NMC Code Section 19: Reduce Risk of Harm

Section 19 of the Code is the broadest harm-reduction obligation.

“Be aware of, and reduce as far as possible, any potential for harm associated with your practice.”

Sub-clauses:

• 19.1 Take measures to reduce as far as possible, the likelihood of mistakes, near misses, harm and the effect of harm if it takes place.
• 19.2 Take account of current evidence, knowledge and developments in reducing mistakes and the effect of them and the impact of human factors and system failures.
• 19.3 Keep to and promote recommended practice in relation to controlling and preventing infection.
• 19.4 Take all reasonable personal precautions necessary to avoid any potential health risks to colleagues, people receiving care and the public.

Section 19 reaches across most of clinical nursing. It’s the section that maps to infection prevention, fall prevention, pressure care, the prevention of deterioration, medication safety, and the broader human factors discipline.

What it means in practice

Three operating frames:

Personal practice. Hand hygiene, PPE, ANTT, sharps safety, equipment checks before use. The behaviours that prevent transmission and error at the individual level.

Environmental awareness. Recognising hazards in the care environment, reporting equipment faults, contributing to ward safety reviews.

Systemic contribution. Participating in audits, reporting incidents and near-misses, contributing to quality improvement work that reduces harm at the population level.

Hand hygiene compliance is the single most consequential Section 19 behaviour. WHO’s Five Moments framework is the standard (covered in Chapter 90).

Common breaches

• IPC non-compliance: visible hand hygiene failures, incorrect PPE, breach of isolation precautions.
• Failure to recognise deterioration: overlaps with Section 3 and 13.
• Equipment-related harm: using faulty equipment, not reporting faults.
• Fall prevention failures: risk assessment not done, fall prevention measures not in place.
• Pressure ulcer development in patients where the standard prevention measures weren’t followed.

CPD that maps to Section 19

• Infection prevention and control Level 2 (CSTF mandatory).
• Hand hygiene assessment.
• PPE training and updates.
• ANTT: aseptic non-touch technique.
• Falls prevention: NICE CG161.
• Pressure ulcer prevention: SSKIN bundle, NICE CG179.
• Human factors in healthcare.
• Patient safety frameworks: NHS Patient Safety Strategy.

Common reflective account themes

Strong Section 19 accounts describe:

• A specific change in your IPC practice after a feedback or audit moment.
• A near-miss you identified and the system response that followed.
• A piece of equipment you reported and the change that followed.
• A safety improvement project you contributed to.

Where Section 19 connects to other sections

• Section 13 (limits of competence): competence is safety.
• Section 16 (raise concerns): safety issues need raising.
• Section 18 (medicines): medicines safety is part of Section 19.

This is the end of Pillar 3 of the Code (Sections 13-19). The next chapter starts Pillar 4 (Promote Professionalism and Trust) with Section 20.