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Risk Matrix — Hospital Ward Patient Safety Register (5×5)

A patient safety register for a fictional elderly-care ward on the familiar NHS 5×5 consequence × likelihood matrix with Low, Moderate, High and Extreme bands: controls reduce exposure from 92 to 56 (−39%), and deterioration (10), falls (9), night staffing (9) and insulin errors (8) remain High, above the Moderate appetite, each with an improvement action. Illustrative register.

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Ward 7B elderly care — patient safety risk registerScored on the familiar NHS 5×5 consequence × likelihood matrix · reviewed at the monthly ward governance meetingHEAT MAP · residual position, arrows from inherent11LOWLOW22LOWLOW33LOWLOW44MODERATEMODERATE55MODERATEMODERATE22LOWLOW44MODERATEMODERATE66MODERATEMODERATE88HIGHHIGH1010HIGHHIGH33LOWLOW66MODERATEMODERATE99HIGHHIGH1212HIGHHIGH1515EXTREMEEXTREME44MODERATEMODERATE88HIGHHIGH1212HIGHHIGH1616EXTREMEEXTREME2020EXTREMEEXTREME55MODERATEMODERATE1010HIGHHIGH1515EXTREMEEXTREME2020EXTREMEEXTREME2525EXTREMEEXTREMEW7W8W6W5W4W7W8W1W2W3W5W4W1W3W6W2Rare1Unlikely2Possible3Likely4Almost certain51Negligible2Minor3Moderate4Major5CatastrophicLIKELIHOOD →IMPACT →R1residual position (after controls)R1inherent positioneffect of existing controlsappetite boundary · red ring = above it25L×I score and rating bandRISK PROFILE BY BANDInherentResidual (current)Extreme2 → 0High6 → 4Moderate0 → 4Low0 → 0Low 1–3 · Moderate 4–6 · High 8–12 · Extreme 15–25EXPOSURE Σ L×I56residual, after current controlsfrom 92 inherent · −39%HIGHEST RESIDUAL RISKW1Delayed recognition of deterioration orsepsis10 · Highowner Ward SisterRISK APPETITEModerate or below4 risks above: W1, W2, W3, W4Risk register8 risks · sorted by residual rating, then score#IDRISK, CONTROLS AND ACTIONSOWNERINHERENTRESIDUALCHANGEDETERIORATIONDelayed recognition of deterioration or sepsisNEWS2 observations with electronic escalation alertsSepsis Six bundle and 24/7 critical care outreach→Show real-time NEWS2 scores on the nurse-in-charge dashboard — due 2027-04 · Digital NurseLead1W1Ward Sister3 × 515 · Extreme2 × 510 · HighABOVE APPETITE−5−33%FALLSInpatient fall with harmMultifactorial falls risk assessment within six hours of admissionEnhanced supervision bay with low beds and sensor alarms→Trial bay-based nursing on the night shift — due 2027-03 · Ward Manager2W2Ward Manager4 × 416 · Extreme3 × 39 · HighABOVE APPETITE−7−44%↓ fallingSTAFFINGNight shifts staffed below the safe establishmentTwice-daily safe-staffing huddle with bank escalation→Recruit six whole-time-equivalent international nurses — due 2027-06 · Matron3W3Matron4 × 312 · High3 × 39 · HighABOVE APPETITE−3−25%→ stableMEDICATIONInsulin prescribing or administration errorInsulin passport and independent double-check for IV insulinDiabetes specialist nurse review within 24 hours→Introduce electronic insulin order sets — due 2027-05 · Ward Pharmacist4W4Ward Pharmacist3 × 412 · High2 × 48 · HighABOVE APPETITE−4−33%COGNITIONDelirium unrecognised on admission4AT screening on admission and daily delirium bundle5W6ConsultantGeriatrician4 × 312 · High2 × 36 · Moderate−6−50%TISSUE VIABILITYHospital-acquired pressure ulcer, category 2 or abovePurpose T assessment and documented repositioningDynamic mattresses for all high-risk patients6W5Ward Manager3 × 39 · High2 × 36 · Moderate−3−33%INFECTIONHospital-acquired C. difficile infectionAntimicrobial stewardship ward roundsSide-room isolation and chlorine-based cleaning7W7InfectionPrevention Nurse2 × 48 · High1 × 44 · Moderate−4−50%IDENTIFICATIONPatient misidentification at the bedsidePositive patient identification policy with barcoded wristbands8W8Ward Manager2 × 48 · High1 × 44 · Moderate−4−50%FINDINGS8 risks rated — inherent 2 Extreme, 6 High; after current controls 4 High, 4 Moderate.Total exposure Σ(L×I) falls from 92 to 56 after current controls — a 39% reduction.Controls move 6 of 8 assessed risks into a lower band; 2 keep their inherent band.4 of 8 risks sit above the Moderate appetite on residual rating — W1 (High 10), W2 (High 9), W3 (High 9), W4 (High 8); each has a treatment action.Highest residual risk: W1 Delayed recognition of deterioration or sepsis — High 10, owner Ward Sister.Controls do most for W2: 16 → 9 (−44%).Illustrative register for a fictional ward; ratings are examples for training, not a clinical risk assessment.

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title "Ward 7B elderly care — patient safety risk register"
subtitle "Scored on the familiar NHS 5×5 consequence × likelihood matrix · reviewed at the monthly ward governance meeting"
likelihood-levels: Rare, Unlikely, Possible, Likely, Almost certain
impact-levels: Negligible, Minor, Moderate, Major, Catastrophic
bands: Low 1-3 green, Moderate 4-6 yellow, High 8-12 orange, Extreme 15-25 red
appetite: Moderate
note "Illustrative register for a fictional ward; ratings are examples for training, not a clinical risk assessment."

risk W1 "Delayed recognition of deterioration or sepsis"
  category: Deterioration
  owner: Ward Sister
  likelihood: 3
  impact: 5
  control "NEWS2 observations with electronic escalation alerts"
  control "Sepsis Six bundle and 24/7 critical care outreach"
  residual: 2x5
  action "Show real-time NEWS2 scores on the nurse-in-charge dashboard" due: 2027-04 owner: "Digital Nurse Lead"

risk W2 "Inpatient fall with harm"
  category: Falls
  owner: Ward Manager
  likelihood: 4
  impact: 4
  control "Multifactorial falls risk assessment within six hours of admission"
  control "Enhanced supervision bay with low beds and sensor alarms"
  residual: 3x3
  action "Trial bay-based nursing on the night shift" due: 2027-03 owner: "Ward Manager"
  trend: falling

risk W3 "Night shifts staffed below the safe establishment"
  category: Staffing
  owner: Matron
  likelihood: 4
  impact: 3
  control "Twice-daily safe-staffing huddle with bank escalation"
  residual: 3x3
  action "Recruit six whole-time-equivalent international nurses" due: 2027-06 owner: "Matron"
  trend: stable

risk W4 "Insulin prescribing or administration error"
  category: Medication
  owner: Ward Pharmacist
  likelihood: 3
  impact: 4
  control "Insulin passport and independent double-check for IV insulin"
  control "Diabetes specialist nurse review within 24 hours"
  residual: 2x4
  action "Introduce electronic insulin order sets" due: 2027-05 owner: "Ward Pharmacist"

risk W5 "Hospital-acquired pressure ulcer, category 2 or above"
  category: Tissue viability
  owner: Ward Manager
  likelihood: 3
  impact: 3
  control "Purpose T assessment and documented repositioning"
  control "Dynamic mattresses for all high-risk patients"
  residual: 2x3

risk W6 "Delirium unrecognised on admission"
  category: Cognition
  owner: Consultant Geriatrician
  likelihood: 4
  impact: 3
  control "4AT screening on admission and daily delirium bundle"
  residual: 2x3

risk W7 "Hospital-acquired C. difficile infection"
  category: Infection
  owner: Infection Prevention Nurse
  likelihood: 2
  impact: 4
  control "Antimicrobial stewardship ward rounds"
  control "Side-room isolation and chlorine-based cleaning"
  residual: 1x4

risk W8 "Patient misidentification at the bedside"
  category: Identification
  owner: Ward Manager
  likelihood: 2
  impact: 4
  control "Positive patient identification policy with barcoded wristbands"
  residual: 1x4