1: Quality and safety Flashcards
Describe some evidence of problems with quality and safety in healthcare
Evidence of preventable harm and substandard care
Variations in healthcare - inequity
Gaps in what is known to be effective and what happens in clinical practice
What are some ways to define quality?
- Safe
- Effective
- Patient-centred
- Timely
- Efficient
- Equitable
Define EQUITY
Everyone with the same need gets the same care
What is INEQUITABLE CARE?
Patients vary in the extent to which they receive high quality care and in access to care
ADVERSE EVENT
An injury caused by medical management rather than underlying disease
Can be unavoidable e.g. first time penicillin allergy
PREVENTABLE ADVERSE EVENT
An event that could be prevented given the current state of medical knowledge
NEVER EVENTS
Events that should not happen under any circumstance - usually preventable
Why do medical errors happen?
- Everyone is fallible
- Most are system errors, do not take into account human factors, not enough defences built in, multiple contributions to an incident
- Healthcare not traditionally safe - blames individuals
What are the three types of error?
- Slips and lapses - errors of action - not as intended
- Mistakes - error of knowledge or planning, action goes to plan but wrong action
- Violation - intentional deviation
Describe the swiss cheese model of accident causation
Successive layers of defences.
Hazards can penetrate the barriers leading to losses - all holes line up when barriers breached at once
What are active failures?
Happen closest to the patient, and lead directly to harm.
Human factors - non-recognition, loss of situational awareness, persistence with wrong course etc.
What are latent problems?
Predisposing conditions that make the active failure more likely - context. Can be error provoking or create long lasting holes. E.g, similar packaging, organisational processes, poor comms
What is a systems based approach?
Suggests errors are due to multiple errors - rather than the fault of the individual
How can human factors be removed?
- Avoid reliance on memory
- Standardise common procedures
- Use checklists often
- Make things visible
- Review and simplify processes
- Decrease reliance on vigilance
- Learn from other industries
- Discourage latent errors
Name some system factors
Institutional, hospital, departmental, work environment, team, individual practitioner, task, patient characteristics
What is the NHS outcomes framework?
Specific national goals and indicators in five domains, linked to payments and financial incentives.
Name 8 NHS quality improvement mechanisms
- Standard setting
- Commissioning
- Financial incentives
- Disclosure
- Regulation
- Data gathering and feedback
- Clinical audit
- Professional regulation
Describe NHS standard setting
NICE quality standards
Based on the best available evidence
Set of statements with markers across a pathway or clinical area, of high quality, clinical and cost effective patient care
Describe commissioning
There are 211 CCGs in England, which commission services for local populations. They drive quality through contracts
Describe financial incentives for high quality care
QOF: quality and outcomes framework. National quality standards with indicators in primary care. GPs score points according to how well they perform against indicators - payments are based on this. Results online
CQUIN: commissioning for quality and innovation. Achieving measurable goals achieved with commissioners
Describe disclosure and quality accounts
All trusts have to publish quality accounts about performance. Published annually with a focus on safety, effectiveness and patient experience.
Describe regulation with the CQC
Care quality commission.
All NHS trusts registered since 2009, check NICE quality standards and quality accounts. Can impose registration conditions, make unannounced visits, issue warnings, fines, prosecute.
What is clinical audit?
A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against criteria and the implementation of changes
Describe the steps of clinical audit
Choose topic and research evidence Criteria and standards First evaluation Implement change Second evaluation Back around circle
