Acute Care Flashcards
1
Q
Summarise the ethical issues surrounding consent in an acute situation
A
- Patients have the right to determine what happens to their own bodies.
- For minor procedures, such as venepuncture, physical examination, small wound
closure or ECG recording, cooperation with the procedure amounts to valid implied consent. - If completion of a consent form will result in an inappropriate delay and increase the risk of patient harm or prolong suffering, a record of the consent discussion should be clearly documented in the patient’s notes. This should be completed as soon as reasonably possible.
- In an emergency and if it is not possible to find out a patient’s wishes, treatment can be provided without patient consent, provided the treatment is immediately necessary to save their life or to prevent a serious deterioration of their condition and in their best interests.
2
Q
Be aware of the importance of human factors when working in teams e.g. the trauma team, the cardiac arrest team
A
- Enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture and organisation on human behaviour and abilities and application of that knowledge in clinical settings.
- Systems error vs individual error.
- Human Factors, often referred to as ergonomics, is an established scientific discipline used in many safety-critical industries.
- A failure to apply human factors principles is a key aspect of most adverse events.
- In healthcare 80% of errors are attributed to human factors at individual level, organisational level, or commonly both.
- Human Factors encompasses all of the factors that can influence the behaviour and performance of human beings in a system. It allows us to understand how people perform under different circumstances and why errors happen.
- Never Events are serious incidents that are considered to be wholly preventable.
Understanding Human Factors helps us build better defences into our systems in order to prevent or reduce the likelihood of serious error resulting in harm to a patient by:
- Allowing us to understand why we make errors.
- Improving our safety culture within teams and the organisation.
- Enhancing teamwork and communication.
- Identify “what went wrong”.
- Helping us predict “what could go wrong” in the future.
- Improving the design of the system/processes we work in.
The most common factors that influence people to make mistakes and errors:
- Communication
- Distraction
- Lack of resources
- Stress
- Complacency
- Lack of teamwork
- Pressure
- Situational awareness
- Lack of knowledge
- Fatigue
- Lack of assertiveness
- Cultural Norms - “the way we do things around here”
- The Swiss cheese model - many levels of defence that have latent conditions, which are caused by poor design, decision-making, procedures, lack of training, limited resources, staffing levels etc. If these holes become aligned over successive levels of defence, they create a window of opportunity for a patient safety incident to occur through active errors.
3
Q
Understand the process of reporting errors in primary and secondary care
A
- General public: National Reporting and Learning System (NRLS).
- Healthcare staff: Local Risk Management Systems (LRMS).
- GP staff: Learn From Patient Safety Events service (LFPSE).
- DATIX form: organisation wide system used by all staff to report both incidents and risks.