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Has risk assessment replaced clinical judgement?

  • Comments (47)

The term cookbook medicine is used to describe decision making that is based on rigid adherence to guidelines, pathways and mandatory risk assessment.

Let’s discuss…

  • Have audits and dashboards used to measure adherence to pathways, guidelines and risk assessment undermined clinical judgement?
  • Are routine risk assessment carried out on all patients regardless of their condition, completed to meet the requirement of the organisation rather than the needs of patients?
  • What routine assessments are you expected to complete for every patient?
  • Comments (47)

Readers' comments (47)

  • Anonymous

    I wrote about the appalling nursing care I was subject to following an accident in which I severely injured my shoulder. "Nurses" who tried to subject me to a "mini mental health" assessment, nurses who had no knowledge of the operative procedure (a reverse shoulder prosthesis) I was to undergo , nurses who wished to complete reams of "documentation" but who could not provide me with analgesia either because they had "not done the course" , did not know where the "keys" were, some made reassuring noises such "in a minute" -- the minute of course would turn out to be 30 minutes or more. I could go on to explain how one nurse wanted to hang my vacuum drain on an IV pole !

    Now contrast this !

    During the same accident mentioned above I damaged my brachial plexus ( guess most of you English "nurses" will have to look that up).

    I recently had the plexus surgically explored in a commonwealth country. The nurses were professional -I was not subject to mental health or any other idiotic assessment. The nurses understood the procedure I underwent and analgesia was easily available on request.

    I am sure there must be, somewhere in the UK, a competent nurse, it was a pity I did not meet her/him.

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  • I think you have raised an important point but it isn't a question of one or the other. Nurses have to make the best decision for each individual patient but professional autonomy has led to as much poor practice as standardised care.

    What we need is transparent accountability. The starting point should be for nurses to be aware of evidence based or risk assessment interventions and consider using them. Nurses should then use professional judgement and explain the rationale for deviating from standard practice.

    Patients should be involved in the decision making about the final intervention and the rationale for any decision should be documented and nurses should be happy to be challenged and defend their decisions

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  • A Nonny Mouse

    Nurses are obviously not considered competent anymore and comments such as english 'nurses' not knowing what a brachial plexus is doesn't really help, spiteful and uneccessary critical comments like that and the regular use of " throughout posts just show how little support and respect we now have. is it any wonder that the thousands of highly trained, cometent, motivated and hardworking nurses really can't wait to get out of the profession asap.

    Nurses who 'have not done the course' as so politely stated, are not allowed to give out medication, anyone with any knowledge would know that it is far safer to administer medication when you are fully trained and deemed competent to do so.

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  • Anonymous

    a 'commonwealth country' - what is that supposed to mean, where did you have your surgery?

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  • Anonymous

    anon 7.31 - how much did your surgery in the commonwealth country cost? there are lots of competent nurses in the UK, how many nurses did you actually meet?

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  • OriginalWarriorNurse

    "Nurses have to make the best decision for each individual patient but professional autonomy has led to as much poor practice as standardised care".

    That is an intriguing premise. One I shall think more of over the next few days. I wonder what others think about professional autonomy creating a disturbance in nursing. Let's talk more about this...

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  • Anonymous

    Anonymous | 1-Jul-2013 7:31 am

    Yes, I remember your last nasty little comments from some time ago. Obviously your problems go far beyond a brachial plexus issue and they appear not to have been resolved. One can only hope that you remain in another country and that you address your PTED (you'll probably need to look that up).

    Try to take some responsibility and get over the blame game.

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  • Anonymous

    Of course there is far too much paperwork. The issue has to be addressed to those who impose it. As for nurses, perhaps some dissent is required and a refusal to complete all but what is necessary would send a message to the PTB.
    I underwent extensive, complicated and protracted treatment for cancer. I would like to thank with all my heart the excellent, knowledgeable, hardworking and caring nurses who looked after me throughout the 18 months.
    I sat amongst many patients during my time in hospital for surgeries and chemotherapy. Overwhelmingly the other patients were happy with their treatment and impressed with the expertise and work ethic of our fantastic NHS nurses. The mean-spirited, embittered and vitriolic like Anonymous | 1-Jul-2013 7:31 am could be counted on the fingers of one hand with some to spare. That individual has bigger problems than a sore shoulder.

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  • michael stone

    There are distinctions between paperwork (records of what has been done and measured, and by whom,etc) and 'written protocols' which need to be filled-in 'tick box' style: the latter can indeed get in the way of 'sensible behaviour', and they were presumably introduced to try and make sure that relatively unskilled/inexpert staff are 'following good practice'.

    But tick-box protocols, are always 'simplistic' compared to genuine expertise - this is very complicated, and what works best seems to (logically) depend on how well you are willing to train staff, which of course depends on how much money you are willing to spend.

    Risk assessment PROTOCOLS (as opposed to the CONCEPT of the necessity to assess risks) are part of 'tick-box'.

    The NHS is also paranoid about its own 'culpability' - 'will someone be able to make a claim against us' - so the lawyers get in on this act as well, ignoring the fundamental conflict between 'protocols' and 'expertise'.

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  • Anonymous

    let's not worry about the silly and spiteful comments made, this is an open forum, anyone can post a comment, this 'anon' could be anyone, anywhere.

    we carry out the same risk assessments for all our patients which a few extras for those 'at risk' - isn't that the same in pretty much every job these days, risk management, harm minimisation - call it what you will.

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