Clinical Governance Flashcards
7 pillars of clinical governance
- Clinical effectiveness
- Audit and peer review
- Risk management
- Education
- Patient information and safety
- Using information and IT
- Staff training
Risk factors may be minimised by:
- identifying the risk
- assessing the risk
- Removing the risk factors
- Reducing the risk factors
- Weighing up the outcome
- Sending adverse incident reports and significant event auditing to the national pt safety agency (NPSA)
Clinical governance framework 12 distinct areas
- Infection control
- Child protection and safeguarding
- Radiography
- Staff, patient, public and environmental safety
- Evidence based practice and research
- Prevention and public health
- Clinical records, pt. privacy and confidentiality
- Staff involvement and development
- Clinical staff requirements and records
- Patient information and involvement
- Fair and accessible care
- Clinical audit and peer review
Infection control
HTM01-05 decontamination in primary care dental practices:
- essential requirement for best practice
- involves whole dental team: adequate staff training needed for CPD
- every practice should have written infection control policy which should be followed
- procedures should be regularly monitored during clinical sessions and routinely audited
- all members of the dental team should understand and practice procedures: regular discussion at team meetings are recommended
- employers have responsibility to provide safe and hygienic environment for employees and patients
Child protection and safeguarding
Children and vulnerable adults
- dentists have a wider responsibility for the welfare of patients, which is not just limited to clinical care
- all members of the dental team have a responsibility to protect patients from harm and should understand what actions need to be taken if they have any concerns
- they should be able to recognise signs of abuse or neglect and find out about local procedures and follow them - raising concerns appropriately
- induction and training may be needed
- all staff need enhanced CRB/ DBS checks
- patient safety: all staff should be open and honest about any incidents, practice policy should be followed on what to do, there should be contemporaneous record keeping, investigations should be learned and there should be reflection at a staff meeting
Staff should:
. Listen and observe the child
. Seek an explanation from both child and parent or carer
. Retain contemporaneous records of everything seen or discussed
. Consider whether they suspect maltreatment or not
. Record all actions taken, including their professional conclusion
. Discuss concerns with colleagues, senior staff members and safeguarding lead
. Note that informal advice can be taken from local social services anonymously
Radiography
IRMER 2000 and health and safety at work act 1974
- dental radiographs are taken very frequently, although the dose is small each time professionals should always consider the collective effect
- a radiation protection adviser and supervisor must be allocated to each practice
- training records should be kept for all staff
- staff should consider the justification and authorisation of radiography
- they should consider equipment - keep maintenance records
- quality assurance - should be a maintenance plan: aim for 70% grade 1 and 20% not more than grade 2
Staff patient and environmental safety
Health and safety at work act 1974, reporting of injuries, diseases and dangerous occurrences regulations (riddor) 2005
= duties employer has to employee and the public, duties of employee to one another and themselves
- providing necessary instruction, training and supervision and implementing health and safety practice policy
- reporting injuries, diseases, dangerous occurrences
- analysing procedures and initiating changes as a result
- ensuring that all potentially harmful substances are handled and stored safely
- providing a safe work environment
- dealing appropriately with hazardous waste
- disposing of mercury and amalgam correctly
- dealing appropriately with asbestos
- handling anaesthetic gases
- ensuring electrical safety
- taking fire precautions
- handling infection control correctly
- taking appropriate precautions regarding radiation
- noting the dates of medicines and clinical products
- handling storage correctly
- keeping adequate records
Evidence based practice and research
Nice guidelines, faculty of dental surgeons guidance
- follow relevant NICE guidelines e.g. Recall intervals and wisdom-tooth removal
- evidence based practice should be reflected in treatment plans, delivering better oral health
- this should be evident in advice given regarding caries, toothbrush use, fluoride, healthy eating , periodontal matters, smoking cessation, alcohol misuse, tooth erosion, and crowns/ cuspal coverage for endodontically treated molars
- there should be compliance with referral protocols, for example the index of orthodontic treatment need (IOTN)
- continuing professional development should be evidence based
Prevention and public health
Delivering better oral health 2014
- evidence based prevention policy for all oral diseases and conditions
- delivering better oral health = smoking cessation, alcohol consumption, diet, fluoride, toothbrushing, caries, periodontal, erosion
Clinical records, patient privacy and confidentiality
Data protection act 1998, Caldicott guidelines 1997, GDC standards section 4
- clinical records should be securely stored: locked/ password protected
- there should be compliance with relevant legislation
- confidentiality should be maintained in all practice settings by all practice staff
- clinical audit reports should be kept
Staff involvement and development
- staff recruitment: relevant qualifications, experience, skills, abilities (scope of practice)
- pre employment checks: immunisation, disclosure barring service (DBS), registration, indemnity
- discrimination policy: written procedure manual including employment policies for example regarding bullying, harassment, sickness and absence
- appropriate staff training: dealing with complaints, appointing someone as a main point of contact, basic life support
- maintenance and CPD: CPD is a mandatory requirement and employers should ensure that staff undergo this
- clinical governance: quality assurance should be monitored via clinical audit and peer review. Meetings should be well attended by staff and contributions should be made via staff feedback and surveys
- there should be a confidential process to allow staff to raise concerns: practice policy should be in place with an identified lead and with links to practitioner advice and support schemes (PASS)
Clinical staff requirements and records
GDC standards sections 7
- all staff should be appropriately trained, registered and indemnified
- staff should all have up to date CPD
- all staff should know and follow policies and protocol for raising concerns and handling complaints
- staff should be aware of changes implemented as a result of any concern and investigations
Patient information and involvement
GDC standards section 1
- communicating effectively: encourage questions and ensure understanding
- patient leaflets should be available in a variety of languages used locally
- patient feedback - surveys and suggestion boxes
- treatment plans - written and signed (there should be written consent)
- clear and effective complaints procedure: written, readily available and can easily lead to changes being made
Fair and accessible care
- access to interpreters
- disability adjustments: Ramps, hearing loops - reasonable efforts made to accommodate disabilities
- emergency appointments available during the day - open access appointments
- all patients treated fairly
- audits and reports, changes made where necessary
Clinical audit and peer review
- all staff involved in choosing audit subjects and procedure and in peer review
- learning outcomes, changes communicated to all staff and local primary care trust
- all staff attend meetings and contribute
