood 4, impact 3, score 12, high: H05 Likelihood 4, impact 5, score 20, critical: H01
3 Possible Likelihood 3, impact 3, score 9, medium: H06 Likelihood 3, impact 4, score 12, high: H03 H04 Likelihood 3, impact 5, score 15, high: H02
2 Unlikely Likelihood 2, impact 4, score 8, medium: H07 H08
1 Rare

After controls

Residual risk

Risk after controls: rows are likelihood from almost certain to rare, columns are impact from insignificant to catastrophic. Cells list hazard numbers.
1
Insignificant		 2
Minor		 3
Moderate		 4
Major		 5
Catastrophic
5 Almost certain
4 Likely
3 Possible
2 Unlikely Likelihood 2, impact 2, score 4, low: H06 Likelihood 2, impact 3, score 6, medium: H03 H04 H05 H07 Likelihood 2, impact 4, score 8, medium: H01 H02
1 Rare Likelihood 1, impact 4, score 4, low: H08
  • Low 1 to 4
  • Medium 5 to 9
  • High 10 to 16
  • Critical 17 to 25

Hazard register

A summary first, then the detail for each hazard.

Summary of hazards with scores before and after controls
No.HazardBeforeAfterOwner
H01 Missed or delayed recognition of patient deterioration 20 Critical 8 Medium Clinical lead for cardiac care
H02 Medication administration and documentation errors 15 High 8 Medium Medicines safety lead
H03 Monitoring equipment failure or misreading 12 High 6 Medium Biomedical engineering lead
H04 Infection and exposure control lapses 12 High 6 Medium Infection prevention and control lead
H05 Handover gaps and staffing shortfalls 12 High 6 Medium Ward manager
H06 Privacy, consent and record keeping breaches 9 Medium 4 Low Information governance lead
H07 Information system outage or data error 8 Medium 6 Medium Information technology manager
H08 Work beyond scope of role or competence 8 Medium 4 Low Clinical education lead
H01

Missed or delayed recognition of patient deterioration

Safety Before 20 After 8

Changes in a patient's observations, symptoms or monitoring trace are not noticed, recorded or escalated in time, so a worsening cardiac condition goes untreated for longer than it should.

Who or what is affected: Patients, families and ward staff

Causes

High workload, alarm fatigue, unclear escalation bands and reliance on memory between checks.

Consequences

Preventable harm, emergency transfer, longer stays and serious incident review.

Existing controls

  • Observations are recorded at set intervals using the agreed chart.
  • Staff follow the local escalation protocol for abnormal readings.

Control gaps

Escalation thresholds vary between staff, and audit results are not yet shared across shifts.

Additional controls

  • Prevent: Use a standard early warning scoring tool with clear escalation bands on every chart.
  • Detect: Audit a sample of charts each month for missed or late escalations and feed findings back to staff.
Likelihood 4 x impact 5 before; 2 x 4 after Owner: Clinical lead for cardiac care Target: Within 30 days Early warning: Observation charts with a missed scheduled check or an abnormal score without a logged escalation.
H02

Medication administration and documentation errors

Safety Before 15 After 8

Support staff prepare, check or record medicines and fluids incorrectly, through wrong dose, wrong patient, wrong time or missed prescriber advice, so the patient receives an unsafe or unintended treatment.

Who or what is affected: Patients, nurses, pharmacists and prescribers

Causes

Interruptions during tasks, similar drug names, handwritten charts and pressure at busy times.

Consequences

Adverse drug reaction, rhythm or blood pressure effects, extra treatment and loss of trust.

Existing controls

  • Two-person check is required for high-risk infusions.
  • Medication charts are reviewed at each handover.

Control gaps

Double checks are not always recorded, and tall-man lettering is not used on all labels.

Additional controls

  • Prevent: Use barcode or double check prompts for all high-risk drugs and fluids in the record system.
  • Respond: Stop the administration, inform the prescriber and record the event as soon as an error is found.
Likelihood 3 x impact 5 before; 2 x 4 after Owner: Medicines safety lead Target: Within 45 days Early warning: Repeated near misses for the same drug or ward within one month.
H03

Monitoring equipment failure or misreading

Technology and data Before 12 After 6

Telemetry leads, monitors, pumps or sensors fail, are set up incorrectly or are read wrongly, so a change in the patient's condition is missed or a false alarm delays care.

Who or what is affected: Patients, biomedical engineers and ward staff

Causes

Worn leads, cable damage, default settings left unchanged and staff unfamiliar with a new device.

Consequences

Missed deterioration, delayed treatment, false alarm fatigue and equipment incident reports.

Existing controls

  • Equipment is checked by a biomedical team on a planned schedule.
  • Alarm limits are set by a clinician at admission.

Control gaps

Daily checks depend on individual staff, and spare equipment is not always stocked.

Additional controls

  • Prevent: Record a daily function check on each monitor and remove any unit that fails it from use.
  • Detect: Log all alarms and review patterns of silenced or ignored alarms each week.
Likelihood 3 x impact 4 before; 2 x 3 after Owner: Biomedical engineering lead Target: Within 30 days Early warning: Repeated alarms silenced without review or a monitor found out of service on a shift.
H04

Infection and exposure control lapses

Safety Before 12 After 6

Hand hygiene, cleaning, isolation or personal protective equipment is not applied correctly, so infection spreads between patients and staff, or staff are exposed to blood or body fluids.

Who or what is affected: Patients, visitors, support staff and cleaners

Causes

Busy shifts, shared equipment, gaps in cleaning and unclear isolation signs.

Consequences

Hospital acquired infection, staff illness, ward closure and loss of public confidence.

Existing controls

  • Hand hygiene audits are carried out by the infection control team.
  • Personal protective equipment is stocked at each bay.

Control gaps

Cleaning of shared monitoring equipment is recorded inconsistently between shifts.

Additional controls

  • Prevent: Place alcohol hand rub and protective equipment at every point of care and check stock each shift.
  • Recover: Trace contacts after an exposure and follow the local occupational health and isolation process.
Likelihood 3 x impact 4 before; 2 x 3 after Owner: Infection prevention and control lead Target: Within 45 days Early warning: Cluster of similar infections or a cleaning record that is incomplete for a bay.
H05

Handover gaps and staffing shortfalls

People Before 12 After 6

Shift handovers omit key risks, pending tasks or changes in medication, and understaffing or unfamiliar cover means essential checks are missed, so the next team works from incomplete information.

Who or what is affected: Patients, nurses, support workers and managers

Causes

Sickness, vacancies, unfamiliar agency staff and handovers given at the bedside under noise.

Consequences

Missed tasks, delayed escalation, repeated errors and staff burnout.

Existing controls

  • A structured handover tool is used at each change of shift.
  • Staffing levels are reviewed weekly by the ward manager.

Control gaps

Handover content is not audited, and cover decisions are made without a clear rule.

Additional controls

  • Prevent: Use a shared handover checklist that lists risks, pending tests and escalations for each patient.
  • Respond: Call in cover or redeploy staff when a shortfall is found, and record the decision and its reason.
Likelihood 4 x impact 3 before; 2 x 3 after Owner: Ward manager Target: Within 30 days Early warning: Shifts with open tasks at handover or staffing below the agreed minimum.
H06

Privacy, consent and record keeping breaches

Legal and compliance Before 9 After 4

Patient information is shared, viewed or left visible without need, consent is not recorded before a procedure or data use, or notes are incomplete, so patients are exposed and the service cannot show what was agreed.

Who or what is affected: Patients, families, staff and regulators

Causes

Shared screens, printed lists left on desks, rushed notes and unclear consent steps.

Consequences

Breach report, loss of trust, complaints and possible regulatory review.

Existing controls

  • Staff sign a confidentiality agreement on joining.
  • Consent forms are kept in the patient record.

Control gaps

Access logs are not reviewed routinely, and consent gaps are found only after an event.

Additional controls

  • Prevent: Limit record access by role and lock screens after a short period of inactivity.
  • Detect: Run a monthly audit of record access and of consent entries for support procedures.
Likelihood 3 x impact 3 before; 2 x 2 after Owner: Information governance lead Target: Within 60 days Early warning: Access to a record by a user with no clinical link to the patient.
H07

Information system outage or data error

Technology and data Before 8 After 6

The electronic record, results system or communication tools stop working or show wrong data, so staff cannot see current information, or act on an out of date result, during care.

Who or what is affected: Patients, clinicians, support staff and information technology team

Causes

Software faults, network failure, power interruption and unverified software updates.

Consequences

Delayed care, duplicate entries, wrong data used and recovery effort after the event.

Existing controls

  • Records are backed up each night by the information technology team.
  • Downtime forms are kept at each nurse station.

Control gaps

Downtime drills are not held at night shifts, and reconciliation steps are not written down.

Additional controls

  • Prevent: Test the downtime procedure twice each year and keep printed copies of key lists.
  • Recover: Restore the record from the latest tested backup and reconcile entries made during the outage.
Likelihood 2 x impact 4 before; 2 x 3 after Owner: Information technology manager Target: Within 60 days Early warning: Repeated system slow down or a failed backup check in the same week.
H08

Work beyond scope of role or competence

Legal and compliance Before 8 After 4

Support staff perform tasks they are not trained, registered or authorized to carry out, or are asked to make clinical judgments, so patients receive care from someone without the right competence.

Who or what is affected: Patients, support staff and clinical leads

Causes

Pressure to cover gaps, informal learning on the job and unclear boundaries between roles.

Consequences

Unsafe care, professional disciplinary action and regulatory concern.

Existing controls

  • Role descriptions list the tasks each grade may perform.
  • Training records are kept for each staff member.

Control gaps

Sign off records are not linked to the rota, so cover decisions do not check competence.

Additional controls

  • Prevent: Check competence sign off before a new task is assigned and display the scope of each role.
  • Respond: Stop the task, refer the question to a qualified clinician and record the concern for review.
Likelihood 2 x impact 4 before; 1 x 4 after Owner: Clinical education lead Target: Within 90 days Early warning: A task recorded for a staff member with no current competence sign off.

Rating method and evaluation

Each risk is rated on two five-point scales. Likelihood runs from Rare to Almost certain, and impact runs from Insignificant to Catastrophic. Multiplying the two gives a score from 1 to 25, which falls into one of four bands: Low from 1 to 4, Medium from 5 to 9, High from 10 to 16 and Critical from 17 to 25. The score guides the order of work and is not a measurement. Inherent risk is the score before any controls. Residual risk is the score after the existing and added controls. Impact considers physical harm first, then the effect on care, cost, records and trust, and a patient safety risk is never rated down only because it has not yet happened. Anything still High needs senior review and a dated plan, anything Medium needs routine controls with a named owner, and anything Low is accepted and monitored. Frontline staff should challenge every rating, and each rating is reviewed whenever its indicator reaches the escalation threshold or an incident occurs.

Likelihood, impact and rating bands

Likelihood

  • 5 Almost certain: Expected to happen in most circumstances.
  • 4 Likely: Will probably happen in many circumstances.
  • 3 Possible: Could happen at some time.
  • 2 Unlikely: Not expected, but it could happen.
  • 1 Rare: Only in exceptional circumstances.

Impact

  • 1 Insignificant: No lasting effect. Handled within routine work.
  • 2 Minor: Small effect that is quickly corrected.
  • 3 Moderate: Noticeable effect that needs managed effort to correct.
  • 4 Major: Serious effect on people, delivery or reputation.
  • 5 Catastrophic: Severe or lasting effect that threatens the whole activity.

Bands (likelihood x impact)

  • Low (1 to 4): Accept and monitor.
  • Medium (5 to 9): Manage with routine controls.
  • High (10 to 16): Senior attention and a treatment plan.
  • Critical (17 to 25): Act first. Do not proceed until reduced.

Monitoring, escalation and review

Review this assessment every 6 months, and sooner when an indicator below reaches its threshold.

Early-warning indicators and escalation thresholds
Indicator to watchEscalate when
Observation charts with an abnormal score and no logged escalation.Escalate to the clinical lead for cardiac care at once when found, and to the ward manager if the pattern repeats within a week.
Monitors or leads recorded as failed or silenced alarms without review.Escalate to the biomedical engineering lead at once, and remove the unit from use until it passes a check.
Medication near misses or high-risk drug administrations without a recorded double check.Escalate to the medicines safety lead within one day, and to the clinical lead if a patient was harmed.
Shifts with open tasks at handover or staffing below the agreed minimum.Escalate to the ward manager during the shift, and to the senior nurse on call if cover cannot be found.
Record access by users with no clinical link to the patient or consent entries missing for support procedures.Escalate to the information governance lead within one working day, who decides on any reporting duty.

Contingency arrangements

If a serious event occurs, such as a sudden deterioration, a medication error with harm or a confirmed privacy breach, the staff member present follows the local emergency and escalation protocol at once and informs the on call clinical lead. The ward manager secures the area, keeps the record of events and ensures the patient is cared for. The information technology team isolates affected systems and restores data from the latest tested backup. The information governance lead decides on reporting duties and contacts with regulators as the jurisdiction requires.

Prioritized action plan

  1. Introduce a shared early warning tool with clear escalation bands, owner clinical lead for cardiac care, within 30 days.
  2. Add a daily function check for each monitor and remove failed units from use, owner biomedical engineering lead, within 30 days.
  3. Adopt a standard handover checklist and audit it monthly, owner ward manager, within 30 days.
  4. Make double check prompts mandatory for high-risk drugs and fluids, owner medicines safety lead, within 45 days.
  5. Hold a downtime drill on every shift pattern and restore a test from backup, owner information technology manager, within 60 days.

Conclusion

Safe cardiac support depends on steady habits: recognizing change early, checking medicines twice, keeping equipment working, handing over clearly and recording consent accurately. The highest scores sit with missed deterioration and medication errors, and each has actions that reduce the residual score. Treat the register as a living record, review it on the stated cycle, and seek qualified clinical, legal and equipment advice for any real decision.

Assumptions and limitations

Assumptions

  • The service operates under a local clinical governance structure with named clinical leads and an incident reporting system.
  • Staff are trained and registered for their roles and work from approved local protocols.
  • Jurisdiction and health system are not specified, so legal duties are described in general terms only.

Limitations

  • The scores are examples for learning and do not describe any real ward, service or patient group.
  • Clinical practice and privacy rules differ by place and change over time, so specialist clinical and legal review is needed.
  • This is educational content and is not clinical, medical, legal or equipment advice.

Related frameworks to study

  • Clinical governance framework with incident learning cycle
  • Hierarchy of controls
  • Three lines model of risk ownership
  • Structured early warning scoring approach
  • Root cause analysis method

Healthcare Risk Assessment

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For Learning Reference Only: This assessment demonstrates how risk assessment principles are applied in a practical setting, providing a useful reference for learning and understanding. Actual assessments may be adapted to suit specific site conditions and circumstances.

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