Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 H+S > Block 11 H + S > Flashcards

Block 11 H + S Flashcards

1
Q

Define patient safety?

A

Coordinated efforts to prevent harm to patients caused by the process of health care itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is an adverse event?

A

Unintended event resulting from clinical care and causing patient harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a near miss?

A

A situation in which events arise during clinical care but fail to develop further

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the main causes of error at an individual and a system level?

A
  • Individual error - Errors of individuals, blames individual for forgetfulness, inattention or moral weakness
  •  System error - Conditions under which an individual works, tries to build defences to eliminate errors or mitigate their effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are active failures?

A

-Unsafe acts committed by people in direct contact with the patient.
- Usually short lived, often unpredictable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is latent error?

A

-Develop over time until they combine with other factors or active failures to cause an adverse event
- Long lived and often can be identified and removed before they cause an adverse event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the different types of errors?

A
  • Knowledge based - Such as forming wrong intentions or plans as a result of inadequate knowledge/experience
  •  Rule based - Encounter relatively familiar problem but apply wrong rule, either misapplication of a good rule or application of a bad rule.
  • Skills based - Attention slips and memory lapses, involve the unintended deviation of actions from what may have been a good plan. We are all prone to these types of errors, mainly due to interruption and distractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are violations?

A
  • Deliberate deviation from some regulated code of practice or procedure
  • They occur because people intentionally break the rules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the types of violations?

A

-Routine - Regularly performed shortcuts due to system, process or task being poorly designed or actions. May become tacitly accepted practice over time
- Reasoned - Occasional reasoned deviation from a protocol or procedure which we believe we have good reason for making (e.g. time constraints), may be in patient’s best interests
- Reckless - Deliberate deviations from a protocol/code of conduct and include acts where opportunity for harm is foreseeable and ignored, although harm may never be intended
- Malicious - Deliberate deviations from a protocol/code of conduct, where the intention is to cause harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What systems are in place in the NHS to try and prevent errors occurring?

A

-National Patient Safety Agency (NPSA) - 2001. coordination of reporting and learning from mistakes that affect patient safety.
- National Reporting And Learning System (NRLS) - 2004. National system for anonymous reporting of patient safety incidents, including near misses. All trusts now have a local system for reporting, linked to the national system. Also has a E- form for reporting incidents anonymously directly to the NPSA.
- Medicines and Healthcare- Products Regulatory Agency (MHRA) - Ensures medicines, healthcare products and medical equipment meat appropriate standards of safety, quality, performance and effectiveness and that they are used safely. Monitoring of medicines and acting on safety concerns. Responsible for adverse incident reporting system for medical devices.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we know if a hospital is safe?

A

-Hospital mortality data
- Data on other measures of safety - Reports of never events and serious incidents,
NHS safety thermometer, patient safety dashboards
- Monitoring and inspections by regulators - Care quality commission (CQC), NHS
Improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What situations are associated with an increased risk of error?

A

-Unfamiliarity with the task
-Inexperience
- Shortage of time
- Inadequate checking
- Poor procedures
- Poor human equipment interface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should we do when adverse incidents occur?

A

-Report it - Incident reporting systems
- Assess its seriousness
 -Analyse why it occurred - Root cause analysis
- Be open and honest with the affected patient and apologise - Duty of Candour
- Learn from the event and put in place actions to reduce risk of repeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the common causes of death and contact with hospital/primary care in children in developing countries?

A

Infection, diarrhoea, malaria, HIV, malnutrition, kwashiorkor, sanitation, water supply, food hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the common causes of death and contact with hospital/primary care in children in developed countries?

A

Congenital abnormalities, infections, respiratory disorders, trauma, malignancy, neurological disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why do children go to A&E?

A

Accidental injury, asthma, respiratory illness, infective process, rashes, appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why are males more likely to die than females?

A 
-Higher suicide rates
- Violence related
- Road traffic accidents
- Behavioural differences between males and females - More likely to take part in
'risky' behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common cause of external deaths in adolescents?

A

-Traffic accidents (>50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why does poverty increase the chance of getting ill?

A 
-Poor nutrition
- Overcrowding
- Lack of clean water
- Harsh realities that may make putting your health at risk the only way to survive or
keep your family safe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why does poor health increase poverty?

A
  • Reducing a family’s work productivity

-  Leading family to sell assets to cover the costs of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the implications of chronic illness in children?

A

-Affects physical, mental and social development
- Repeated absence at school
 -Affect on parents and siblings
- Financial affect (family and community)
- Can be lifelong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What conditions are screened for before birth?

A

 Antenatal screening tests - Identify major abnormalities
– Alpha fetoprotein - Raised in neural tube defects and some GI abnormalities
– Downs test - Alpha fetoprotein and HCG
– Ultrasound - Growth check, cardiac abnormalities, diaphragmatic hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What tests are done neonatally?

A
  • Blood spot test - PKU, cystic fibrosis, sickle cell disease, congenital hypothyroidism
  • Physical examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the timings for screening and developmental surveillance?

A 
-Antenatal screening (12th week of pregnancy)
- Neonatal examination
- New baby review (14 days)
- 6-8 week check
- 1 year check
- 2-2.5 year check
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the purpose of the 6-8 week postnatal check?

A

-Take history
- Assess psychological and social situation
- Examination of mother - Abdomen, vaginal exam?, BMI
- Examination of baby - Weight, head circumference, appearance and movement,
hips, heart, spine, eyes
- Health promotion - Immunisations, breast-feeding, reducing risk of SIDS, car safety
 -Assessment of parenting and emotional attachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is looked for in the heart examination at the 6-8 week check?

A

-Look for cyanosis, ventricular heave, respiratory distress, tachypnoea
- Feel apex beat
- Listen for murmurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is developmental displasia of hip (DDH)?

A

Ball and socket joint of hip doesn’t form properly - Too shallow so femoral head is loose and can dislocate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the tests for DDH?

A

-Barlows test - Flex and adduct hip then push posteriorly, positive test causes the femoral head to slip out of the acetabulum
- Ortolanis test - Gently abduct hip, puts dislocated hip back in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the normal vital signs of a healthy baby?

A

-Respiratory rate - 30-60 breaths per minute
- Heart rate - 100-160 beats per minute
- Temperature - 37°C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What immunisations should be given in the first year?

A

-8 weeks - 5-in-1 vaccine, PCV vaccine, rotavirus vaccine, Men B vaccine
- 12 weeks - 5-in-1 vaccine 2, rotavirus vaccine 2
- 16 weeks - 5-in-1 vaccine 3, PCV vaccine 2, Men B vaccine, 2
- 1 year - Hib, Men C vaccine, MMR vaccine, PCV vaccine 3, Men B vaccine 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is puerperium?

A

-Postnatal period
- Period of about 6-8 weeks after childbirth during which the mother’s reproductive
organs return to their original non-pregnant condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the main aims of antenatal care?

A

-Monitor progress of pregnancy to optimise maternal and foetal health
- Develop a partnership between woman and health professional
- Exchange information that promotes choice - About lifestyle, location of birth, etc
- Recognise deviations from the norm and refer appropriately
- Increase understanding of public health issues
- Provide opportunities to prepare for birth and parenthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which key documents influence antenatal care provisions?

A

-MBRRACE-UK (mothers and babies - reducing risk through audits and confidential enquiries across the UK)
- NICE antenatal care guideline (2008, modified 2014)
- Evidence based practice
- Local policy/guidelines for practice
- Midwifery 2020
- National maternity review ‘Better births’

35
Q

What were the key themes of the national maternity review ‘Better births’?

A 
-Personalised care
- Continuity of carer
- Safer care
- Better postnatal and perinatal mental health care
- Multi-professional working
 -Working across boundaries
- A fairer payment system
36
Q

What tests are done at antenatal visits?

A

-Physical examination - Weight, BP, urinalysis
- Blood tests - FBC, antibodies, ABO and Rh, HIV
- Psychosocial and emotional support - General wellbeing, work, financial, anxiety

37
Q

What are some of the risk factors for adverse outcomes to pregnancy?

A

-Chronic or acute disease - May be complicated with pregnancy
- Proteinuria - Could indicate renal pathology
- Significant increase in blood pressure readings - Pre-eclampsia, may lead to
eclampsia (fits and convulsions)
- Significant oedema Hypertensive disorder?
- Uterus large or small for gestational age - Lots of conditions affect these
-Malpresentation - Cephalic or breach
- Infection - Increases risk of miscarriage/stillbirth
- Sociological or phychological factors - Mental health problems can lead to antenatal
depression/postnatal depression

38
Q

What are the different forms of pregnancy loss?

A

-Spontaneous miscarriage - Loss of pregnancy before 24 completed weeks of pregnancy
- Ectopic pregnancy - Fertilised ovum implants outside uterus (embryo grows in fallopian tube or even abdomen
- Termination of pregnancy
- Stillbirth - Born after 24 weeks and does not show any sign of life

39
Q

What is the MBRRACE report (2014)?

A

-Looked at standards of care and mortality and morbidity rates
- 2/3 of mothers died from medical and mental health problems, 1/3 from direct
causes
- 3/4 women who died had known mental health problems before they died

40
Q

What are common causes of death in the postnatal period?

A

Infection, haemorrhage, thrombosis, hypertensive disorders (eclampsia)

41
Q

What physical health and wellbeing issues might a woman experience in the postnatal period?

A

-Perineal care - Infection, inadequate repair, wound breakdown/non-healing
- Urinary retention
- Dyspareunia - Difficult or painful sex
- Headache
- Fatigue
- Backache
- Constipation
- Haemorrhoids
- Breast and nipples - Redness, pain, cracked

42
Q

What mental health problems may be experienced in the postnatal period?

A
  • 50-80% The blues - Very weepy over small things, time-limited, recovers very quickly, if it continues then begin to worry about postnatal depression
  •  10-15% Postnatal depression - Tiredness, worthlessness, low mood
  • 0.2% Puerperal Psychosis - Severe episodes of mental illness that begins suddenly, mania, depression, confusion, hallucinations, delusions
43
Q

What was the main outcome of the Peel Committee Report (1970)?

A

Sufficient facilities should be made available for 100% of childbearing women to give birth in hospital

44
Q

What is the medical model of birth?

A

-Birth seen as a dangerous journey, only normal in retrospect, therefore assume the worst
- Low threshold for intervention (to fix defective bodies)

45
Q

What is the social model of birth?

A

Birth is seen as a normal physiological process, which women are uniquely designed to achieve

46
Q

What are some of the cultural issues during pregnancy?

A

-Unintended pregnancy - Delay in seeking prenatal care and having a premature baby, higher levels of stress and depression
- Pregnancy may or may not fit with the mothers plans
- Social disapproval for pregnancy out of wedlock and teenagers

47
Q

What was the outcome of the midwives’ act (1902)?

A

-Established normality in childbearing as the midwife’s role - Refer to doctors as soon as abnormality occurs
- This ensures equal access to midwives and doctors for childbearing women of all socioeconomic standing

48
Q

What are the benefits of institutionalised childbirth?

A

-Standardisation of care
- Access to good facilities to support childbirth
- Availability of populations of childbearing women and infants for the purposes of
midwifery and obstetric training
- Faster access to emergency care
- Access of effective obstetric analgesia

49
Q

What are the risks of institutionalised childbirth?

A

-Medicalisation
-Depersonalisation of birth
- Lack of privacy
- Inflexibility in labour and birth practices
- Limitation of resources

50
Q

What is the role of doctors in welfare?

A

-You must consider the safety and welfare of children and young people, whether or not you routinely see them as patients
- Identifying signs of abuse or neglect early and taking action quickly are important in protecting children and young people
- Know what to do if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect
- Act on any concerns about a child or young person who may be at risk of, or suffering, abuse or neglect

51
Q

What are the indicators of a successful breastfeed?

A

-Baby - Audible and visible swallowing, sustained rhythmic suck, relaxed arms and head, moist mouth, regular soaked nappies
- Women - Breast softening, no compression of nipples at end of feed, relaxed

52
Q

What problems can occur with breastfeeding?

A 
-Nipple pain
- Engorgement
- Mastitis
- Inverted nipple
- Ankylossia (tongue ties)
- Sleepy baby
53
Q

What is ‘quality’ in relation to healthcare?

A

The extent to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

54
Q

Why is there a heavy emphasis on quality management in healthcare?

A

Quality management produces improved quality, reduced costs, increased productivity and an increased market share

55
Q

Why is consumer protection necessary?

A

Medical practice has three deficiencies internationally:
- Medicine has weak evidence base
- Large variations in clinical practice - Doctors do give different treatments to patients
with similar needs and personal characteristics
- Failure to measure success outcomes in healthcare

56
Q

What data are available to improve patient safety?

A

-Hospital episode statistics (HES) - Details referring GP, procedures given, duration of stay and discharge/death, lack of basic national data in primary care
- Patient reported outcome measurements (PROMs) - Before procedure and after procedure quality of life measurement slowly developing
- Reference cost data - Cost data are poor

57
Q

What is the summary hospital level mortality indicator (SHMI)?

A

The 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

58
Q

What are the key consumer protection agencies?

A

-Care Quality Commission (CQC) - Regulates ‘quality’ and financial performance of all health and social care providers, public and private, provides regulatory framework, licenses all providers of health and social care
- NHS Improvement (formerly ‘Monitor’) - Ensures financial obligations are met in terms of balancing income and expenditure
- National Institute for Health and Clinical Excellence (NICE) - Set standards for treatment

59
Q

Who enforces the NICE guidelines?

A

-Royal Colleges
- GMC
- Professional audit

60
Q

How can consumer protection be improved?

A

-Appraisal by peers
- Revalidation by the GMC
- Medical audit as a compulsory part of routine practice and annual job planning
- GP and consultant contracts - Increasing transparency in comparative performance
in relation to activity, costs, and patient reported outcomes
- Transparency and accountability

61
Q

What is clinical governance?

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

62
Q

What are the types of neglect?

A

-Physical neglect
- Educational neglect
- Emotional neglect
- Medical neglect

63
Q

What are the signs of neglect?

A

-Malnutrition, begging, stealing or hoarding food
- Poor hygiene, matted hair, dirty skin, body odour
- Unattended physical or medical problems
- Frequent lateness or absence from school
- Inappropriate clothing, especially inadequate clothing in winter
- Frequent illness, infections or sores
- Being left unsupervised for long periods

64
Q

What are the 4 types of child abuse?

A

-Physical abuse - Deliberate aggressive actions on the child that inflict pain
- Neglect - Failing to provide a child’s needs
-Psychological abuse - Behaviours towards children that cause mental anguish or deficits
- Sexual abuse - When someone touches a child in a sexual way or commits a sexual act with him or her

65
Q

Who are the people involved in reproductive ethic debates?

A

-Parents - Procreative autonomy, parents wishes regarding reproductive choices should be respected, state interference should be minimal
- Future or existing child - Parents wishes should not be respected if not in interests of the future child
 -Third parties, including the state - Use of resources, health care providers objections of conscience

66
Q

What was the main outcome of the human fertilisation and embryology act (1990)?

A

‘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 (including the need of that child for a father)’

67
Q

What were some of the criticisms of the ‘welfare criterior’?

A

-Fertile couples don’t have to meet this criterion
- Predicting the welfare of future children is very difficult
- Research suggests not the case that a father is always required for a child to flourish

68
Q

What was the main outcome of the human fertilisation and embryology act (2008)?

A

Continues to talk about a duty to take account the welfare of the child in providing fertility treatment (hence, a welfare criterion remains) but replaces reference to ‘the need for a father’ with ‘the need for supportive parents’, thus valuing role of all parents

69
Q

What is the pro-life argument?

A

-Abortion ends the life of a foetus
- Human foetuses have moral status of a person (do they?)
- It is wrong to end the life of a person/a creature with the moral status of a person
(depends on the circumstances?)
- Therefore, abortion is morally wrong

70
Q

What is procreative autonomy?

A
  • To have control over one’s reproductive capabilities

-  The freedom to choose whether or not to have children

71
Q

What did the abortion act (1967, amended 1990) state?

A

A person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith:
- Pregnancy has not exceeded 24 weeks
- Termination is necessary to prevent injury to physical or mental health
- Continuing pregnancy would involve risk to the life of the pregnant women
- Risk that is the child was born it would suffer from physical or mental
abnormalities

72
Q

What are the arguments for assisted reproduction?

A

-Procreative autonomy
- Helps get around fertility problems
 -More successful than other forms of assisted reproductive technology
- Can help single women and same-sex couples have a child

73
Q

What are the arguments against assisted reproduction?

A

-Involves destruction of embryos
- Higher risk of multiple pregnancy with associated risks of mortality and morbidity
- Is ‘unnatural’
- Encourages the mentality which views people as things which can be bought or sold
as wanted
- IVF babies are more at risk of birth defects than naturally conceived babies
- Psychological and physical health risk on parents
- ART can be expensive

74
Q

What is pre-implantation genetic diagnosis and what are the associated ethical issues?

A

-Genetic profiling of embryos prior to implantation (as a form of embryo profiling), and sometimes even oocytes prior to fertilisation
- Can be used for avoiding genetic diseases
- Issues - Sex selection, saviour siblings

75
Q

What provisions, if any, should be made for doctors who conscientiously object - What are the 3 views?

A

-Objections should always be respected - The autonomy of the medical provider is paramount, no-one should be made to do something that goes against their strongly held personal beliefs
- Objections should never be respected - Women’s interests should always take priority, sometimes argued that if doctors don’t like this then shouldn’t have chosen medicine as a profession
- Objections can sometimes be respected (this is the position of the GMC) - It might be possible for women’s interests to be met while at the same time not requiring doctors to do something that would cause them a great deal of distress e.g. perhaps can refer patients to abortion services or provide patients with information

76
Q

Which act says a 16 year old has full capacity?

A

The family law reform act 1969

77
Q

What is Gillick competency?

A

Child (under 16) can consent to medical treatment if deemed competent by medical professional, without need for parental permission or knowledge

78
Q

What are the Fraser guidelines?

A

Doctor can give contraceptive advice and treatment to a person under 16 if she is mature and intelligent, likely to continue to have sex, and if the treatment if in her best interests

79
Q

What should you do before conducting an intimate examination?

A

-Explain to the patient why an examination is necessary and give the patient an opportunity to ask questions
- Explain what the examination will involve
- Get consent and record that the patient has given it
 Offer a chaperone
- Give the patient privacy to undress

80
Q

What is the role of the midwife in postnatal care?

A

-Screening/identification of actual and/or ‘at risk’ clients
Pregnancy and postnatal period are ‘window of opportunity’ to make lifestyle changes - Smoking cessation, diet, exercise
- Sign-posting, liaison and referral - Mental health services, MDT working
- Health promotion - Women and family
- Source of information - Bonding, breast feeding
- Reassurance and support
- Safeguarding - Vulnerable adult or child

81
Q

What are the aims from NICE postnatal care up to 9 weeks after birth guidelines (2006,
updated 2015)?

A
  • A documented, individualised postnatal care plan for every woman
    - Communication, particularly about transfer of care
    - Information giving - Empower women to take care of their and their baby’s health
    - Assess the health and wellbeing of the woman and her baby
    - Alert women to signs and symptoms of potentially life-threatening conditions
    - Encourages breastfeeding - Large proportion of postnatal care
    - Assess emotional wellbeing
    - Parents should be given information regarding assessing baby’s general condition,
    identifying common health problems and how to contact a healthcare professional or emergency service if needed
82
Q

Who is in the pregnancy MDT?

A 
-Midwives
- GPs
- Obstetrics
- Support workers
 -Health visitors
- Maternity care assistants
- Public health practitioners
83
Q

What is the role of MDT postnatal care and support teams?

A

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.

84
Q

What are some of the barriers to MDT work?

A

-Separate 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

Year 2 H+S (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions