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Risky Business

Southern NSW Local Health District
Project Added:
4 July 2016
Last updated:
19 July 2016

Risky Business


A staff engagement and education process was developed by Bombala Multipurpose Service (MPS) and Delegate MPS, to improve admission documentation for high-risk patients.


To ensure 100% of patients at Bombala MPS and Delegate MPS have a completed Adult Risk Screen Form (ARSF) by November 2016.


  • Provides acute admissions with a thorough assessment of their health status within 24 hours of admission.
  • Identifies high-risk patients during the screening process, so measures can be taken to reduce risks.
  • Provides patients with a comprehensive care plan.
  • Gives staff a thorough understanding of the patient and eliminates guesswork.
  • Improves staff communication during handover.
  • Reduces the risk of falls and pressure injuries.


The ARSF was introduced to SNSWLHD in 2011, in an effort to streamline the risk screening process and reduce the amount of paperwork required when admitting an acute or sub-acute patient. The form acts as a screening tool, identifying whether the patient is at risk of falls, pressure injuries, malnutrition, medication management and alcohol misuse, so that only appropriate patients are sent for further assessment. It has saved nurses a significant amount of time and has since been implemented in maternity and oncology wards throughout SNSWLHD.

Bombala MPS and Delegate MPS introduced the ARSF in 2014 to admit respite patients and residents. It was anticipated that the form would improve admission documentation for high-risk patients, particularly those who were admitted due to falls and pressure injuries. Care planning would also be improved as a result of using the form.

An education package was developed and implemented at both sites. However, an internal survey conducted several months after the form was implemented found:

  • the form had not reduced the amount of paperwork required to complete an admission
  • nurses felt they didn’t have enough time to complete the form
  • nurses felt that as a small facility in a small community, they didn’t need to screen patients as they knew them quite well
  • patients are often at risk of everything on the form due to their age
  • nurses often copied the previous form without screening the patient again, particularly if the patient is admitted to the facility on a regular basis.

An audit conducted in September 2014 found that both sites had poor compliance in completing the ARSF, compared to the other MPS in SNSWLHD. It was anticipated that engaging and educating staff on the importance of risk screening would improve compliance and streamline the admissions process at Bombala MPS and Delegate MPS.


  • From June to October 2015, the project team used traditional methods of engaging and educating staff as a baseline.
  • Staff were encouraged to participate in the audit process, to improve their knowledge and understanding of the ARSF and the importance of compliance.
  • The data collection phase of the project highlighted a problem with team morale, which became a priority over developing solutions for this project. The team is now being rebuilt using the Essentials of Care methodology and clinical improvement has been placed on hold until the new team is in place.

Project status

  • Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

June 2015 – November 2016

Implementation sites

  • Bombala MPS
  • Delegate MPS


Evaluation and results

  • The ARSF will be audited every six months, to assess ongoing changes to compliance.
  • The November 2015 audit showed an improvement of 2% in compliance from the May 2015 audit, following implementation of the baseline education solutions.
  • The next audit is due in November 2016 and will demonstrate whether engaging staff in the auditing process makes a positive difference to compliance.
  • A staff survey will be conducted on completion of the pilot project, to determine any changes to staff satisfaction and productivity.

Lessons learnt

  • It is important to give yourself more time than you think to complete the project, as everyday priorities often take over.
  • Team engagement is essential and often takes creativity and persistence.
  • Maintaining a high level of morale is essential before clinical improvement can be undertaken – one of our key challenges was addressing feedback from staff, who said they were too busy to get involved.
  • Understanding the correct way to tackle a challenge is important when implementing clinical improvements.
  • It’s important to remember that not everything will go to plan; often the project leads you in a different direction than originally anticipated.
  • Do not assume you have a solution to your problem before you’ve gathered the data, as it may not be the best way to address the challenge.


Rhonda Stewart
Senior Nurse Manager
Bombala MPS and Delegate MPS
Southern NSW Local Health District 
Phone: 02 6458 5777

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