Care Flashcards
What must we do when communicating with patients?
Avoid using jargon
Be clear and concise
Frequently check if they have understood
Maintain eye contact
Think about facial expression, gesture, posture, personal space and touch e.g. nodding of head
What human rights apply to care?
Fairness
Respect
Equality
Dignity
Autonomy
What non-verbal communication can we do?
Sign language
Use of props
Blinking
Movement of limbs
Story board
What do we use to handover at hospital?
Situation - name, age, reason come in, concerns
Background - hx of presenting complaint, pt’s medical background/social
Assessment - vital signs, concerns
Recommendation - explain what is needed
What is our trauma handover?
Age
Time of incident
Mechanism of injury
Injuries sustained
Signs and symptoms
Treatment given/immediate needs
What are the 6 C’s of care?
Care
Compassion
Competence
Communication
Courage
Commitment
What is good standard of care?
Caring for a person as an individual, with courtesy, respect and dignity - advocating for them where required, making every effort to involve pt in own care
Always act with consent or for non-competent individuals in their best interests
Work within scope of practice
Respect pt’s confidentiality - all info divulged is confidential, record relevant and necessary info, protecting it from being lost, damaged, tampered with, ensure only used for purposes it has been provided for
Act with openness and transparency supporting duty of candour - report incidents affecting pt safely to pt and organisation
Follow IPC policies and procedures to prevent and protect pt’s, colleagues, and others from infection
Strive to preserve life and alleviate suffering, preventing unnecessary harm or loss upholding our duty of care
Explain what duty of care is?
Our legal obligation to act in a way that prevents unreasonable harm or loss where a reasonable person might see harm occur - must justify if delays to care e.g. not safe ONS
What is negligence?
When duty of care is breached - harm occurred due to the actions of the healthcare professional - can include emotional distress and loss of income/future earnings/enjoyment of life
What happens if pt disagrees with your medical advice and duty of care is conflicted?
Capacity must be assessed
What is scope of practice?
Established by employer - what can and cannot be done by medical professional - if perform outside of this it can be considered negligent
BM, temp
OP, NP, suction, BVM, defib, ECG acquisition
Cervical collar, rescue board, scoop, pelvic splint, traction splint, arterial tourniquet, box splint, vacuum splint
Chest seal
Inhaled drugs - oxygen and entonox
What is whistleblowing?
Act of reporting suspected wrongdoing at work
Who do you report whistleblowing to (in order)?
Go through whistleblowing policy
If not available, speak to line manager
Raise with higher management if not satisfied
Go to Care Quality Commission as last resort
What is duty of candour?
Being open and honest with patient, telling them openly if they have been harmed by our care/believe they can be harmed by our actions and apologising/offering appropriate remedies
Also, involves being open and honest with organisation - must report within 10 days of incident or fined up to £10,000
Incident must have be unintended or unexpected
Why is duty of candour so important?
Helps us to learn from incidents and improve
What is involved in a person-centred approach?
Treating a patient as a whole rather than their medical needs
Tailoring their needs based on personal priorities (flexible care)
Understand patient’s life, environment, values, and goals
What do we need to do to promote health?
Promote smoking cessation services
Provide education on recommended daily allowance of alcohol
Encourage helmets when riding bikes
Encourage hand washing
Encourage attending breast cancer screenings/smear tests
Encourage seat belts
What happens if pt unconscious and harm or loss occurred due to our intervention?
Inform family friends if pt deceased or lacking capacity and provide reasonable support
What does the MCA do?
Over 16s
Protect individuals right to ‘govern’ themselves
Protects against having treatment forced upon them
Protects them from situations when they are not fit to think for themselves
What does it mean when someone doesn’t have capacity?
They are unable to make a decision at the time they are required to make it due to impairment/disturbance of the brain - regardless if temporary or permanent e.g. post-ical, alcohol, drugs, dementia, learning disabilities, brain damage
How do we assess capacity?
Need to determine if there is evidence of an impairment before moving onto defining whether someone is unable to make a decision
Assess can they understand info relevant to the discussion? - make sure presented in easy way for them to understand
Do they know the nature of decision?
Do they know the reason why a decision is needed?
Do they know the likely effects of deciding one way or another or making no decision at all i.e. able to weight up info?
Are they able to retain info long enough to make a decision?
Able to arrive at a decision and communicate this e.g. talking, sign language, any other means?
LA5 can be used as a tool to assist in reasoning process
What are the 5 principles of MCA
Assume capacity unless lack of capacity established
Do not treat as unable to make a decision…
Unless all practicable steps to help them come to a decision have been taken without success
Because decision is unwise
Decision made under Act must be done in person’s best interests
Less restrictive option
What must we do if patient with capacity refuses?
Confirm patient has had all necessary facts to make a decision
Explain consequences of refusal
Document refusal - have pt sign
Give alternative treatment options or advice
How do we act in the best interests of a patient?
Make care person-centred - make every effort to encourage pt to participate participation in decision making process, find out pt’s views e.g. past and present wishes/feelings, beliefs, avoid discrimination - don’t base on age, appearance, condition or behaviour
Implement life-sustaining treatment e.g. implement if without treatment likely to to cause significant or irreversible deterioration of health
DO NOT force removal if pt’s condition less serious and pt care can be provided ONS by alternative measures
If capacity likely to be regained, consider whether putting off decision is possible if not urgent
Restraint only necessary to prevent harm
What is an LPA?
Can make decisions on pt’s behalf when they are no longer able to regarding health and welfare
Must be registered with Office of Public Guardian and must be in health sector
NOT valid if pt has capacity
What is Deprivation of Liberty Safeguards
Liberty is deprived to keep someone safe from harm who lack’s capacity
Usually residents in hospital or care homes
They cannot leave when they want/can be medicated against their will
Need to be aware why it’s in place and aware of content
All other settings require court of protection - under continuous supervision and control with LAS
What is an independent MCA?
Assists in making important decisions for people who are no longer able and have no friends or family - vulnerable adults who lack capacity
In an emergency, if cannot get a hold of them can just act in pt’s best wishes
Decisions e.g. person to be moved into long-term care for 28 days+ in hospital or 8 weeks in care home or long-term move 8 weeks or more
What is an ADRT?
Advanced statement that is made when the pt has capacity, states what medical treatment they wish to refuse at a future point when they don’t have capacity - usually made when EOL or palliative/likely to deteriorate
Needs to be in writing
Signed and witnessed
Dated
Specifies exact treatment being refused
Explicitly say intention to refuse treatment even if life is at risk
How do we know an ADRT is not valid?
Pt has withdrawn decision at time when they have capacity
Conferred power to LPA post date of ADRT
Pt acted in a way inconsistent with ADRT to such a degree it questions validity
Pt made decision under duress and it was not one of their own accord
Can ask CTM or clinical hub if question validity
When is ADRT not applicable?
Proposed treatment is not treatment specified in ADRT
Circumstances different from those set out in ADRT
Reasonable grounds to believe person would have not made same decision if had known more at the time they made ADRT.
What do we need to consider about ADRT?
How long ago it was made
If pt’s changed personal life e.g. Jahovah’s witness changed to another religion
If developments in medical treatment such as new meds, treatment, or therapies have been made that pt did not foresee and would consider
When is restraint used?
Used when necessary to prevent harm to pt who lacks capacity
Amount of time/type used is proportionate to likelihood and seriousness of harm the pt faces
What do we need to be aware of when restraint is used?
Monitoring pt for asphyxia - pt becomes quiet
Agitated pt’s can deteriorate quickly
Airway/breathing must not be compromised - even putting handcuffs in front of body means pt can breath better as allows pt to sit up
Monitor vital signs where possible
Never use techniques that inflict pain as a means of control
What happens if we don’t handle pt’s info in an approved manner?
Can cause distress/embarrassment for pt and organisation
Legal or disciplinary action
What is patient identifiable info?
Clinical record numbers
Images
Voice recordings
Rare disease info
How do we maintain confidentiality?
Seek consent before sharing
Share only necessary info
Maintain physical security of info e.g. tablet not left unlocked
Access info only you need
What info can police ask for regarding pt’s?
Personal info when detecting/preventing crime
Can only ask for health info if relates to investigation/prevention of serious crime
When can we share info without consent?
If in public interest i.e. not acting will put other adults or children at risk/duty of care to intervene if crime has been committed e.g. reporting driver to DVLA when advised to not drive
Can share info to social services if believe child can be harmed and primary caregiver lacks capacity/are suspects who should not be informed they are under criminal investigation - otherwise seek consent first
What is diversity?
Recognising and valuing differences between individuals across groups
What are the protected characteristics?
Age
Disability
Sex
Gender reassignment
Marriage or civil partnership
Pregnancy and Maternity
Race
Religion and beliefs
Sexual orientation
What is equality?
In general it’s about ensuring each individual or group is given the same resources and opportunities regardless of factors such as protected characteristics
And in healthcare we recognise people have different individuals needs so much treat people in a way that the outcome for each person can be the same i.e. pt’s can receive good standard of care
What is inclusion?
Striving to meet needs to different people and taking deliberate actions to create environments where everyone feels respected and can achieve full potential
What does equality and diversity do to help?
Better health outcomes
Improved pt access and experience
Representation
Inclusive leadership
How do we challenge discrimination?
Promote discussion - make people feel safe to discuss this
Provide sources of further info
Avoid appearing judgemental
Obtain support from line manager or organisation’s equality and diversity lead
What does the term safeguarding mean?
To protect individuals/groups from harm by putting in controls and measures in place
What does the term abuse mean?
Any action that causes significant harm to an individual e.g. physical or psychological damage/injury
Who is more at risk of abuse (adults)?
Learning difficulties
Older people who are isolated
Those with memory problems
Dependent on others for support
Carer is addicted to alcohol or drugs
Live with a carer
Who is more at risk of abuse (children)?
Parental or carer drug or alcohol misuse
Carer mental health problems
Intra-familial violence/hx of violent offending
Previous child maltreatment in members of the family
Known maltreatment of an animal by carer or parent
Vulnerable and unsupported parents or carers
Pre-existing disability in the child
What do we need to consider about cultural influences?
Impacts on people seeking help due to fear may be outcasted/honour violence inflicted, or may believe abuse is normal and apart of cultural practice
What are the different forms of abuse?
Physical abuse - intended to cause pain, injury, physical harm e.g. inappropriate restraint, handled roughly with lifting aids
Psychological/emotional abuse - damaging a person’s psychological wellbeing e.g. power imbalance, feeling unworthy/humiliated/controlled by words or actions
Sexual abuse - forcing/enticing person to take part in sexual activity against their wishes/not able to consent e.g. touching outside of clothing, indecent exposure, grooming
Neglect - persistent failure to meet person’s physical and psychological needs (deliberate or accidental or not understanding needs) e.g. not providing adequate access to medical care
Financial abuse - unlawful use of person’s property, money, valuables, pressured into giving money, making profit without consent
Discriminatory abuse - failure to consider personal or religious beliefs in care plan that can impact on spiritual welfare, age discrimination is offence under Equality Act 2010
FGM - partial, complete, removal of female genitalia to control reproductive and sexual rights
What are signs of physical abuse (non-accidental injury)?
Bruising at multiple stages of repair
Bruises on children who are not yet crawling
Injuries inconsistent with age of pt
Frequent hospital attendance
Inappropriate hx for injury
Cigarette burns and handgrip bruises
Fear of those around them
Fear of making mistakes
Withdrawn and quiet
Delays in seeking help for illness or injury
What are signs of emotional abuse?
Lack of social skills
Low self-worth
Depression
Self-harm
Poor relationships with others
Helplessness
Excessive fear or anxiety
What are signs of sexual abuse?
Physical signs e.g. anal/vaginal soreness
Sexual transmitted infection
Unusual discharge
Inappropriate use of sexual language for age
Child being sexually active at young age
Guilt or shame
Appearing frightened by or avoiding being near to certain people
What are the signs of neglect?
Poor appearance and hygiene
Untreated injuries or dental issues
Poor physical development for age
Poor language or communication skills for age
Pressure sores
Signs of malnourishment or dehydration
Dirt, urine, or faecal smell in person’s environment
What the signs of financial abuse?
Unexplained loss of money
Unusual bank account activity
Rapid deterioration in person’s standard of living as no longer afford essential goods and services
Relative/carer moving into home and taking control
What must we do if we come across FGM?
Report to police if informed by girl under 18 she has FGM or observe physical signs for girl under 18 as criminal offence in UK/to take child abroad for procedure - causes long-term physical and mental health impacts on well-being
Can Munchausen’s syndrome be abusive?
Yes, carer/parent can fabricate illness and induce symptoms of illness in adult and child - physical/emotional abuse
What do we do when we spot signs of abuse?
Remain calm and professional
Manage the pt’s presenting complaint first
Accept given explanation and limit questioning if suspicious - DO NOT accuse parents/carers as more likely to refuse transfers
Think about if there is an immediate risk of harm (safety), if so recommend hospital admission to remove them from situation and include concerns in handover - if refused, seek further advice from safeguarding team/contact police
Think about if others need to be considered e.g. children
Inform parents/carers of concerns unless believe it might put pt at risk of harm and justify reasoning for not informing them of epcr
Preserve evidence e.g. don’t use items you believe have been used to assault victims
What do we do if someone discloses abuse?
Treat them with dignity and respect
Take them seriously - act in a manner that suggests you believe them, including body language
Write down ‘word for word’ what has been disclosed - remain factual
Preserve evidence e.g. ask victims to not wash/change clothes
Include in handover
Why do we contact EBS?
To refer pt’s who are at risk/are being abused or neglected - we report all concerns no matter how small
Find out if pt has had any previous referrals
What do we do if we believe EBS are not handling referral adequately?
Speak to senior manager or colleagues about concerns
Make records of all concerns and pass this on to EBS
What must we always on every job?
Be aware of signs of abuse/neglect ‘think the unthinkable’
Consider abusers can be charming and explain things away
What is CONTEST and what are the 4 related P’s?
CONTEST deals with terrorism and works to reduce vulnerabilities/threats of terrorism
Pursue - investigates/disrupts attacks
Prevent - works to stop people from supporting/becoming terrorists
Protect - improves protective security to stop an attack
Prepare - works to minimise impact of attack/recovery as quickly as possible
What is the goal of PREVENT?
To prevent a person from coming to support terrorism or forms of extremism leading to terrorism. They work in sectors where there is a risk of radicalisation and address this e.g. challenge ideologies, draw people away from environments where this is promoted
What is my job when it comes to radicalisation?
I need to recognise those at risk of becoming radicalised/recognise if a person holds extremist views on a job e.g. learning difficulties, socially isolated, prisoners, e.g. hx from family/friend, gradual/sudden change in ideological views, reaction to certain events
I need to contact EBS with my concerns
What does the Health and Safety at Work Act do?
Stops you from getting hurt or ill at work by lawfully ensuring H&S risks are controlled as reasonably possibly
What are employers required to do under the H&S at work Act?
Complete risk assessments deciding what could harm anyone affected by work-related activities and arrange plans for controlling, monitoring + reviewing measures that have been implemented from this
Inform staff of risks/how they are controlled/who is responsible - make sure staff have access to written H&S policy
Provide PPE and free training/equipment
Provide toilets, washing facilities, drinking water, first aid kit
Notify H&S executive of major injuries/fatalities at work
Ensure adequate supervision
Have insurance to cover staff when injured at work + display physical copy/electronic copy
Consult with employees about current measures
What are employees required to do under the H&S at work Act?
Follow training provided by employer when using any work item
Take care of own and other people’s H&S
Co-operate with employer on preventing risks and informing employer when think method is inadequate/puts people at risk
Be aware of any changes/updates from bulletins/emails/know where to find all info regarding H&S
What are employers responsible for when it comes to Manual Handling?
Reducing risk of injury as far as reasonably practicable e.g. providing work equipment and PPE
What do employers do when it comes to work equipment?
Make sure it is suitable for purpose it is used
Make sure working conditions are appropriate for work equipment
Ensure it is only used for its purpose
Ensure it is maintained in an efficient state/in good repair
When do we use PPE?
As a last resort when risk of harm cannot be adequately controlled in other ways e.g. hard hats, gloves, eye protection, high-vis, safety footwear, FFP3 with suctioning, CPR, pandemic flu, MERS
Who is responsible for managing/minimising risks for substances hazardous to health and how do they do this?
Employers
They do a risk assessment and implement measures to prevent/control emission, release, and spread of substances hazardous to help
They take into account routes of exposures e.g. inhalation, skin and ingestion
Provide training and PPE to minimise risk
What are substances hazardous to health?
Chemicals
Fumes
Dusts
Vapours
Mists
Gases/asphyxiating
Biological agents where hazard symbols are on packaging
What does a H&S executive do?
Responsible for reducing work-related death/serious injuries by researching and investigating incidents, providing a range of improvement orders or filing prosecutions for breaches to prevent future injuries/death and hold people/company responsible.
Why must we follow H&S regulations?
To protect us, colleagues, patients, employers from risk of harm making work safer and more enjoyable
What is a hazard?
Anything that might cause harm e.g. chemicals, electricity
What is a risk?
Chance someone can be harmed and how serious the harm could be e.g. high or low chance of injury to pt, staff, public - can be affected by service interruption, REAP increases - can cause financial/legal consequences or reputation issues
Clinical risk - chance of adverse outcome resulting from clinical investigation/treatment/care
How to we minimise chance of harm as far as reasonably practicable on a job?
Upholding duty of care to pts, ourselves, and colleagues by performing risk assessment - usually dynamic - performed when arriving ONS and regularly throughout pt care
What are the steps of a risk assessment?
Identify hazards e.g. what could go wrong and why, equipment
Decide who might be harmed and how e.g. manual handling
Evaluate risk e.g. likelihood (rate 1-5, 1 rare, 5 almost certain), how bad, how often, decide on precautions e.g. can hazard be eliminated and risk be controlled giving lower rating, access to hazard reduced, work practices reducing risk? PPE?
Record findings and proposed actions, identify who will lead on what action
Review assessment and update if required
Why is infection and prevention control so important?
Stops us from getting ill leading to several days or weeks off
Prevent pt’s condition worsening - those on chemo/steroids can be killed by healthcare-associated infections
Duty of care - protect us from passing infections onwards
What does the Care Quality Commission do?
Monitors and inspects all health and social care - holds employers accountable for meeting codes of practice and issues fines, public warnings, and closures if standards are not met.
For instance, looks at IPC:
Manage/monitor prevention of infection
Use risk assessments
Provide/maintain clean environment
Ensure anti microbial use
Provide info on infections to service users
Identify people more at risk of developing infection and find ways to reduce risk of transmitting
Make sure employees aware of responsibility to reduce spread
Provide isolation facilities
What does the Public Heath of England do?
Monitors/helps control outbreaks of infectious diseases e.g. hepatitis, herpes, measles
What is a microorganism?
Lives outside/inside larger organisms, bacteria, viruses, fungi, and parasites
Examples of bacteria?
Group A streptococcus - throat and ear infections
methicillin-resistant Staphylococcus aureus - pneumonia - resistant to antibiotics
Examples of viruses?
Reproduce by using cellular machinery of other organisms e.g. rhinovirus, shingles, chickenpox
Examples of fungi?
Dermatophytes e.g. athletes foot
Candida e.g. vaginal thrush
Examples of parasites?
Lives at expense of host e.g. bacteria, viruses, animals e.g. roundworms, malaria, toxoplasmosis
What are the steps of chain of infection?
Pathogen required
Reservoir - place where pathogen can live and replicate e.g. human body and water
Exit route - method for pathogen to leave reservoir e.g. urine, faeces, vomit, sputum, sneezing/coughing
Route of transmission e.g. touching pt, contaminated bedding, clothing, hands of healthcare workers, bodily fluids
Entry route - respiratory, GI, skin
Susceptible host - more vulnerable to infection that others e.g. old age, meds, natural defences compromised by wounds, cannulas, catheters
How do we tackle spread of infection?
Good hand hygiene - most important for reducing HCAIs
Cleaning, sterilising equipment + environment
Treating pt’s with antibiotics
Wearing PPE e.g. a FFP3 mask when travelling with infectious pt, protective suits
Covering open wounds with waterproof plasters
Be vaccinated and have adequate nutrition
Wash uniform after every shift on hottest wash/uniform changes after contaminated
Prevent sharp injuries/splash contamination
Cover mouth when sneezing/disposing of single use tissues/washing hands immediately afterwards
How do we have good hand hygiene?
Clean hands before and after direct pt contact/care/aseptic procedure
After any exposure to body fluids
After any interaction with contaminated objects/surroundings
After removal of gloves
Can use alcohol rub but not if hands soiled and not if alcohol-resistant e.g. CDIFF
Be bare below the elbows
DO NOT wear jewellery/watches, nail polish
Cover cuts/abrasions with waterproof dressings
Preserve hand health - wash too much can cause dermatitis and develop cracking/blisters so use moisturisers
How do we maintained good personal hygiene?
Having shower everyday
Brush teeth
Wash hair
Wash hands before/after going toilet, eating food
Wearing clean clothes
How do we dispose of waste (colours included)?
Sharps bin - contaminated syringes, medicine residue
Orange clinical waste - contaminated gloves, PPE, dressings, airway, laryngoscope blades
Black bin - domestic waste, packaging
Becomes incinerated
What are the colours of wash buckets and usage?
Red - bathrooms, washrooms, showers, toilets
Green - kitchen and dining areas
Blue - general areas
Yellow - isolation areas, inside of ambulances
What are the 3 stages of cleaning?
Decontamination - cleaning/removing of physical dirt/visible contamination from surfaces - detergent wipes e.g. green clinells or soap+water
Disinfection - reduces number of viable of microorganisms by heat or chemicals e.g. red clinells used after pt with candida auras (anti microbial resistant microorganisms)
Sterilisation - removes all viable microorganism including viruses/bacterial spores - chlorine disinfectant
How do we clean the vehicle, environment, and equipment?
Green clinells - decontamination
How do we clean after pt’s with drug resistant organisms travel with us?
Red clinell wipes if require higher clean - disinfectant
How do we clean body fluid spillages?
Wear gloves and apron
Orange spill wipes - soaks 1L
Green with green clinells after
Take off road and mop with anti bak
Discard mop and clean yellow buckets
Wash hands after
What do we do with significant spillages or bed bugs?
If over 1L and contaminations into grooves of trolley bed/floor tracks or bed bugs contact VRC as requires decontamination by vehicle prep team
Clean what you can e.g. bed bugs with green clinells or use spill kit
Crew shower and uniform change if appropriate
If under 1L we clean not VRC
How do we discard of cytotoxic and cytostatic medicines?
Place in yellow container with purple lid
Each container should be replaced every 3 months - must be locked and label filled in
How do we manage sharp boxes?
Fill till 3/4
Make sure snapped shut to prevent injury
What do we do if we have a COSHH spill?
Follow guidelines on what to do in case of spill and know where cleaning products are stored
What do you do if you have a biological spillage?
Isolate where spill occurred
Use spill pack -
Place absorbent pad/granules on spill
Remove pad into appropriate waste bag
Use disinfectant wipe
Mop floor with cleaning solution
Dispose of cleaning materials into appropriate waste bag
How do we prevent a sharps injury?
Keep sharps covered where possible
Know where stored
Check integrity of packaging frequently
Ensure others know you are using a sharp item
What do you do if you have a sharps injury?
Encourage wound to gently bleed, wash under running water and soap
DO NOT suck wound or scrub around it
Report injury
Seek medical attention as prophylaxis may be required - Hep B, C, HIV can be spread
What do you do if you experience splash contamination?
Open cuts/wounds/mucous membranes e.g. eyes and mouth
Irrigate areas with water and attend ED as prophylaxis may be required
What is stress?
Adverse reaction to excessive pressure or demands placed on them e.g. work
How can stress affect behaviour?
Difficulty sleeping
Altered eating
Smoking/drinking more
Avoiding friends and family
Sexual problems
How can stress affect us physically?
Tiredness
Indigestion
Nausea
Headaches
Aching muscles
Palpitations
How can stress affect us mentally?
Increased indecision
Difficulty concentrating
Poor memory
Feeling inadequate
Low self-esteem
How can stress affect us emotionally?
Mood swings
Increased anxiety
Feeling numb
How can we manage stress?
Physical activity
Healthy diet
Taking control - have a say in what you do/work you do
Talking to someone/sharing troubles - management, organisation, colleagues, family
Avoiding unhealthy habits e.g. smoking, caffiene, alcohol
Accept things can’t change and focus on areas where you can have an impact
What is manual handling?
Transporting or supporting of a load (discrete moveable object) by hand or force e.g. lifting, putting down, pushing, pulling
What is the most common injury with poor technique in manual handling?
Musculoskeletal injuries, back
Herniated disc - repetitive action/sudden movements cause outer layer (annulus fibrosis) to rupture and protrude out
Can then result in sciatic from pinching on the nerves
What does TILE stand for?
Task - involve holding load away from body, long distances? twisting or strenuous effort?
Individual - requires specialist training? a hazard? capable of lifting? you or colleague pregnant?
Load - heavy and bulky? difficult to get hold of? unstable? unpredictable? harmful? likely to grab out on stairs?
Environment - constraints on posture e.g. ceiling low? confined spaces, poor uneven flooring, hot/cold/wet weather, poor lighting
Equipment - what is available? what reduces risk to pt and us, is it safe to use? trained and competent to use (can look at manual or ask carers to use hoist)?
What do you do if pt refuses manual handling aids?
Offer alternative aids, if not accepted call line manager while ONS to make a decision
What are the rules of twisting beyond 10%, beyond 45%?
Reduce weight by 10%
Rude weight by 20%
What handling aids are there?
Handling belts, slide sheets, bananas boards, lifting cushions etc
What do we need to check before every shift regarding manual handling equipment?
Check trolleys and carry chairs are in date and are not damaged/defective
What is good manual handling?
Stable position - feet apart with one leg slightly forward for balance
Good posture - squat, don’t flex back
Keep load close to wait - heaviest side of load next to body as can lift most below elbow
Avoid twisting/leaning sideways - shoulders kept level and facing in same direction as hips, move feet instead of twisting
Put down and adjust if needed
How do lift in a team?
Run through plan before moving so everyone is clear
“Ready, set, move”
Do actions at same time
How do we lift a bariatric (morbidly obese) pt?
May need specialist equipment or additional colleagues as extra weight and reduced mobility
How do we move someone in a confined space?
Use slide sheet to move:
Pt - arm further away from me they put across their chest, arm nearer to me lay down next to them
Me - support pt’s hip and shoulder and roll pt onto side
Colleague - slide sheet under
What are the different positions a pt can in on the stretcher?
Semi-recumbent - head+torso at angle of 45 degrees
Recumbent - laying flat, suspected spinal injuries
Fowler - semi-recumbent and knees elevated (legs downwards) - helps relieve tension of abdominal muscles
Trendelenberg - laying flat and legs elevated
What does the Medicines Act allow and not allow?
General sale of drugs to public that do not require a prescription
DOES NOT allow prescription only meds to be sold - need a prescription from doctor or non-medical prescriber
What does the Misuse of Drugs Act do?
Control drugs that are considered dangerous or. harmful (risk of dependence or misuse)
Morphine and diazepam/midazolam are allowed to be used by paramedics in specific conditions
What are the different classes of drugs?
Class A - morphine, cocaine
Class B - amphetamine, codeine
Class C - diazepam and lorazepam
What are the different routes drugs can be administered?
Parenteral - skin/mucous membranes breached
e.g. IV or IM
Non-parenteral - passive absorption e.g. inhalation, neb, oral, rectal, buccal, transdermal
What must we check before administering a drug?
Pt not allergic to drug
Check for contra-indications
Correct drug
Dose of drug required
Presentation of drug e.g. concentration, tablet, ampoule
Packing intact/ampoule integrity intact
Clear fluid (diazepam is milky-white always)
Drug not expired
Pt consents (if possible/capacity) and provided with clear instructions e.g. aspirin chew and dissolve, DO NOT swallow, buccal tablets place between gum and cheek
What must we do after administering a drug?
Document
Monitor for adverse reaction
How to be overcome barriers to accessing healthcare?
Educational campaigns - tv adverts, posters, leaflets, 111 advice
Language line
Transport services offered to those with poor mobility
Temporary respite for those who are carers
Low income pts can be reimbursed for journeys
What are some barriers when it comes to accessing healthcare?
Culture/language barriers
Poor education
24/7 carer for someone
Geographical barriers
Concerns over what could be discovered
How might we communicate with someone with learning difficulties?
Ask what their preferred method of communication is and how to adapt for this e.g. find out from carers + family OR look at person’s care plan as may be found on there
Can use story boards or makaton (sign language)
What is the difference between a working relationship and a personal relationship?
Working - paid to be there, contact restricted to working hours, follow policies and procedures and have limited physical contact, remain professional, no gifts are exchanged, conscious of what we’re discussing, not formed out of choice
Personal - informal, contact can be abundant, choose to be friends, not governed by policies/procedures and can discuss views/opinions openly, physical contact freely used and gifts exchanged, unpaid
What are some barriers to communication?
Physical obstacles - door, contact via phone
Language - translator
Extreme emotions
Age - babies that cannot communicate to infants who cannot understand
Learning difficulties/disabilities
What makes consent valid?
Given voluntarily, free from pressure exerted by relatives, partners, ambulance staff, police etc.
Pt appropriately informed about why intervention should be done/plan of action in order to consent
Pt has capacity
Over 18 - under 18s require parental consent
What is patient-centred care?
Considering pt’s values, preferences, verbalised needs in pt’s treatment + involving pt in own treatment - most likely to be successful if it coincides with their wishes
What rights does an individual have when it comes to care?
Right to life - preserve life
Right to autonomy - make decisions for themselves, can refuse care, must not be coerced and pressure
What is good standard of care?
Obtaining consent otherwise do not have pt - acting in best interests if does not have capacity
Providing safe, patient-centred care
Remaining respectful and preserving dignity at all times
Duty of care - preventing harm - wearing PPE as last resort
Duty of candour - fessing up to making a mistake immediately
Safeguarding - identifying risks/abuse/harm and referring
Respecting confidentiality - not passing info on justifiable cause e.g. under 18 safeguarding concern
Not going outside of scope and keeping up to date with training - CSRs and CPD
