All PMHP Flashcards
definition of clinical governance
Clinical governance is the term used to describe a systematic approach to maintaining and improving the quality of patient care within a health system
“A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish
name dimensions of quality healthcare (6)
person centred efficient effective safe equitable timely
define dimensions of quality healthcare
Person-centred
Partnership between patient, families and those delivering healthcare which respects individual needs and values and demonstrates compassion, continuity, clear communication and shared decision-making
Safe
No avoidable injury or harm from healthcare received
Appropriate, clean and safe environment provided for delivery of healthcare services
Effective
Does the intervention work?
The most appropriate interventions, support and services provided to everyone
Efficient
Is the output (benefit) maximised for the given input (costs)?
Wasteful or harmful variation eradicated
Equitable
Are all patients fairly treated ?
Is the distribution of care based on need ?
High quality services provided to everyone, no matter who they are or where they live.
Timely
Appropriate treatment, support and services provided at the right time for everyone
factors contributing to adverse events
human factors such as teamwork, communication, stress and burnout;
structural factors such as reporting systems, infrastructure, workforce loads and the environment;
clinical factors such as complexity of care and length of stay.
components of clinical governance
Research and development education and training clinical audit clinical effectiveness openess risk management
how can the dimensions of healthcare/clinical governance be implemented
Setting quality standards
Delivering quality standards
Monitoring quality standards
definition of a clinical guideline
aim
Systematically developed statements which assist in the decision-making about appropriate health care for specific clinical conditions”
-Aim
To improve the quality of healthcare
Clinical guidelines can:
provide recommendations for the treatment and care of individuals
be used to develop standards for clinical audit
be used in education & training of health professionals
help patients to make informed decisions
improve communication between patient and health professional
how much CPD should be carried out and how is this recorded/monitored
Mandatory CPD (2017 onwards):
Requirement: 100 hours verifiable CPD within 5-year cycle and at least 10 years verifiable every 2 years
Enhanced CPD scheme
Dentist to maintain own records
Verifiable = concise educational aims & obj / ILOs / quality controls (provide documentary evidence (certificate)
Checked by GDC
If requirements not met, can be taken off GDC register and not allowed back on until met all CPD requirements
name some formats of CPD
Courses and lectures Training days Peer Review Clinical Audit Reading journals Attending conferences E-learning activity
name some highly recommended CPD topics
a. Medical Emergencies: at least 10 hours in every CPD cycle – and we recommend that you do at least two hours of CPD in this every year;
b. Disinfection and Decontamination: we recommend that you do at least five hours in every CPD cycle; and
c. Radiography and radiation protection: we recommend that you do at least five hours in every CPD cycle. If you are a Dental Technician you can do CPD in materials and equipment instead of radiography and radiation protection: at least five hours in every CPD cycle.
We also recommend that you keep up to date by doing CPD (verifiable or general) in the following areas:
■ Legal and ethical issues
■ Complaints handling
■ Oral Cancer: Early detection
■ Safeguarding children and young people / safeguarding vulnerable adults
definition of clinical audit
Clinical audit is a process that has been defined as “a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change”.
The key component of clinical audit is that performance is reviewed (or audited) to ensure that what should be done is being done, and if not it provides a framework to enable improvements to be made.
clinical audit steps
Select topic
Set agreed standards & decide on data requirements
Observe practice and collect data
Analyse data and determine any deviation from standard
Identify any areas of change required
Make necessary changes
Repeat audit process and determine whether improvements have occurred
clinical audit cycle
- identify problem/issue
- set criteria and standard
- observe practice/data collect
- compare performance to criteria/standard
- implement change
what is peer review
Peer review provides an opportunity for groups of dentists to get together to review aspects of practice.
The aim is to share experiences and identify areas in which changes can be made with the objective of improving the quality of care/service offered to patients, share learning and implement change
Has a structured process for setting up, conducting, and reporting
how is alcohol disributed in body
where is conc’ greatest and why
when is absorption quickest
distributed through body water
Concentration in liver is greater because blood
comes directly to it from the stomach and small
intestine via the portal vein
Very little alcohol enters body fat
Water soluble
¡ Slowly absorbed from the stomach
¡ More rapidly absorbed in small intestine
¡ Rate of absorption quicker on empty stomach at
concentration of 20-30% (sherry)
¡ Spirits (40%) delay gastric emptying and are absorbed
more slowly
¡ Aerated alcohol e.g. champagne gets into the system
more quickly
¡ Food retards absorption
where is alcohol metabolised
90% metabolised in liver
¡ 2-5% excreted in sweat, urine or
breath
what drugs increase/decrease gastric absorption of alcohol
Drugs like cimetidine will delay gastric emptying
and reduce absorption
Drugs like antihistamines have the opposite effect
when is peak blood alcohol conc’
how long does it take to reduce
what rate is it excreted at
Peaks 1 hour after drinking on empty stomach
Declines over next 4 hours
Removed at rate of 15mg/100ml/hr
Detectable levels still present for several hours
After 3 pints of beer blood alcohol will be detectable in the morning
how are heavy drinkers affected - metabolism
Normal metabolism increases
¡ Microsomal ethanol oxidising system comes into
play i.e. enzyme induction occurs, this system can
also be induced by drugs (gamma GT will be
increased in heavy drinkers)
how does intoxication affect a person
what is the current legal driving limit in the uk
Mild sedative
Mild anaesthetic
Stimulates dopamine and serotonin
Sense of wellbeing relaxation and dis-inhibition
50mg/100ml is current legal driving limit in the
UK
How is a person affect by ingesting
100mg/100ml
200mg/100ml
>400mg/ml
what can occur that causes consumption to become fatal
100mg/100ml people become elated and aggressive ¡ 200mg/100ml slurred speech and unsteadiness ¡ >400mg/100ml commonly fatal § atrial fibrillation § respiratory failure § inhalation of vomit
safe daily alcohol limits for:
men
women
pregnant women
Men- no more than 2-3 units per day spread over more than 3 days(14 units per week) Women- no more than 2-3 units per day spread over more than 3 days (14 units per week) Pregnant women-no alcohol during pregnancy. Can also cause problems with conception
medical issues associated with heavy drinking
GI tract § Acute gastritis § Liver problems § GI bleeding § Oral, oesophageal, stomach, bowel cancer § Pancreatic disease § Obesity and malnutrition § Vitamin deficiencyfolic acid, Vits B1, B2, B6, E, B1 and D Heart § Cardiomyopathy § Cardiac arrhythmias § Hypertension § Increased triglycerides and LDL cholesterol Traumatic injuries ¡ Skin, muscles, nerves and bones § Acute or chronic myopathy § Osteoporosis § Osteomalacia ¡ Blood § Macrocytosis § Thrombocytopenia § Leucopoenia ¡ Chest ¡ Gynaecological problems ¡ Obstetric problems
medical conditions with a dental effect in association with chronic alcohol consumption
Bleeding ¡ Poor wound healing ¡ Drugs § Drug metabolism § Drug interactions § Non-compliance § Interactions with illicit drugs ¡ Patients with Hepatitis C ¡ Hormones and metabolism § Pseudo-Cushing's syndrome ¡ Immune system ¡ Mental health ¡ Nervous system § Epilepsy § Wernicke-Korsakoff syndrome § Cerbral atrophy ¡ Renal
oral issues with chronic alcohol consumption
Salivary gland enlargement-sialosis ¡ Xerostomia ¡ Poor wound healing and osteomyelitis § Suppression of immune system by alcohol § Dental erosion- § Bruxism
liver issues in realtion to dentistry
Reduced synthesis of clotting factors in damaged liver Combined with reduced absoption of Vitamin K II, VII, IX, X Thrombocytopenia due to splenomegaly associated with portal hypertension Megakaryocyte maturation is also reduced also leading to fewer platelets Platelet aggregation is reduced Both will lead to prolonged bleeding Drug metabolism In patients without liver damage Heavy drinking induces liver enzymes This may increase the metabolism of some drugs More rapid destruction Reduced plasma concentration Lack of effects In patients with liver damage Reduced drug metabolism LA, analgesia, sedatives and antibiotics
how can alcohol interact with drugs
-why is paracetemol contraindicated with alcohol
Alcohol will interact with drugs producing a sedative effect on the nervous system and increase or prolong the effect
-In heavy drinkers paracetemol can be converted to anintermediate metabolite which is very hepatotoxic
why should patient with hepatitis c abstain from alcohol
25% patients with hepatitis C will develop cirrhosis
¡ Alcohol in any amount leads to more rapid
development of severe liver disease
¡ Patients with hepatitis C should abstain from alcohol
completely
alcoholics are generally malnourished, explain some of their nutritional deficits
Alcoholics are generally malnourished § General neglect § Substitution of food with alcohol § Deficiencies of ▪ Thiamine-beriberi,Wernicke’s encephalopathy ▪ Folic acid-macrocytosis ▪ Vitamin C-scurvy
what kinds of cardiac issues can alcohol cause
Cardiomyopathy ¡ Cardiac arrhythmias ¡ Hypertension ¡ Stroke ¡ Protective effects
what is cardiomyopathy
Degenerative heart disease with no
coronary artery disease-various aetiologies
¡ Well-established complication of chronic
alcohol abuse
¡ Most cases asymptomatic
¡ Can lead to arrhythmias, cardiomegaly and
congestive heart failure (dyspnea and
peripheral oedema)
name some cardiac arrythmias
ECG changes can be marked § Atrial fibrillation § Prolonged Q-T interval § Inverted T waves § Heart block § Ventricular arrhythmias ¡ ‘Holiday heart syndrome’ and sudden death
how can chronic drinkers be affected by hypertension
- how much a day can > risk
- cessation of alcohol intake takes how long to reduce risk
Chronic intake of 30 g/day or more alcohol
¡ Hypertension reverses within 2 to 3 weeks of
cessation of alcohol intake even in heavy
drinkers
how can alcohol contribute to oral cancer
Ethanol metabolite acetaldehyde promotes
tobacco initiated tumours
§ Damages DNA and alters oncogene production
§ Alcohol facilitates absorption of carcinogenic
substances across the oral mucosa
§ Partly due to thinning of oral mucosa due to
nutritional deficiency
how can alcohol cause NCTSL
Alcohol is very acidic ¡ Gastro oesophageal reflux disease (GORD)- acid in alcohol directly relaxes the oesophageal sphincter ¡ Vomiting ¡ Multifactorial-bruxism ¡ Restoration difficult until problem controlled
what is one unit of alcohol
One unit § One standard measure of spirits (pub measure) § One standard 125ml glass of wine § Half pint of beer/lager
what is the definition of screening
The purpose of screening is to identify
people who need more comprehensive
assessment for substance misuse disorders. It
does so by uncovering indicators of serious
substance-related problems among
adolescent. As such, it covers the general
areas in a client’s life that pertain to
substance use without making an involved
diagnosis or assessment.
what is the CAGE intervention method for alcohol screening
Have you ever felt you ought to Cut down on your
drinking?
¡ Do you get Annoyed at criticism of your drinking?
¡ Do you every feel Guilty about your drinking?
¡ Do you ever take an Early morning drink first thing in
the morning to get the day started or eliminate the
shakes?
Yes’, ‘sometimes’ or ‘often’ to 2 or more questions
may indicate an alcohol problem
