Clinical Governance

Question 1

What is clinical governance?

Answer 1

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

Question 2

What are the aspects of institute of medicine’s dimensions of quality healthcare?

Answer 2

1. Person-centred- people are not always ‘patients’
    Ensure respect for individual needs, shared decision making, clear communication, compassion, continuity
2. Safe- avoiding injury or harm
    Clean and safe- PPE, infection prevention
    Appropriate- patient in right place
3. Effective- evidence based interventions
4. Efficient- value for money (budget and health economics)
5. Equitable- treating patients fairly, no bias for age/gender/religion/class/location
6. Timely- right time and place for everyone (ensuring no adverse delays or waiting times)

Question 3

What % of patients are harmed through healthcare?

Answer 3

10% patients are harmed through healthcare
-> 3-25% in acute care (hospital care)

Question 4

What % of patients receive treatment as per clinical guidelines?

Answer 4

half

Question 5

What factors contribute to adverse events?

Answer 5

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.

Question 6

What are the pillars of clinical governance?

Answer 6

• Education and training
• Clinical audit
• Clinical effectiveness
• R and D
• Openness- report issues, evaluate errors, transparency, duty of candour
• Risk management

Question 7

What can be done to deliver dimensions of quality healthcare and clinical governance?

Answer 7

Setting quality standards

Delivering quality standards

Monitoring quality standards

Question 8

How are quality standards set in healthcare?

Answer 8

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

Question 9

What are the steps in the evidence pipeline?

Answer 9

Aware
Accept
Applicable
Able
Act
Agree
Adhere

Question 10

What are the leaks in evidence pipeline?

Answer 10

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

Question 11

How are quality standards set?

Answer 11

Critical appraisal of literature

Development of clinical guidelines and protocols

Implementation strategies

Question 12

What is the definition of clinical guidelines?

Answer 12

Systematically developed statements which assist in the decision-making about appropriate health care for specific clinical conditions

Question 13

What are the aims of clinical guidelines?

Answer 13

Uses best evidence to improve healthcare practice
- Recommendations
- Criteria for audits
- Education and training
- Informative to patients
- Improve communication between patient and health professionals

Question 14

What are the different levels of evidence?

Answer 14

Systematic Review (Cochrane) & RCT
Cohort
Case-Control
Case Series
Narrative Review, Editorial
Case Report / Epidemiology / Animal Studies

Question 15

What are the SDCEP guidelines based on?

Answer 15

Current legislation/professional regulations

Group consensus after critical evaluation of evidence

Group consensus after considering expert opinion

Question 16

What are topics for which SDCEP guidance is available?

Answer 16

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

Question 17

What are some of the activities carried out to deliver quality standards in healthcare?

Answer 17

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

Question 18

What are the activities that are focussed on quality improvement in healthcare?

Answer 18

Clinical audit

Peer Review

Enhanced Significant Event Analysis - Critical incident review

Research projects

Quality Improvement Projects / Scottish Patient Safety Initiative (still to be defined)

Question 19

What are the CPD requirements for a dentist?

Answer 19

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

Question 20

What are the requirements needed for CPD to be verifiable?

Answer 20

Concise educational aims & obj
ILOs / quality controls

-> provide documentary evidence (certificate)

Question 21

What are examples of CPD activities?

Answer 21

Courses and lectures
Training days
Peer Review
Clinical Audit
Reading journals
Attending conferences
E-learning activity

Question 22

What are the highly recommended CPD topics in order to achieve patient safety?

Answer 22

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

Question 23

What is a clinical audit?

Answer 23

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.

Question 24

What are the steps in clinical audit?

Answer 24

• 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

Question 25

What are the steps in the audit cycle?

Answer 25

1. Identify issue
2. Set criteria and standards
3. Observe practice and collect data
4. Compare performance with criteria and standards
5. Implement change

REPEAT

Question 26

Which processes and outcomes may you wish to carry out audits on? (examples)

Answer 26

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

Question 27

What are the strength of clinical audits?

Answer 27

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)

Question 28

What are the components of peer review?

Answer 28

• Share experience
• Share learning and implement change
• May be based off audit

Question 29

What is PDSA, how is it different from audit?

Answer 29

Plan do study act
-> Similar to audit but starts by implementing change i.e Hand hygiene