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Healthcare risk assessment

Physical, Occupational and Rehabilitation Therapy Risk Assessment: Patient Safety, Equipment and Records Controls

A worked example of how a rehabilitation therapy service finds, scores and controls the risks that threaten patient safety, equipment reliability, consent, records and staff competence in daily practice.

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

This assessment shows how a therapy service can find, rate and control the risks that matter most to patient safety, clinical stability, records and staff competence. Eight risks were chosen because they are plausible in everyday physical and occupational therapy work. Falls during mobility training, unrecognized deterioration and infection spread are rated highest before controls, because they can cause serious harm quickly. Each risk is scored before controls and again after existing and added controls, and most fall to Medium or Low once those controls are in place. Deterioration is the risk that most needs specialist clinical review, because the right stop criteria depend on each patient's medical history. The first actions are a pre-session screening checklist, a written escalation pathway, single use covers for shared equipment, a consent checklist and a competence matrix. The service is a teaching example, so every score illustrates method, not a real organization or patient.

Focus area
Physical, occupational and rehabilitation therapy
Setting
Outpatient and community rehabilitation service providing physical and occupational therapy to adults with mobility, neurological and musculoskeletal conditions
Method
Five by five likelihood and impact risk register with clinical escalation

Scope

This assessment covers a therapy team that delivers physical and occupational therapy sessions in a clinic, a rehabilitation gym and patients' homes, from initial assessment and treatment planning to exercise, equipment use, documentation and discharge. It looks at risks to patient safety, clinical deterioration, infection control, consent, records, staffing and escalation. Jurisdiction, clinic size, patient mix and records system are assumptions made for teaching, and this example does not describe any real service.

Context

The service has a clinical lead, several physiotherapists and occupational therapists, rehabilitation assistants, a receptionist and a clinic manager. Patients are referred by physicians and other services, and therapy includes manual handling, gait training, transfer practice, exercise prescription, splinting and home adaptation advice. Electronic records hold assessments, goals and session notes, and portable equipment such as hoists, walking aids and electrotherapy devices is used in the gym and at home. Each risk is scored before controls to show its natural level, then again after existing controls and added controls.

Objectives, assets and stakeholders

The objective is to deliver safe, effective and respectful therapy that improves function and independence, avoids avoidable harm, and keeps the trust of patients, families and referrers. The assets in scope are patients' physical and cognitive safety, clinical records, consent documents, rehabilitation equipment, the treatment spaces and the team's skills. Stakeholders include patients and their families, therapists and assistants, the clinical lead, referring physicians, funders, regulators and the public. Clear roles matter: every risk has one owner role, and the clinical lead reviews the register with the team each quarter and reports serious events to the governing body.

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: H03 H06 Likelihood 4, impact 4, score 16, high: H01
3 Possible Likelihood 3, impact 3, score 9, medium: H08 Likelihood 3, impact 4, score 12, high: H04 H05 H07 Likelihood 3, impact 5, score 15, high: H02
2 Unlikely
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: H03 H06 H08 Likelihood 2, impact 3, score 6, medium: H01 H02 H04 H05 H07
1 Rare
  • 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 Fall or injury during mobility and transfer training 16 High 6 Medium Clinical lead
H02 Clinical deterioration not recognized during therapy 15 High 6 Medium Clinical lead
H03 Infection transmission in clinic and home visits 12 High 4 Low Infection prevention lead
H04 Unsafe or poorly maintained equipment 12 High 6 Medium Clinic manager
H05 Consent and privacy breaches in records and communication 12 High 6 Medium Information governance lead
H06 Inaccurate or incomplete clinical documentation 12 High 4 Low Clinical lead
H07 Staff competence gaps and unsafe handovers 12 High 6 Medium Clinical lead
H08 Service disruption and loss of access to records 9 Medium 4 Low Clinic manager
H01

Fall or injury during mobility and transfer training

Safety Before 16 After 6

A patient falls or is strained during gait training, sit to stand practice or a transfer, because the task is more demanding than their current balance, strength or cognition allows, or because the helper's technique or the equipment is unsuitable.

Who or what is affected: Patients, therapists and rehabilitation assistants

Causes

Rapid progression, fatigue, poor footwear, cognitive impairment and single staff supervision.

Consequences

Fracture, head injury, longer admission, loss of confidence and a formal incident review.

Existing controls

  • Falls risk screening is recorded at the initial assessment.
  • Transfers follow a written technique and staff are trained before supervising them.

Control gaps

Falls risk scores are not re-checked after a change in medication or condition.

Additional controls

  • Prevent: Set task difficulty against a documented balance and strength score and require a second helper for high risk transfers.
  • Detect: Check the patient's position and gait safety at the start of each session and record any near miss.
Likelihood 4 x impact 4 before; 2 x 3 after Owner: Clinical lead Target: Within 30 days Early warning: Two or more near misses or unplanned loss of balance in the same patient within one month.
H02

Clinical deterioration not recognized during therapy

Operational Before 15 After 6

A patient develops chest pain, breathlessness, dizziness, abnormal blood pressure or a new neurological sign during exercise or treatment, and the therapist does not recognize it or delays escalation to the referring clinician or emergency service.

Who or what is affected: Patients, therapists and referring clinicians

Causes

High intensity programmes, incomplete referral information and staff uncertainty about when to stop.

Consequences

Serious harm, transfer to acute care, delayed treatment and a breach of professional duty.

Existing controls

  • Vital signs are taken before higher intensity exercise for patients with cardiac or respiratory conditions.
  • A written list of stop criteria is displayed in the gym.

Control gaps

Stop criteria are not tailored to each patient's medication or comorbidity.

Additional controls

  • Prevent: Apply a pre-session screening checklist and defer exercise when stop criteria are met.
  • Respond: Follow a written escalation pathway with a named clinician to contact and a rule for calling emergency services.
  • Recover: Review each deterioration event with the team and update the stop criteria.
Likelihood 3 x impact 5 before; 2 x 3 after Owner: Clinical lead Target: Within 30 days Early warning: A session stopped for a vital sign or symptom change without a documented escalation.
H03

Infection transmission in clinic and home visits

Safety Before 12 After 4

Staff or patients spread infection through shared gym equipment, hands, soft furnishings or home visits, particularly where patients have open wounds, compromised immunity or respiratory illness, and hand hygiene or cleaning is missed.

Who or what is affected: Patients, therapists, assistants and household members

Causes

Shared equipment, busy schedules, unfamiliar home environments and staff working while unwell.

Consequences

Infection in a vulnerable patient, staff sickness, service closure and complaints.

Existing controls

  • Hand hygiene facilities are available in every treatment area.
  • Equipment is wiped down at the end of each session.

Control gaps

Home visit kits are not cleaned between visits and there is no sickness reporting for staff.

Additional controls

  • Prevent: Use single use covers for mats and balls and require hand hygiene before and after each patient contact.
  • Detect: Audit cleaning and hand hygiene each month using a simple checklist and feedback.
Likelihood 4 x impact 3 before; 2 x 2 after Owner: Infection prevention lead Target: Within 30 days Early warning: Two or more patients or staff with the same infection reported within two weeks.
H04

Unsafe or poorly maintained equipment

Technology and data Before 12 After 6

Hoists, electrotherapy units, treadmills, splints or walking aids develop faults, are used past their service date, or are set up incorrectly, so patients or staff are injured or treatment is not delivered as intended.

Who or what is affected: Patients, therapists and visitors

Causes

Heavy use, missed service dates, damaged cables and staff unfamiliar with settings.

Consequences

Injury, failed treatment, equipment loss and regulatory concern.

Existing controls

  • Equipment is labelled with a service date.
  • Staff report faults to the clinic manager.

Control gaps

Home equipment loans are not logged against the same service schedule.

Additional controls

  • Prevent: Remove faulty equipment from use with a visible tag and check every item against a service schedule.
  • Detect: Run a pre-use check of load limits, cables and brakes before each shift and log the results.
Likelihood 3 x impact 4 before; 2 x 3 after Owner: Clinic manager Target: Within 45 days Early warning: An equipment fault report or a service date missed for any item in use.
H05

Consent and privacy breaches in records and communication

Legal and compliance Before 12 After 6

Treatment starts without a documented, informed consent, or patient information is shared with the wrong person, left on a shared screen, sent unencrypted or kept longer than the records policy allows.

Who or what is affected: Patients, family members and the clinical team

Causes

Time pressure, shared devices, email to family members and unclear rules on who may receive information.

Consequences

Complaint, regulatory action, loss of trust and distress to the patient.

Existing controls

  • Consent is recorded at the first visit.
  • Records are kept in a password protected system with individual logins.

Control gaps

Consent is not revisited when treatment goals or treating staff change.

Additional controls

  • Prevent: Use a consent checklist that must be complete before a treatment is recorded and limit who can see each record.
  • Detect: Audit a sample of records each quarter for consent, access and retention issues.
Likelihood 3 x impact 4 before; 2 x 3 after Owner: Information governance lead Target: Within 60 days Early warning: A record opened by a user with no active caseload link to that patient.
H06

Inaccurate or incomplete clinical documentation

Legal and compliance Before 12 After 4

Assessments, goals, session notes or discharge summaries are late, vague or inaccurate, so the next clinician works from a wrong picture of the patient's status, risks or progress.

Who or what is affected: Patients, next clinicians and funders

Causes

Heavy caseloads, copy and paste from earlier notes and unclear measures of progress.

Consequences

Poor continuity, wrong decisions, funding disputes and complaints.

Existing controls

  • Session notes are required before the record is closed.
  • Goals are set using a standard template at the initial assessment.

Control gaps

Notes are not checked for accuracy against the actual session content.

Additional controls

  • Prevent: Use structured note templates that prompt for risk, response to treatment and next steps.
  • Detect: Review a sample of notes each month against the goals and the outcome measures.
Likelihood 4 x impact 3 before; 2 x 2 after Owner: Clinical lead Target: Within 60 days Early warning: Session notes entered more than 48 hours after the session or with no stated goal.
H07

Staff competence gaps and unsafe handovers

People Before 12 After 6

A newly qualified or assistant therapist is given a task beyond their competence, or patient information is lost during a shift change, leave or referral, so risks are missed or treatment is repeated or stopped without reason.

Who or what is affected: Patients, staff and the wider team

Causes

Rapid staff turnover, cover shifts, weak induction records and informal handovers.

Consequences

Preventable harm, duplicate or missed treatment and a dip in quality.

Existing controls

  • New staff complete a supervised induction before working alone.
  • Handover notes are written at the end of each day.

Control gaps

Competence sign off is not refreshed each year and handovers are not audited.

Additional controls

  • Prevent: Keep a competence matrix that states which tasks each grade may perform without direct supervision.
  • Respond: Use a structured handover format with a verbal check for any patient flagged as high risk.
Likelihood 3 x impact 4 before; 2 x 3 after Owner: Clinical lead Target: Within 60 days Early warning: A high risk patient handed over without a verbal check recorded.
H08

Service disruption and loss of access to records

Operational Before 9 After 4

The records system, phone line or building becomes unavailable, or a key therapist is absent, so patients miss sessions, risks are not visible to staff and urgent calls are not answered.

Who or what is affected: Patients, referrers and staff

Causes

Power or network failure, system fault, illness and holiday periods with thin cover.

Consequences

Missed care, delayed escalation, data loss and reputational harm.

Existing controls

  • Records are backed up each night.
  • A cover list names a backup therapist for each caseload.

Control gaps

The backup therapist cover list is not checked against current caseloads.

Additional controls

  • Prevent: Keep a printed summary of high risk patients and their key risks in a secure place on site.
  • Recover: Test the restore of the records system and the call forwarding plan each quarter.
Likelihood 3 x impact 3 before; 2 x 2 after Owner: Clinic manager Target: Within 90 days Early warning: A cover list entry that is out of date or a failed backup check.

Rating method and evaluation

Each risk is rated on two five-point scales. Likelihood runs from Rare to Almost certain, and impact runs from Negligible 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 is a guide for ordering work, not a measurement of any patient. Inherent risk is the score before any controls. Residual risk is the score after existing and added controls. Impact is judged on physical harm, distress, time to recover, effect on treatment goals and harm to trust, and a risk to a patient is never rated down only because it has not yet happened. Anything still High needs senior clinical attention and a dated plan, anything Medium needs routine controls with a named owner, and anything Low is accepted and monitored. Therapists and assistants should challenge the ratings, especially when they have seen near misses, and each rating is reviewed whenever an indicator reaches its threshold. Clinical judgments about stop criteria and escalation require specialist review.

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
Falls, near misses or unplanned loss of balance during therapy in any patient.Escalate to the clinical lead within one working day, and to the governing body if a fall causes injury.
Sessions stopped for a vital sign or symptom change without a documented escalation.Escalate to the clinical lead at once, and review the stop criteria for that patient within the week.
Equipment with a fault report or a missed service date.Escalate to the clinic manager at once, remove the item from use, and report to the governing body if it is used on a patient.
Session notes entered more than 48 hours late or without a stated goal.Escalate to the clinical lead when more than five percent of notes in a month are late, and review with the team.
Records opened without an active caseload link, or consent records incomplete at the first visit.Escalate to the information governance lead on the same day, and to the clinical lead if a pattern continues for a month.

Contingency arrangements

If a serious event occurs, such as a fall with injury, a collapse during exercise or a confirmed data breach, the therapist stops the activity, makes the patient safe and calls the emergency response or referring clinician as the escalation pathway directs. The clinical lead informs the governing body and the family as required, and preserves records. The information governance lead assesses any breach and follows the relevant reporting duties in the jurisdiction. Equipment involved is quarantined, and affected patients are offered a clear plan for continued care.

Prioritized action plan

  1. Introduce a pre-session screening checklist with stop criteria for each patient, owner clinical lead, within 30 days.
  2. Publish a written escalation pathway naming the clinician to contact and the rule for emergency calls, owner clinical lead, within 30 days.
  3. Issue single use covers for shared mats and equipment and require hand hygiene before and after each contact, owner infection prevention lead, within 30 days.
  4. Remove faulty equipment from use, tag it and align home loan records with the service schedule, owner clinic manager, within 45 days.
  5. Introduce a competence matrix and a structured handover format with verbal checks for high risk patients, owner clinical lead, within 60 days.

Conclusion

Safe therapy depends on a few steady habits: screening before exercise, clear stop criteria, supervised transfers, clean shared equipment, consent that is checked and complete notes. The highest scores sit with falls, deterioration and infection, and each has actions that bring the residual score down. Treat the register as a living record, review it on the stated cycle, and seek qualified clinical and legal advice for any real patient, consent or records question.

Assumptions and limitations

Assumptions

  • The service operates under a recognized clinical governance model and is inspected by an external health authority.
  • Therapists hold current professional registration and receive induction on the service's policies.
  • Jurisdiction and funding model are not specified, so legal and professional duties are described in general terms only.

Limitations

  • The scores are examples for learning and do not describe any real patient, service or incident.
  • Clinical practice standards, consent rules and records law differ by country and change over time, so specialist clinical and legal review is needed.
  • This is educational content and does not replace a formal site-specific assessment or licensed clinical advice.

Related frameworks to study

  • Clinical risk management cycle of identify, assess, control and review
  • Hierarchy of controls
  • Three lines model of risk ownership
  • Structured handover tools such as a recognized situation, background, assessment and recommendation format

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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