Admin Flashcards
What is capacity
Capacity is a functional term that refers to the mental or cognitive ability to understand the nature and effects of one’s acts
Components of competence
Competence is a legal term. It requires the ability to:
Maintain and communicate a choice
Understand the relevant information
Appreciate the situation and its consequences
Manipulate the information in a rational fashion
Components of medical negligence
Medical negligence requires substandard care
A duty of care existed
Standards of care were violated
The person suffered an injury
The injury was caused by the substandard care
Criteria for detaining under the mental health act
The patient has a mental illness that requires urgent treatment in an inpatient setting for the safety of the patient and others. The patient must have refused or be unable to consent to voluntary admission. Appropriate treatment must be available and cannot be given in a less restrictive setting
What are barriers to ideal rostering
Sick leave Lack of staff Lack of trained people Staff request Family commitments Education vs Employment Lack of money for overtime
Criteria for Emergency Treatment of patients lacking capacity
Any action must be in the best interest of the patient
Anything done must be the least restricitve of the patient’s rights and freedoms
When possible every effort should be made to enable the patient to make their own decision
Treatment should not be delayed while attempts are made to establish validity of advanced decisions
Medical staff have a duty of caree to the incapacitated patient
What is culturally safe care
care that is spiritually, socially and emotionally safe,
as well as physically safe for people; where there is no assault challenge or denial of their identity, of who they
are and what they need. It is about shared respect, shared meaning, shared knowledge and experience of learning
together.”
What is cultural competency
Cultural competency is a set of attitudes, skills and knowledge that allow an individual to interact effectively in
cross-cultural situations. It requires a medical practitioner to continue to undertake a process of reflection on
their own cultural identity and recognise the impact their culture has on their own medical practice.4 Cultural
competence focuses on the capacity of doctors and other health staff to integrate culture into the clinical context
and tailor care to meet patients’ social, cultural and linguistic needs.
Benefits of culturally safe care
reduce unnecessary investigation; increase accurate and timely
diagnoses; and increase adherence to treatment and attendance rates at follow up appointments. It can also
reduce: reluctance to seek medical care; and discharge against medical advice and take own leave rates. Overall,
it leads to better clinical outcomes and improved patient wellbeing
Components of open disclosure
Acknowledgement that harm has occurred
An expression of regret
Factual explanation of what happened
Information about further treatment needed and potential consequences
Steps being taken to manage event and prevent recurrence
Requirements for informed consent
patient must be legally capable of giving consent (competent)
consent must be informed
consent must be specific
consent must be freely given
consent must cover that which is actually done
PDAS framework for creating new protocols
Plan: plan a change
Do: carry out the change
Study(Check) Examine results. What did we learn
Act: Adopt the change or abandon it
Treatment decisions for the incompetent
Advanced care directives
Substitute decision maker eg guardian, spouse, MPOA
Substitute decision maker must be act in patient’s best interest or attempt to reach the decision that the patient would have made
Frame-work for discussing NAI
Open with what you plan to talk about.
Reassure the care giver that the child is being well looked after. They may want you to talk about the medical management first.
Take a detailed history of the events. Establish who is in the house, who looks after the child. Social stressors, does the caregiver have any concerns that the injuries could have been caused by someone in the house.
It is likely you will have to probe a couple of times, a new partner is often a red flag.
If you don’t get a clear mechanism then you can just say “I am concerned the injuries I can see here might not be consistent with the story and because of that I am required to investigate further to make sure all us know that your son/daughter are safe.
You will have to explain mandatory reporting and CPS. You are obligated to report and it is not a choice (explain this to the caregiver). Explain that CPS are looking for ways to help and it is only as a last resort that they remove children from the home.
Make sure any other siblings are safe.
Summarize your plan making sure to include any medical management.
Criteria for disclosing medical info to a 3rd party
Patient written consent Disclosure will not harm patient or others Disclosure only of relevant information Not under duress Appropriate rationale
Disclosure without patient’s consent
Death is reportable to coroner Mandatory reporting of child abuse Notifiable illness Disclosure of drug/alcohol tests to courts Court order Realistic threat to safety of others Reporting of impaired healthcare workers
Components of handover
Free from interruptions Safe department Adequate time ISBAR One speaker at a time
When can patient be held against their will?
Patient is detained under mental health act
Patient is detained under duty of care eg intoxicated
Patient is a young child
With permission of MPOA
Options for safely returning the absconded patient
Contact patient or their next of kin
Contact police for welfare check
Place on assessment order
Look for patient
Factors associated with not waiting
Access block Crowded wait room Long waiting times Late provision of treatment Patients have social commitments Patient intoxicated Perceived lack of concern Patient got better
Tactics for reducing did not wait rate
Adequate staff and beds More senior staff Improved comfort Improved communication from triage Dedicated nurse Prioritise children/mental illness Communication of expected waiting times
Options for medical board when doctor is impaired
Suspend right to practice
Place conditions on doctor’s practice
Ask that doctor volunatrily undertake treatment
Methods for assessing a registrars performance
Number of patients seen Review of documentation Feedback from colleagues Patient feedback WBAs Trainee reflection
Negative Consequences of access block
Increased wait time Patients may not be seen Patients may not receive timely treatment Increased staff burnour Delirium/Morbidity/Mortality Loss of privacy
Methods to improve flow
SSU Increase staff and seniority Encourage inpatient discharge Fast Track More inpatient beds
Adapting to Shift work
Adequate sleep Recovery time between shifts Rolling roster Healthy diet Breaks at work Improved lighting
Benefits of SSU
Reduces number of patients breaching “4 hour rule”
Reduces number of patients being admitted to inpatient units
Reduced length of stay for many conditions when compared to inpatient units
allows increased monitoring time
funding for department
Limitations of SSU
SSU cannot resolve access block
Patients in SSU who need inpatient admission are a further source of access block
May encourage inappropriate SSU admissions to meet KPIs
SSU not suitable for complex or unstable patients
Can delay necessary inpatient admission
multiple h/o poor continuity of care
boarding of patients
Predictors of failed SSU
Elderly patient Patient has poor mobility Natural course of illness exceeds short stay time Patient lacks social supports multiple co-morbidities patient referred for admission
Benefits of guidelines
- translates current evidence into clinical practice
- distills large amount of information into concise guide
- Can aid decision making by junior staff
- sets standard of practice
- translates current evidence into clinical practice
- discourages inappropriate treatment
Drawbacks of guidelines
Guidelines may not be suitable for particular patients
May be inferior to experienced clinician gestalt
Guidelines may be outdated
Guidelines cannot be used in court
needs ongoing quality review
Risk factors for violent patient
Mental illness
Drug abuse/Intoxication
Delirium - any cause
Head trauma
Male, Hx of violence, longer wait times
