Block 11 Flashcards
1
Q
Define patient safety?
A
Coordinated efforts to prevent harm to patients caused by the process of health care itself
2
Q
What is an adverse event?
A
Unintended event resulting from clinical care or causing patient harm
3
Q
What is a near miss?
A
Situation in which events arise during clinical care but fail to develop further
4
Q
What is the swiss cheese model of accident causation?
A
Although many layers of defence lie between hazards and accidents, there are flaws in each layer that, if aligned, can allow the accident to occur
5
Q
What are the main causes of error at an individual and system level?
A
Individual - errors of individuals, blames individual for forgetfulness, inattention of moral weakness
System - conditions under which individual works, tries to build defences to eliminate errors or mitigate their effect
6
Q
What are active failures?
A
Unsafe acts committed by people in direct contact with patient
7
Q
What is a latent error?
A
Develop over time until they combine with other factors or active failures to cause an adverse event
8
Q
What are the different types of error?
A
- Knowledge based
- Rule based
- Skills based
9
Q
What are violations?
A
Deliberate deviation from regulated code of practice/procedure
10
Q
What are the types of violation?
A
- Routine - due to system being poorly designed
- Reasoned - in patients best interest
- Reckless - opportunity for harm is foreseeable and ignored (may never be intended)
- Malicious- intention to cause harm
11
Q
What systems are in place to prevent errors?
A
- National Patient Safety Agency 2001 - reporting and learning from mistakes
- National reporting and learning system 2004 - anonymous reporting of patient safety incidents
- Medicines and Healthcare Products Regulatory Agents - medicines, healthcare products and medical equipment meet appropriate standards
12
Q
How to know if a hospital is safe
A
- Hospital mortality data
- Data on other measures of safety - e.g. NHS safety thermometer
- Monitoring and inspections by regulators - CQC + NHS improvement
13
Q
Situations associated with increased risk of error
A
Unfamiliarity with task Inexperience Shortage of time Inadequate checking Poor procedures Poor human equipment interface
14
Q
What to do when adverse incidents occur?
A
- Report it
- Assess seriousness
- Analyse why it occurred (root cause analysis)
- Open and honest and apologise
- Learn and reduce risk of repeat
15
Q
What are the most common causes of death and admission to hospital/primary care for children in developing countries?
A
Infection Diarrhoea Malaria HIV Malnutrition Kwashiorkor Sanitation Water supply Food hygiene
16
Q
What are the most common causes of death and admission to hospital/primary care for children in developed countries?
A
Congenital abnormalities Infection Respiratory disorders Trauma Malignancy Neurological disease
17
Q
Common causes for why children go to A+E
A
Accidental injury Asthma Respiratory illness Infective process Rashes Appendicitis
18
Q
Why are males more likely to die than females?
A
Higher suicide rate
Violence related
Road traffic accidents
Behavioural difference between male and female - more risky behaviour
19
Q
Most common cause of external death in adolescents?
A
Traffic accidents (>50%)
20
Q
Why does poverty increase chances of being ill?
A
Poor nutrition
Overcrowding
Lack of clean water
Harsh realties that may make putting your health at risk the only way to survive
21
Q
Why does poor health increase poverty?
A
Reduces family’s work productivity + family sells assets to cover treatment
22
Q
Implications on chronic illness in children
A
- Affects physical, mental and social development
- Repeated absence at school
- Affect on parents and siblings
- Financial affect
- Can be lifelong
23
Q
What conditions are screened for before birth?
A
Antenatal screening test - identifies major abnormalities like…
- Alpha fetoprotein - raised in neural tube defects and GI abnormalities
- Downs test - AFP and HCG
- Ultrasound - growth check, cardiac abnormalities, diaphragmatic hernia
24
Q
what Neonatal tests are done?
A
- Blood spot test - PKU, Cystic fibrosis, Sickle cell disease, congenital hypothyroidism
- Physical examination
25
Timings for screening and developmental surveillance
```
week 12 pregnancy - antenatal screening
Neonatal exam
New baby review (14 days)
6-8week check
1 year check
2-2.5 year check
```
26
Purpose of the 6-8 week postnatal check
1. Take history
2. Assess psychological and social situation
3. Examination of mother - abdomen, vaginal exam, BMI
4. Examination of baby - weight, head circumference, appearance and movement, hips, heart, spine, eyes
5. Health promotion - immunisation, breast-feeding, reducing SIDS, car safety
6. Assessment of parenting and emotional attachment
27
What is looked for in the heart exam at 6-8weeks?
1. Cyanosis, ventricular heave, respiratory distress, tachypnoea
2. Feel apex beat
3. Listen for murmurs
28
What is developmental displasia of the hip (DDH)?
Ball and socket joint of hip doesn't form properly - too shallow so femoral head can dislocate
29
Tests for DDH
1. Barlows test - flex and adduct hip, then push posteriorly (positive test = femoral head slips out acetabulum)
2. Ortolanis test - gently abduct hip (puts dislocated hip back in place
30
What are the normal vital signs of a healthy baby? (RR, HR, Temp)
RR - 30-60bpm
HR - 100-160bpm
Temp - 37
31
Immunisation schedule of baby up to 1
8 weeks - 6in1 vaccine, rotavirus vaccine, MenB vaccine, PCV vaccine
12 weeks - 6in1 vaccine, rotavirus vaccine 2
16 weeks - 6in1 vaccine, PCV vaccine 2, MenB vaccine 2
1 year vaccine - Hib, Men C vaccine, MMR vaccine, PCV vaccine 3, MenB vaccine 3
32
What is the 6in1 vaccine?
1. Diptheria
2. Tetanus
3. Whooping cough (pertussis)
4. Polio
5. Hib disease
6. Hepatitis B
33
What is the PCV vaccine?
Pneumococcal conjugate vaccine
34
What is the Hib vaccine?
Haemophilus influenzae type b
35
What is the puerperium period?
Postnatal period - period of about 6-8 weeks after childbirth during which mothers reproductive organs return to their original non-pregnant condition
36
The main aims of antenatal care
1. Monitor progress of pregnancy to optimise maternal and foetal health
2. Develop a partnership between woman and health professional
3. Exchange information that promotes choice - about lifestyle, location of birth etc
4. Recognise deviations from the norm and refer appropriately
5. Increase understanding of public health issues
6. Provide opportunities to prepare for birth and parenthood
37
Which key documents influence antenatal care provisions?
- MBRACE-UK (mothers and babies - reducing risk through audits and confidential enquires)
- NICE antenatal care guideline
- Evidence based practice
- Local policy/guidelines
- Midwifery 2020
- National maternity review 'better births'
38
What are the key themes of the national maternity review 'better births'?
1. Personalised care
2. Continuity of care
3. Safer care
4. Better postnatal and perinatal mental health care
5. Multi-professional working
6. Working across boundaries
7. Fairer payment system
39
What tests are done at antenatal visits?
1. Physical examination - weight, BP, urinalysis
2. Blood tests - FBC, ABO and Rh, HIV
3. Psychosocial and emotional support
40
Risk factors for adverse pregnancy outcomes
1. Chronic/acute disease
2. Proteinuria
3. Increased BP
4. Significant oedema
5. Uterus large or small for gestational age
6. Malpresentation - cephalic or breach
7. Infection - increased risk of miscarriage/stillbirth
8. Sociological or psychological factors
41
What are the different forms of pregnancy loss?
1. Spontaneous miscarriage - before 24 completed weeks
2. Ectopic pregnancy - implants outside uterus
3. Termination of pregnancy
4. Stillborn - after 24 weeks
42
What is the MBRACE report 2014?
Looked at standards of care and mortality/morbidity rates
- 2/3 of mothers died from medical and mental health problems and 1/3 from direct causes
- 3/4 those who died had known mental health problems before they died
43
Common causes of death in postnatal period
Infection
Haemorrhage
Thrombosis
Hypertensive disorders (eclampsia)
44
What physical and wellbeing issues might a woman experience in the postnatal period?
```
Perineal care - infection, inadequate repair, wound breakdown/non-healing
Urinary retention
Dyspareunia - difficult/painful sex
Headache
Fatigue
Backache
Constipation
Haemorrhoids
Breast and nipples - red,painful and cracked
```
45
What mental health problems may be experienced in the post-natal period?
50-80% 'the blues' = very weepy over small things, time-limited, recovers quickly
10-15% postnatal depression - tiredness, worthlessness, low mood
0.2% Puerperal psychosis - severe episodes of mental illness that begins suddenly, mania, depression, confusion, hallucinations
46
What was the main outcome of the peel committee report? (1970)
Sufficient facilites should be made available for all childbearing women to give birth in hospital
47
What are the risks of a C-section?
1. General anaesthesia - danger of mendelsohns syndrome (aspiration pneumonia) and paralytic ileus
2. Surgical techniques - risk to other internal organs
3. Childbearing risks for further births
48
What is the medical model of birth?
Birth seen as a dangerous journey, only normal in retrospect, therefore assume the worst
Low threshold for intervention
49
What is the social model of birth?
Birth is a normal physiological process which women are designed to achieve
50
What are the cultural issues during pregnancy?
Unintended pregnancy - delay in seeking prenatal care and having a premature baby
Pregnancy may not fit in with plans
Social disapproval for pregnancy out of wedlock and teenagers
51
What was the outcome of the midwives act 1902?
Established normality in childbearing as the midwife's role - doctor comes if abnormality occurs
Ensures equal access to midwives and doctors for childbearing women of all socioeconomic standing
52
Name some benefits of institutionalised childbirth
1. Standardisation of care
2. Access to good facilities to support
3. Availability of cases for medical training
4. Fast access to emergency care
5. Access of effective obstetric analgesia
53
Name some risks of institutionalised childbirth
1. Medicalisation
2. Depersonalisation of birth
3. Lack of privacy
4. Inflexibility in labour and birth practices
5. Limitation of resources
54
What is the role of a doctor in child welfare?
1. Consider safety and welfare of children whether you see them regularly or not
2. Identify signs of abuse/neglect early and take action
3. Know what to do if you are concerned a child is at risk of suffering abuse or neglect
4. Act on concerns about a child at risk of suffering abuse or neglect
55
What are the indicators of a successful breastfeed?
Baby - audible and visible swallowing, sustained rhythmic suck, relaxed arms and head, moist mouth, regular soaked nappies
Woman - breast softening, no compression of nipples at end of feed, relaxed
56
What are some problems that may occur with breastfeeding?
1. Nipple pain
2. Engorgement
3. Mastitis
4. Inverted nipple
5. Ankylossia - tongue ties
6. Sleepy baby
57
What is quality in relation to health care?
Extent to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge
58
Why is there a heavy emphasis on quality management in healthcare?
Quality management...
- improved quality
- reduced costs
- increased productivity
- increased market share
59
Why is consumer protection necessary?
- Medicine has weak evidence base
- Large variations in clinical practice
- Failure to measure success outcomes in healthcare
60
What data is available to improve patient safety?
1. Hospital episode statistics (HES) - details from referring GP, procedures given, duration of stay and discharge/death
2. Patient reported outcome measurements (PROMs) - before procedure and after procedure quality of life measurement slowly
3. Reference cost data
61
What is the summary hospital level mortality indicator?
Ratio between the actual number of patients who die within 30 days of discharge compared with the number that would be expected to die on the basis of average
62
What are the key consumer protection agencies?
1. Care Quality Commision (CQC) - regulates quality and financial performance
2. NHS improvement - ensures financial obligations met
3. NICE - set standards for treatment
63
Who enforces NICE guidelines?
1. Royal colleges
2. GMC
3. Professional audit
64
How can consumer protection be improved?
1. Appraisals
2. Revalidation by the GMC
3. Medical audit as a compulsory part of routine practice
4. GP and consultant contracts - increasing transparency in comparative performance in relation to activity, costs, and patient reported outcomes
5. Transparency and accountability
65
What is clinical governance?
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
66
What are the types of neglect?
1. Physical
2. Educational
3. Emotional
4. Medical
67
What are the signs of neglect?
- malnutrition, begging/stealing food
- poor hygiene
- unattended physical or medical problems
- frequent lateness from school
- inappropriate clothing
- frequent illness
- being left unsupervised for long periods of time
68
What are the types of child abuse?
1. Physical
2. Neglect
3. Psychological
4. Sexual
69
Who are involved in reproductive ethical debates?
1. Parents
2. Future or existing child
3. Third parties including the state
70
What was the main outcome of the human fertilisation and embryology act 1990?
A woman shall not be provided with fertility treatment services unless account has been taken of the welfare of any child who may be born as a result of the treatment
71
What are some of the criticisms of the welfare criteria (1990 act)?
1. Fertile couples dont have to meet this criteria
2. Predicting welfare of future children is difficult
3. Research suggests you do not need a father for a child to flourish
72
What was the main outcome of the human fertilisation and embryology act 2008?
Same as the 1990 act (must take account the welfare of the child) but replaces 'need for father' with 'need for supportive parents'
73
What is the pro-life argument?
1. Abortion ends the life of a foetus
2. Human foetuses have moral status as a person
3. It is wrong to end the life of a person with moral status
4. Abortion is morally wrong
74
What is procreative autonomy?
To be able to choose whether or not to have children
75
What did the abortion act (1967+1990) state?
Not guilty of offence for abortion
76
What are the requirements for an abortion?
1. Performed by registered medical practitioner
2. 2 registered medical practitioner have to approve it
3. Pregnancy not exceeded 24weeks
4. Necessary to prevent injury to physical/mental health
5. Continuing pregnancy would risk life of mother
6. Risk that the child will suffer physical or mental abnormalities
77
What are the arguments for assisted reproduction?
1. Procreative autonomy
2. Helps reduce effect of fertility problems
3. More successful than other forms of assisted reproductive technology
4. Can help single and same sex couples to have a child
78
What are the arguments against assissted reproduction?
1. Destroys embryos
2. Higher risk of multiple pregnancies = high risk
3. Unnatural
4. Encourages mentality the views people as things that can be bought or sold
5. IVF babies more at risk of birth defects
6. Psychological and physical health risk to parents
7. ART can be expensive
79
What is pre-implantation genetic diagnosis and what is an associated ethical issue?
- Genetic profiling of embryos prior to implantation and sometimes oocytes before fertilisation
- can be used to avoid genetic disease
- could be used for sex selection/ saviour siblings
80
What provisions should be made for doctors who conscientiously object - what are the 3 views?
1. Objections should always be respected
2. Objections should never be respected
3. Objections can sometimes be respected (GMC position)
81
What does the family law reform act 1969 state?
That 16 year olds have full capacity
82
What is gillick competency?
Child (under 16) can consent to medical treatment if deemed competent by medical professional, without need for parental permission or knowledge
83
What are the Fraser guidelines?
Doctor can give contraceptive advice and treatment to a person under 16 if she is mature and intelligent, likely to continue having sex, and if the treatment is in her best interests
84
What should you do before conducting an intimate examination?
1. Explain why it is necessary and give opportunity to ask questions
2. Explain what exam will involve
3. Get consent and record it
4. Offer a chaperone
5. Give patient privacy to undress
85
What is the role of the midwife in postnatal care?
1. Screening/identification of actual and/or at risk clients
2. Pregnancy and postnatal period are a window of opportunity to make lifestyle changes
3. Sign posting and referral - mental health services
4. Health promotion
5. Source of information - breast feeding
6. Reassurance and support
7. Safeguarding - vulnerable adult or child
86
What are the aims from NICE postnatal care up to 9 weeks after birth guidelines (2006 updated 2015)
1. A documented, individualised postnatal care plan for every woman
2. Communication particularly about transfer of care
3. Information giving - empower women to take care of their health and babies
4. Assess health and wellbeing of the woman and her baby
5. Alert women to signs and symptoms of potentially life-threatening conditions
6. Encourage breastfeeding
7. Assess emotional wellbeing
8. Parents should be given info regarding assessing babies general condition , identifying common health problems and how to contact a healthcare professional or emergency service if needed
87
Who is in the pregnancy MDT?
- Midwives
- GPs
- Obstetrics
- Support workers
- Health visitors
- Maternity care assisstants
- Public health practitioners
88
What is the role of MDT postnatal care and support teams?
Postnatal care should be a continuation of the care the woman received during her pregnancy, labour and birth, and involve planning and regularly reviewing the content and timing of care, for individual women and their babies
89
What are some of the barriers to MDT in postnatal care?
- Seperate documentation
- Poor working relationship
- Lack of awareness and appreciation of the roles and responsibilities of others
- Limited time and resources
- Overlapping of roles and duplication of services
- Poor communication
- Lack of information sharing
- Lack of collaboration
- Lack of trust and confidence in the abilities of other agencies
- Increased workload
- Lack of appropriately trained staff
