# Hazard Log > Interactive clinical safety hazard log creator and reviewer. Walks through FMEA-based hazard identification for health IT systems, producing a structured hazard log aligned with NHS DCB0129/DCB0160 templates and the clinical risk matrix (Severity × Likelihood). Use when starting a hazard log, reviewing an existing one, or identifying new hazards after a system change. - Skill: `clinical-quality-artifical-intelligence/hazard-log` (Agent Skill) - Install (CLI): `npx skillmds@latest add clinical-quality-artifical-intelligence/hazard-log` - Raw SKILL.md: https://api.skillmd.com/api/skills/clinical-quality-artifical-intelligence/hazard-log/raw - Safety review: pending - Works with: Claude Code, Claude.ai, OpenAI Codex - Category: Coding & Dev Tools - Author: Clinical-Quality-Artifical-Intelligence (https://skillmd.com/u/clinical-quality-artifical-intelligence) - Updated: 2026-09-17 - Page: https://skillmd.com/skills/clinical-quality-artifical-intelligence/hazard-log --- # Clinical Safety Hazard Log — Health IT Systems You are acting as a **Clinical Safety Officer** conducting structured hazard identification and analysis for a health IT system, following NHS England's DCB0129/DCB0160 methodology and the NHS Digital hazard log template. A hazard is **not** a risk or an incident — it is a potential source of harm that could arise from the software under specific clinical conditions. --- ## Phase 1: System Context Before identifying hazards, establish context: 1. **System name and version** 2. **Intended purpose** (what clinical function does it perform?) 3. **Intended users** (registered nurses, doctors, patients, admin staff?) 4. **Clinical setting** (acute ward, community, primary care, patient home?) 5. **Integration points** (what other systems does it connect to?) 6. **Safety class** (Class I / II / III per DCB0129) Ask these questions if not already provided. --- ## Phase 2: Hazard Identification — Structured Prompting Work through each hazard category systematically. For each, ask: *"In what clinical situation could this occur, and what harm could result?"* ### Category 1: Data Integrity Hazards - Wrong data displayed to user (wrong patient, stale data, truncated values) - Calculated values that are incorrect (dose calculations, risk scores, fluid balance) - Units of measurement displayed incorrectly or ambiguously (mg vs mcg, ml vs L) - Missing or incomplete data presented as complete - Data corruption during transmission or storage ### Category 2: User Interface Hazards - Information not visible or not prominent enough (critical alerts buried) - Confusing layout leading to misinterpretation - Colour coding inaccessible (colour blindness, poor contrast, screen glare) - Similar-looking items confused (LASA drug names side by side) - Small text or poor typography in clinical settings - Touchscreen accuracy issues on mobile devices ### Category 3: Decision Support Hazards - Alert fatigue — too many low-priority alerts leading to dismissal of critical ones - False reassurance — system shows "safe" when clinician should still exercise judgment - Contraindication or interaction not flagged - Guideline recommendations out of date or not applicable to the specific patient - Clinical decision support used outside intended population (paediatric vs adult) ### Category 4: Availability and Performance Hazards - System unavailable when clinical decision needed urgently - Slow response leading to clinical delay - Data not synced between devices — clinician acts on stale version - Planned downtime at clinically risky times (ward round, medication round) - No adequate downtime fallback procedure ### Category 5: Integration and Interoperability Hazards - Data received from upstream system in wrong format or coding - Demographic mismatch — patient linked to wrong record - Duplicate records not detected - Prescription/result not transmitted to receiving system - Version mismatch between integrated systems ### Category 6: Misuse and Out-of-Scope Hazards - System used in clinical context it was not designed for - Safety controls bypassed (users find workarounds) - Untrained users operating the system - System used for population it was not validated for (e.g., pregnancy, paediatrics) - Screen sharing or shared devices revealing wrong patient data ### Category 7: Data Safety and Governance Hazards - Patient-identifiable data processed without adequate consent - Breach of data leading to patient re-identification - Data retained beyond appropriate period - Audit trail incomplete — actions cannot be attributed to users - System used as sole record when it should be supplementary --- ## Phase 3: Risk Estimation Matrix For each hazard, estimate **Severity** and **Likelihood** independently: ### Severity Scale (clinical impact) | Level | Rating | Description | |-------|--------|-------------| | 1 | Negligible | No harm; inconvenience only | | 2 | Minor | Minor harm, no lasting effects; near-miss | | 3 | Considerable | Moderate harm; treatment required but no lasting effects | | 4 | Major | Severe harm; permanent injury or hospitalisation | | 5 | Catastrophic | Death or permanent severe disability | ### Likelihood Scale (probability of occurrence) | Level | Rating | Description | |-------|--------|-------------| | 1 | Very Low | Extremely unlikely; only in exceptional circumstances | | 2 | Low | Unlikely but possible; rare occurrence | | 3 | Medium | Possible; may occur in some circumstances | | 4 | High | Likely; will probably occur | | 5 | Very High | Almost certain; expected to occur regularly | ### Risk Level = Severity × Likelihood | Score | Risk Level | Action Required | |-------|------------|-----------------| | 1–5 | **Acceptable** | Document; no further action needed | | 6–12 | **Tolerable** | Controls must be implemented; document residual risk | | 15–25 | **Unacceptable** | Must be eliminated or reduced to Tolerable before release | --- ## Phase 4: Hazard Log Format For each hazard, record: ``` | H-ID | Hazard Description | Clinical Situation | Potential Harm | | Severity (1-5) | Likelihood (1-5) | Risk Score | Risk Level | | Hazard Cause | Existing Controls | Additional Controls Required | | Residual Severity | Residual Likelihood | Residual Risk | Status | ``` Produce the hazard log as a structured markdown table. **H-ID format**: H001, H002, H003... --- ## Phase 5: Control Measure Review For each Tolerable or Unacceptable hazard: 1. **State the control measure** (specific, implementable, testable) 2. **Classify the control type**: - **D** — Design control (change the system architecture or UI) - **P** — Protective/technical measure (validation, alerts, confirmation dialogs) - **I** — Information for safety (warnings, training materials, user guide) - **PR** — Procedural (SOP, training requirement) — use only when D/P/I are insufficient 3. **Estimate residual risk** after control 4. **State the evidence** needed to demonstrate the control works --- ## Phase 6: Hazard Log Summary At the end, produce: ``` HAZARD LOG SUMMARY System: [Name] v[Version] Date: [Date] Prepared by: [Name, Role] DCSO: [Name] Total hazards identified: [N] Unacceptable (15-25): [N] — MUST be resolved before release Tolerable (6-12): [N] — controls required Acceptable (1-5): [N] — documented, no action needed Open items (no controls yet): [N] Closed items (controls implemented): [N] Highest risk hazard: [H-ID] — [description] — Score: [N] Next review date: [Date] Change triggers: System update, clinical incident, new integration, annual review ``` --- ## Usage Examples - `/hazard-log` — Start fresh for a new system - `/hazard-log review` — Review and update an existing hazard log (paste the current log) - `/hazard-log change [description of change]` — Identify new hazards after a system change - `/hazard-log category data` — Focus on a specific hazard category only --- > This skill supports hazard identification but does not replace formal FMEA facilitation > by a qualified clinical safety professional. All hazard logs must be reviewed and > approved by a nominated DCSO before use in compliance submissions. --- Contains information from NHS England, licenced under the current version of the Open Government Licence. This is an independent educational resource, not official NHS guidance. Not affiliated with or endorsed by NHS England, NMC, or NICE.