(1) Patient Safety and Qaulity

Question 1

What is clinical governance?

Answer 1

A framework through which NHS organisations are ACCOUNTABLE for continuously improving the QUALITY and safeguarding high standards of care by creating and environment in which excellence in clinical care will flourish

Question 2

How can human factors be eliminated to give a safer design?

Answer 2

• Avoid reliance on memory
• Simply and standardise common processes and procedures
• Make things visible
• Routine checkups and evaluations

Question 3

Describe the Swiss cheese model of accident causation.

Answer 3

• There are layers of defense to safeguard accidents
• Holes in layers of Swiss cheese = flaws
• When holes line up e.g. through the checkups, accidents occur

Question 4

What are the main components of a clinical audit? i.e. what have you got to do to perform one

Answer 4

• Recognise problem
• Set standards and criteria using the NICE duide line
• First evaluation
• Implementing changes
• Second evaluation

Question 5

What are three types of error that commonly occur?

Answer 5

• Slips and Lapses = human errors e.g. not achieve the desire outcomes
• Mistakes = errors in knowledge and planning
• Violence = intentional deviations from criteria

Question 6

What is the NHS outcomes framework?

Answer 6

• Specific national outcome goals and indicators in 5 domains, linked to payments and financial incentives
• GP performance scores based on indicators derived from NICE guidance and payment dependent on the scores

Question 7

What is a clinical audit?

Answer 7

• Systemic evaluations to minimise human errors

- By setting standards and CRITERIA and implementing changes

Question 8

What is an adverse event?

Answer 8

Undesired outcomes due to healthcare may be unavoidable

Question 9

What does the term equity mean?

Answer 9

Same quality of health care for everyone

Question 10

What does we mean when we use the term inequitable care in England?

Answer 10

Variation between the quality and availability to access of health care

Question 11

Why do medical errors happen?

Answer 11

• Everyone makes mistakes
• Medicine is complicated, too many uncertainties and unknowns
• Systemic errors e.g. lack of training, staff, long working hours

Question 12

What is the role NHS outcome framework?

Answer 12

• Provides a national overview of how the NHS is performing
• Holds the Health Secretary and NHS commissioning accountable for public money and acts to change NHS culture to drive up quality

Question 13

What are the five domains of the NHS outcomes framework?

Answer 13

• Prevent premature deaths
• Improve quality of life for those with long term conditions
• Help to recover from episodes of illnesses
• Provide high quality of healthcare
• Treat and care in safe & protect from avoidable harm

Question 14

What are active failures with reference to the Swiss cheese model of accident causation?

Answer 14

• Accidents most likely to occur at sharp ends - those closest to patients e.g a direct failure

Question 15

What are latent conditions (failures) with reference to the Swiss cheese model of accident causation?

Answer 15

• Predisposing conditions e.g. lack of training, staff, long working hours etc
• These problems can build up to predispose another failure

Question 16

Suggest some types of PREVENTABLE adverse events.

Answer 16

• Intravenous -> intramuscular injection
• Surgery at wrong site
• Drugs at wrong dosage
• Transfusion of blood of the wrong group

Question 17

Why do medical errors happen?

Answer 17

• Everyone makes mistakes
• Medicine is complicated, too many uncertainties and unknowns
• Systemic errors e.g. lack of training, staff, long working hours
• Personal effort is necessary but not sufficient to deliver safe care

Question 18

What are the NICE quality standards? What do they enable?

Answer 18

• Set of prioritised statements designed to drive measurable quality improvements within a particular area of care
• Guidance derived from latest evidence based researches
• To ensure clinical and cost effective procedures
• To approve new drugs, technologies etc
• Enable the public to know what to expect
• Allow evaluations of the outcomes and assess improvement

Question 19

What are quality accounts?

Answer 19

• NHS healthcare providers score on their performance according to the NICE guidance
• The scores are made available to the public annually online

Question 20

What is the role of the commissioning outcomes framework (COF) in healthcare?

Answer 20

• Holds Clinical Commissioning Groups accountable for their progress in delivering outcomes
• Used indicators that are shown to have a strong line to outcomes
• Drive local improvement in quality and outcomes for patients

Question 21

What is the role of the quality and outcomes framework (QOF) in healthcare?

Answer 21

• Sets indicators of the quality of care provided by Primary health care
• GPs score points according to their performance against indicators
• Payment are calculated based on the scores
• Results are posted online

Question 22

What is the role of the care quality commission (CQC) in healthcare?

Answer 22

CQC considers NICE quality standards, checks quality accounts and can:

• Impose registration ‘conditions’ if not satisfied
• Make unannounced visits
• Give warnings, restrictions, fines, prosecution, closure

Question 23

What is the difference between inequality and inequity in the care setting?

Answer 23

• Inequality = variation in quality of care

- Inequity = difference is avoidable and unfair

Question 24

Explain why a systemic based approach may be useful in preventing latent conditions (2).

Answer 24

• When things go wrong in a complex system, it is due to multiple errors e.g. the Swiss cheese model
• Systems-based approaches require learning from other high risk and low error industries, and to promote a organisational cultures of “no-blame” learning