16.1 Risk assessment
Each injectable practice across UCLH was assessed according to the eight NPSA criteria, described in the table below. The risk assessment was conducted in all clinical areas in order to capture local variations in practice. Many injectables are used in multiple different ways, so were risk assessed multiple times according to local practice. For example, a dopamine infusion in UCLH Cardiology is prepared and administered in a different way to that in UCLH Neonatal Unit. The criteria are outlined in the following table.
All injectable practices were given a final score out of eight, according to the number of criteria that applied to that practice. The NPSA advises that practice that scores 1–2 is low risk, 3–5 is moderate risk and 6 or more is high risk. The NPSA requires risk reduction strategies to be put in place to minimise high-risk practices and mitigate the risk if possible. Our scores have been embedded into the monographs in Section B.
At UCLH it was recognised that the NPSA risk scores are very much weighted towards the preparation of the injectable rather than the clinical risk. For example, a morphine bolus would get a low score because it was relatively easy to prepare, despite being potentially very harmful to the patient. Thus a database of all practice rated as high risk according to the NPSA rating plus any practice known to be high risk for other reasons was created. The additional inclusion criteria included all opiates, anaesthetic agents, benzodiazepines, all drugs with a narrow therapeutic index which require blood monitoring, and all drugs that require acute monitoring to ensure efficacy or monitoring for serious adverse effects, e.g. beta-blockers.
The database comprises approximately 100 high-risk injectable practices across the Trust. These were further stratified according to how widespread they are and how frequently they are performed in order to identify which practices should be prioritised for risk minimisation. Some examples of high-risk and widely used injectables at UCLH are given in the table below.
| Number | Risk factor | Applies when |
| 1 | Therapeutic risk | There is significant risk of patient harm if the injectable medicine is not used as intended1 |
| 2 | Use of a concentrate | The product must be further diluted (after reconstitution) before it can be injected |
| 3 | Complex calculation |
