Admin / Legal / Ethical

Question 1

Describe approach to access block

Answer 1

1) Investigation. Gather information.
2) Establish priorities. Who is critically ill.
3) Delegate. Maintain oversight. Correct staff to correct areas.
4) Escalate. ED, exec. Discuss with ambulance clinician.
5) Safety & support. Early senior decision making. Escalate concerns. Staff have breaks
6) ED actions.
- Target: ED beds, resus beds.
- Pts safe to move from resus, ICU TF.
- SSOU WR. Senior review for DC
- private, DC lounge, HITH
- Doctor at triage
7) Plan. Review again 2 hrs. Plan for next shift

Question 2

Handover in major disaster

Answer 2

METHANE 
Major incident declared ?
Exact location? 
Type of event
Hazards 
Access and egress 
Number of casulaties 
Emerg services present and required

Question 3

External emergency preparation

Answer 3

Declare CODE BROWN
Space, People, Equipment, Drugs, Other services, post-disaster
Space - clinical, triage, waiting, ambulance
People - retain, other teams, form teams, briefing.
Equipment
- clinical: trolleys with relevant equipment, trolleys, chairs. PPE.
- non-clinical: torches, radios, phones
Drugs: analgesia, antibiotics
Others: ED director, executive, media, security

Post-disaster: restock, debrief

Question 4

Steps in open disclosure

Answer 4

Factual explanation
Expression of regret
Explain further investigations, treatments, likely consequence
Steps to prevent recurrence

Question 5

Responding to a complaint

Answer 5

SAIN RICE
Support
Acknowledge - express regret, contact person/process, consent to meet?
Investigate - med record, staff involved.
Notify, report, document - other units, staff, complaints, legal, MDO
Respond - in person meeting / with consent.
Implement
Communication/education
Evaluation

Question 6

Criteria for Mental Health Act involuntary treatment

Answer 6

Apparent mental disorder
At risk to self or others
Significant consequences of not recieving treatment
Not able to access less restrictive treatments

Question 7

End of life care - priorities in discussion

Answer 7

Understanding of current condition / illness
PMHx
Function - eating, dressing, social
- FRAILTY: fatigue, ambulation, LOW, weakness, poor activity
Quality of life
Advanced care plan

Current situation and outcome
Management of symptoms
To bedside, family, religious/social needs

Question 8

Consent

Answer 8

Informed
Specific to procedure / treatment
Without coersion
Have capacity (Understand, retain, weigh up, communicate)

Question 9

Discharge against medical advice

Answer 9

Address concerns of patient (ie withdrawral)
Involve family / friends
Assess capacity and risk
Outpatient follow up / alternative treatment

Documentation

Question 10

Clinical debrief

Answer 10

Reasons: learn and reflect, improve processes, identify staff at risks.

Prepare - location, current staff  
Delivery 
- psychological safety, objectives 
- overview of case
- positives 
- changes / improvement 
- actions and key learnings 
- discuss supports available
Post debrief 
- allocation of of tasks 
- documentation

Question 11

Management of violent patient

Answer 11

DOC to identify and treat medical/psychiatric causes

Maintain safety. Quiet area, no weapons. Access and egress.
Verbal discussion (assessment of orientation, medical hx, trauma, psych hx, behaviour, content of speech ie threats)
Offer oral sedation
Involve family / friends
Physical restraint, 5 points, staff safe, team leader, 1 voice. Explain.
Chemical restraint.
O2, monitoring, IV, BSL, ECG, CT.

Question 12

Principle of duty of care

Answer 12

Legal requirement

• relationship exists between pt and staff
• avoid acts of omissions leading to pt being harmed
• duty of care to assess for medical / psychiatric causes.

Question 13

Approach to impaired colleage

Answer 13

“I’m concerned ___, I care and I want to help”.
Confidential unless serious risk to yourself or mandatory reporting.

Work - enjoyment/satisfaction
Home - family, partner, finances
MH - mood, sleep, enjoyment, D&A, suicide / SH.

X has happened, safety risk

Actions

• mandatory reporting
• director
• time off
• support: GP, family, EAP.

Question 14

Approach to struggling trainee

Answer 14

“Noticed you are struggling” “usually something else”.
Confidential unless serious risk to yourself or mandatory reporting.

Work - enjoyment/satisfaction, clinical, colleages.
Home - family, partner, finances
MH - mood, sleep, enjoyment, D&A, suicide / SH.

Summarise

Actions

• identify areas for improvement, goal setting. Support plan.
• DEMT
• time off
• support: GP, family, EAP.

Question 15

Cessation of CPR

Answer 15

20 min CPR
No ROSC / viable rhythm established
No reversible factors that would change outcome

OR

• preexisting illness preventing meaningful recovery
• no response @20 min effective ACLS

Question 16

Indications for prolonged resuscitation

Answer 16

Young person with persistent VF 
Hypothermia 
Asthma 
Toxicological 
Thrombolytic given in CPR for PE/ACS 
Pregnancy prior to resuscitative hysterotomy