Clinical Governance Flashcards
What is clinical governance?
Systematic approach to maintaining and improving quality of patient care within health system
Framework for continuously improving service and safeguarding high standards
Legal responsibility for quality of health care
What are the aspects of institute of medicine’s dimensions of quality healthcare?
- Person-centred- people are not always ‘patients’
Ensure respect for individual needs, shared decision making, clear communication, compassion, continuity - Safe- avoiding injury or harm
Clean and safe- PPE, infection prevention
Appropriate- patient in right place - Effective- evidence based interventions
- Efficient- value for money (budget and health economics)
- Equitable- treating patients fairly, no bias for age/gender/religion/class/location
- Timely- right time and place for everyone (ensuring no adverse delays or waiting times)
What % of patients are harmed through healthcare?
10% patients are harmed through healthcare
-> 3-25% in acute care (hospital care)
What % of patients receive treatment as per clinical guidelines?
half
What factors contribute to adverse events?
Human factors
-> teamwork, communication, stress and burnout
Structural factors
-> reporting systems, infrastructure, workforce loads and the environment;
Clinical factors
-> complexity of care and length of stay.
What are the pillars of clinical governance?
- Education and training
- Clinical audit
- Clinical effectiveness
- R and D
- Openness- report issues, evaluate errors, transparency, duty of candour
- Risk management
What can be done to deliver dimensions of quality healthcare and clinical governance?
Setting quality standards
Delivering quality standards
Monitoring quality standards
How are quality standards set in healthcare?
Good clinical practice changes in light of evidence from research
Important to reduce to a minimum time lag of implementation of research findings into clinical practice
What are the steps in the evidence pipeline?
Aware
Accept
Applicable
Able
Act
Agree
Adhere
What are the leaks in evidence pipeline?
Leaks- 0.8x lost each time
-> 20% of new effective care is implemented/adhered to
-> Sometimes lack of remuneration leads to gold standard not being followed
How are quality standards set?
Critical appraisal of literature
Development of clinical guidelines and protocols
Implementation strategies
What is the definition of clinical guidelines?
Systematically developed statements which assist in the decision-making about appropriate health care for specific clinical conditions
What are the aims of clinical guidelines?
Uses best evidence to improve healthcare practice
- Recommendations
- Criteria for audits
- Education and training
- Informative to patients
- Improve communication between patient and health professionals
What are the different levels of evidence?
Systematic Review (Cochrane) & RCT
Cohort
Case-Control
Case Series
Narrative Review, Editorial
Case Report / Epidemiology / Animal Studies
What are the SDCEP guidelines based on?
Current legislation/professional regulations
Group consensus after critical evaluation of evidence
Group consensus after considering expert opinion
What are topics for which SDCEP guidance is available?
Acute Dental Problems
Anticoagulants and Antiplatelets
Bisphosphonates
Caries in Children
Conscious Sedation
Decontamination
Drug Prescribing for Dentistry
Emergency Dental Care
Medication related to osteoradionecrosis
Oral Health Assessment and Review
Periodontal Care
Practice Management
What are some of the activities carried out to deliver quality standards in healthcare?
Education and training: CPD of all staff
Clinical effectiveness: evidence–based practice in daily use (includes aspects of efficiency)
Openness on poor performance and practice
-> Processes and systems which recognise and manage poor performance should be in place and open to public scrutiny
Risk management- patients and practitioners
What are the activities that are focussed on quality improvement in healthcare?
Clinical audit
Peer Review
Enhanced Significant Event Analysis - Critical incident review
Research projects
Quality Improvement Projects / Scottish Patient Safety Initiative (still to be defined)
What are the CPD requirements for a dentist?
Requirement: 100 hours verifiable CPD within 5-year cycle and at least 10 hours verifiable every 2 years
-> records maintained by dentist and checked by GDC
What are the requirements needed for CPD to be verifiable?
Concise educational aims & obj
ILOs / quality controls
-> provide documentary evidence (certificate)
What are examples of CPD activities?
Courses and lectures
Training days
Peer Review
Clinical Audit
Reading journals
Attending conferences
E-learning activity
What are the highly recommended CPD topics in order to achieve patient safety?
Medical emergencies- 10 hours every cycle (2 each year)
Decon- 5 hours every cycle
Radiation protection- 5 hours every cycle
Legal and ethical issues
Complaints handling
Oral Cancer: Early detection
Safeguarding children and young people / safeguarding vulnerable adults
What is a clinical audit?
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.
What are the steps in clinical audit?
- Set topic
- Set agreed standards and data requirements (from guidelines)
- Observe practice and collect data (100 patients)
- Analyse data- determine if any deviation from standard
- Identify changes
- Make changes
- Repeat
What are the steps in the audit cycle?
- Identify issue
- Set criteria and standards
- Observe practice and collect data
- Compare performance with criteria and standards
- Implement change
REPEAT
Which processes and outcomes may you wish to carry out audits on? (examples)
Process:
Medical / smoking / alcohol consumption
Brief smoking cessation advice to smokers
Fluoride varnish applied to teeth of all children
Outcome:
Repeat radiographs
Percentage of failed endodontics within defined time period
What are the strength of clinical audits?
Critical review of current practice:
Encourages learning about new techniques and treatments
Small group work:- modifying attitudes and management of clinical conditions
Re-enforcement of agreed procedures
Observation of practice:- indicate gaps in knowledge and/or skills (opportunity for training)
What are the components of peer review?
- Share experience
- Share learning and implement change
- May be based off audit
What is PDSA, how is it different from audit?
Plan do study act
-> Similar to audit but starts by implementing change i.e Hand hygiene
