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“Lunch & Learn”2015 Webinar SeriesAugust, 2015NFPA 99RISK ASSESSMENTSPresented By:Bill LauzonHeather WernerLauzon Life Safety Consulting, LLC262-945-4567Lauzon.LSC@gmail.com

NFPA 99RISK ASSESSMENTSLauzon Life Safety Consulting, LLC262-945-4567Lauzon.LSC@gmail.com 2

NFPA 99RISK ASSESSMENTSPresented by:Bill LauzonHeather WernerLauzon Life Safety Consulting, LLC262-945-4567Lauzon.LSC@gmail.com3

CURRENTLYUSE NFPA 991999 EDITION4BIGGEST IMPACT: NEW HOSPITALS

IF 2012 LSC GETS ADOPTED:5

IF 2012 LSC GETS ADOPTED:MAY APPLY TOALLHOSPITALS&NURSINGHOMES6

TOTALLY RE-WRITTENRequirementsChange From:Occupancy-BasedtoRisk-Based7

TOTALLY RE-WRITTENRequirementsChange From:Occupancy-BasedtoRisk-Based“You DO IT if thespace is health care,regardless if there isa need”8

TOTALLY RE-WRITTENRequirementsChange From:Occupancy-BasedtoRisk-Based“You DO IT if thespace is health care,regardless IF there isa need”9

TOTALLY RE-WRITTENIn other words:You get to evaluatewhich requirementsapply to yoursituation10

REORGANIZED CHAPTERS11

Re-Organized Chapters19993 – Electrical Sys4 – Gas & Vacuum5 – Envir6 – Materials7 – Elec Equipment8 – Gas Equipment9 – Mfr Requirements10 – Laboratories11 – Emergency Prep12 – Hospital13 – Other Health16 – Nursing Home17 – Limited Care18 – Home Care19 - Hyperbaric20124 – Risk Assessment5 – Gas & Vacuum6 – Electrical Sys7 – Info Technology8 – Plumbing9 – HVAC10 – Elec Equipment11 – Gas Equipment12 – Emergency Mgmt13 – Security Mgmt14 – Hyperbaric15 – Features of Fire Prot12

9 Gone19993 – Electrical Sys4 – Gas & Vacuum5 – Envir6 – Materials7 – Elec Equipment8 – Gas Equipment9 – Mfr Requirements10 – Laboratories11 – Emergency Prep12 – Hospital13 – Other Health16 – Nursing Home17 – Limited Care18 – Home Care19 - Hyperbaric20124 – Risk Assessment5 – Gas & Vacuum6 – Electrical Sys7 – Info Technology8 – Plumbing9 – HVAC10 – Elec Equipment11 – Gas Equipment12 – Emergency Mgmt13 – Security Mgmt14 – Hyperbaric15 – Features of Fire Prot13

6 New19993 – Electrical Sys4 – Gas & Vacuum5 – Envir6 – Materials7 – Elec Equipment8 – Gas Equipment9 – Mfr Requirements10 – Laboratories11 – Emergency Prep12 – Hospital13 – Other Health16 – Nursing Home17 – Limited Care18 – Home Care19 - Hyperbaric20124 – Risk Assessment5 – Gas & Vacuum6 – Electrical Sys7 – Info Technology8 – Plumbing9 – HVAC10 – Elec Equipment11 – Gas Equipment12 – Emergency Mgmt13 – Security Mgmt14 – Hyperbaric15 – Features of Fire Prot14

6 Re - Arranged19993 – Electrical Sys4 – Gas & Vacuum5 – Envir6 – Materials7 – Elec Equipment8 – Gas Equipment9 – Mfr Requirements10 – Laboratories11 – Emergency Prep12 – Hospital13 – Other Health16 – Nursing Home17 – Limited Care18 – Home Care19 - Hyperbaric20124 – Risk Assessment5 – Gas & Vacuum6 – Electrical Sys7 – Info Technology8 – Plumbing9 – HVAC10 – Elec Equipment11 – Gas Equipment12 – Emergency Mgmt13 – Security Mgmt14 – Hyperbaric15 – Features of Fire Prot15

HIGHLY RECOMMENEDBuy the HandbookExplanations of themany changes Expert insightsDescriptive photosHelpful tables & chartsMore expensive, butwell worth it16

NFPA Members:10% discount 70.50 – Book or PDF 151 – Book or PDF17

BOOK Easy to flip to referenced sections Can copy & show othersPDF Easy to search for topicsNFPA Free Access FreeNon-seachableNon-copiableNon-flippable18

TODAY’S FOCUSChapter 4RiskAssessment19

RISK ASSESSMENTIt guides the use of theother chaptersNot: IT, Emerg& SecurityMgmt, Fire Protection20

Chapter 4RISKASSESSMENTApplies to:Not to:20124 – Risk Assessment5 – Gas & Vacuum6 – Electrical Sys7 – Info Technology8 – Plumbing9 – HVAC10 – Elec Equipment11 – Gas Equipment12 – Emergency Mgmt13 – Security Mgmt14 – Hyperbaric15 – Features of Fire Prot21

4.1 – Building Systems Categories1High PatientImpact2Minor PatientImpact3Slight PatientImpact4No PatientImpactConsider equipmentoperationNOTIntervention bypeople22

4.1 – Building Systems CategoriesConsider equipment operationNOT intervention by peopleSEVARITY OF FAILURE Harm to PatientsHarm to Staff & VisitorsRELIABILITY Importance of redundancyProbability of system failureLevels of sedationComplexity of treatment23

4.1 – Building Systems CategoriesConsider worst-outcome scenarioof a failure impactMajor/DeathMinorNoHarmDiscomfortFactor A - HARM to PATIENTSjklmFactor B – RELIABILITY bleNo Impacton Pt Care24

4.1 – Building Systems CategoriesEvaluate effect of failure,Based on harm to patients, staff & visitors12Failure may causedeath or serious injuryFailure limited tominor injuries34Failure may causediscomfortNo impact on patientsor caregivers25

4.1 – Building Systems CategoriesEvaluate potential for failure,Based on system reliability1System must alwayswork (life support)3NormalReliability Needed2High ReliabilityExpected4No Impact onPatient Care26

Category 1Failure likely to cause major injury/death1Available at all timesfor life-supportsystemsSystem must alwayswork (life support)Major injury Any amputation Loss of sight, or injury to eye Unconsciousness that requiresresuscitation, medicaltreatment, or hospital admit Acute illness from biologicalagents27

Category 1Failure likely to cause major injury/death1Available at all timesfor life-supportsystemsSystem must alwayswork (life support)Examples of FailuresIn this category Emergency power to OR's Medical gas system in ICU Ventilator-assisted procedurein a MOB Cardiac cauterization imagingequipment28

Category 2Failure likely to cause minor injuryMinor injury2Failure limited tominor injuries Not serious Not involving risk to lifeHigh ReliabilityExpected29

Category 2Failure likely to cause minor injury2Failure limited tominor injuriesHigh ReliabilityExpectedExamples of FailuresIn this category Task or procedural lighting inpatient rooms Potable water in the patientcare areas30

Category 3Failure not likely to cause injury, but maycause discomfort3Failure may causediscomfortNormal ReliabilityNeededExamples of FailuresIn this category Heating system in southern US Humidity control in nonoperating areas Dental drill Motorized bed adjustments Cooling tower makeup water innw US31

Category 4Failure would have no impact onpatient careExamples of FailuresIn this category3Failure may causediscomfortNormal ReliabilityNeeded Gray water lawn sprinklingSeasonal lighting systemsPublic address systemPneumatic tube systemsVacuum systems in a researcharea32

RISK ASSESSMENTMust follow & documentaccording to a DEFINEDrisk assessment procedureExamples:ISO 31010 – Risk Assessment TechniquesNFPA 551 – Guide for Eval of Fire Risk AssessmentsSEMI S10-0307E – Guidelines for Risk Assess & EvalOther formal processASHE Risk Tool33

ISO 31010 - RISK ASSESSMENTRisk assessment is part of the core elements of risk management Communication and Consultation Context establishment Risk Assessment, includes:Risk identification,Risk analysis &Risk evaluation Risk treatment Monitoring and reviewRisk can be assessed atany level of a facility’soperations or goals.34

ISO 31010 - RISK ASSESSMENTThere are 31 risk assessment techniques in Annex B of ISO/IEC 31010Amazon Cause & effect analysis Brainstorming 298 Full & semi-structured interviews Layer protection analysis192 pages Decision tree Dephi methodsoftcover Human reliability analysis Checklist Bow tie analysis Preliminary hazard analysis Reliability centered maintenance Hazard & operability study Hazard analysis & critical cont pts Sneek circuit analysis Markov analysis Toxicity assessment Monte Carlo simulation Structured “What-If” technique Bayesian statistics & Bayes nets Scenario analysis FN curves Business impact analysis Risk index Root cause analysis Consequence/probability matrix Failure mode & effects analysis Cost/benefit analysis Fault tree analysis Multi-criterial decision analysis Event tree analysis Cause & consequence analysis35

ISO 31010 - RISK ASSESSMENTThere are 31 risk assessment techniques in Annex B of ISO/IEC 31010Amazon Cause & effect analysis Brainstorming 298 Full & semi-structured interviews Layer protection analysis192 pages Decision tree Dephi methodsoftcover Human reliability analysis Checklist Bow tie analysis Preliminary hazard analysis Reliability centered maintenance Hazard & operability study Hazard analysis & critical cont pts Sneek circuit analysis Markov analysis Toxicity assessment Monte Carlo simulation Structured “What-If” technique Bayesian statistics & Bayes nets Scenario analysis FN curves Business impact analysis Risk index Root cause analysis Consequence/probability matrix Failure mode & effects analysis Cost/benefit analysis Fault tree analysis Multi-criterial decision analysis Event tree analysis Cause & consequence analysis36

NFPA 551- FIRE RISK ASSESSMENT 45 at NFPA30 pagessoftcover37

SEMI S10-0307E -RISK ASSESSMENTSUPERSEDED BY SEMI S10-0215SEMI:Semi-Conductor Equipment & Materials International 300 at SEMI onlinedownload38

ASHE- RISK ASSESSMENTINSTRUCTIONS&3 WORKSHEETSFree download ofExcel Spreadsheet toASHE members39

ASHE- RISK ASSESSMENT“Instructions” explains how touse the 3 worksheets40

ASHE- RISK ASSESSMENT1. “Systems “worksheet is usedto enter & record the RiskCategory # for the varioussystems within a given space41

ASHE- RISK ASSESSMENT2. “Equipment” worksheet is used toenter & record the Risk Category #for facility equipment42

ASHE- RISK ASSESSMENT3. “Emergency Mgmt” worksheetused to enter & record the RiskAssessment for buildings43

ASHE- HAZARDVULNERABILITY ANALYSISSimilar to H-V Tool of 201444

ASHE- RISK ASSESSMENTArticle from:“Inside ASHE”Summer 2015 issueASHE Conferencepresentation byGeorge Mills, TJCHospitals need to do riskassessments NOW forcompliance with:EC.02.01.01 EP 1 – Identify RisksEC.02.01.01 EP 3 – Take Action45

ASHE- RISK ASSESSMENTLet’s take anotherlook at the ASHEspreadsheet46

ASHE- RISK ASSESSMENTStep 1 – List EVERY room& space in the facility47

ASHE- RISK ASSESSMENTStep 2 –Evaluate & document the risk forEACH utility system48

ASHE- RISK ASSESSMENT1. Grab a floor plan49

ASHE- RISK ASSESSMENT 2. Methodically list every room 50

ASHE- RISK ASSESSMENTList every room51

ASHE- RISK ASSESSMENT3. Methodically evaluate the risk(1-4) for EVERY Utility in everyroom52

ASHE- RISK ASSESSMENTASHE Form is missing documentation ofHOW you figured the Risk Categories 1. Evaluation of patient impact2. Evaluation of system reliability53

LLSC- RISK ASSESSMENTSYSTEMSROOMSChanges from the ASHE form:Switched H & V to fit on a letter sheet54

LLSC- RISK ASSESSMENTAdded lines to document the “harm”& “reliability” evaluations55

LLSC- RISK ASSESSMENTExcel file available via e-mail request to:Lauzon.LSC@gmail.com56

NFPA 99 - RISK ASSESSMENTDevelop a uniform Risk Assessment processBest to coordinate with: Quality ImprovementInfection PreventionEnvironment of CareThey usually have experience in risk assessments57

ASHE- RISK ASSESSMENTWHAT do you dowith thisjumble of numbers?58

Now let’sApply the Risk CategoriesTo the NFPA 99 Chapters12High Patient ImpactMinor Patient Impact34Slight Patient ImpactNo Patient Impact59

Applying the Risk Categories5 – Gas & Vacuum6 – Electrical Sys7 – Info TechnologyApply8 – Plumbing9 – HVAC10 – Elec Equipment11 – Gas Equipment12 – Emergency Mgmt13 – Security MgmtNot Apply14 – Hyperbaric15 – Features of Fire Prot60

NFPA 99 – CHAPTER 5GAS & VACUUM SYSTEMSOrganized by RiskCategory requirements(not retroactive, except for operation& management requirements)61

NFPA 99 – CHAPTER 5GAS & VACUUM SYSTEMS62

NFPA 99 – CHAPTER 5GAS & VACUUM SYSTEMS201219991High PatientImpactLevel 1Hospital2Minor PatientImpactLevel 2HospitalASC3Slight PatientImpactLevel 3Dental4No PatientImpactNewRisk Categoriesare similar tothe formerLevel 1Level 2Level 363