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DEP Paper 1 > Clinical Information > Flashcards

Clinical Information Flashcards

1
Q

What are the standards of proficiency for the HCPC?

A

Practice safely and effectively within their scope of practice.
Practice with in the legal and ethical boundaries
Maintain own health and wellbeing
Work automously using their own judgement
Practice inclusive, recognising culture, equality and diversity
Understand the importance of confidentiality.
Communicate effectively
Work appropriately with others.
Maintain records appropriately.
Reflect and review practice.
Assure the quality of their practice.
Understand and apply the key concepts of the knowledge base relevant to their work.
Draw on appropriate knowledge and skills to inform practice.
Have a safe practice environment.
Promote health and prevent ill health

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2
Q

What is clinical governance?

A

A framework which makes the NHS accountable for continually improving the quality of service and safeguarding high standards of care. Creating an environment where excellence in critical care can flourish.

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3
Q

What does clinical governance consider?

A

Safety, quality and effectiveness.

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4
Q

What is required in order for clinical governance to be effective?

A

Robust national and local systems, quality improvement and a learning culture.

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5
Q

What does CQC stand for?

A

Care Quality Commission

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6
Q

What is the CQC?

A

An independant regulator of health and social care in England.

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7
Q

Who do the CQC assess?

A

Care homes, hospitals, dental services, Clinics, home care agencies, GP services, mental health and community care.

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8
Q

Under the CQC, what does everyone have a right to?

A

Care that is tailored to your needs and preferences, allowed visitors, dignity and respect, consent, safety, safeguarding from abuse, food and drink, complaint procedures, proper and fit staff and duty of candour.

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9
Q

What do the CQC consider?

A

That the provider is Safe, Caring, responsive to people’s needs, Effective in their care and Well-lead. SCREW

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10
Q

What does everyone have a right to under the health and safety act?

A

A safe working environment, with controlled risks.

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11
Q

What does the health and safety act consider?

A

Safety and systems
Maintained equipment
Storage of materials
Handling of materials
Use of materials
Transportation of materials
Risk assessments

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12
Q

Who is able to serve notices and prosecute under the health and safety act?

A

Health and safety executive
Local authorities

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13
Q

What are an employers duties under the health and safety act?

A

Decide what can cause harm
Install precautions
Explain the risks
Co-operate with the HSE
Give training
Supply and maintain PPE
Supply water
Supply toilets
Supply first aid
Report serious injuries

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14
Q

What are an employees duties under the health and safety act?

A

Follow training
Responsible for everyone
Co-operate with their employer
Inform employers of risks

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15
Q

What does COSHH stand for?

A

Control of substances hazardous to health

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16
Q

How can you prevent or reduce exposure?

A

Identify the hazard
Identify how to prevent it
Provide control measures
Ensure there is compliance
Train and educate
Monitor exposure
Have emergency plans in place

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17
Q

What control measures can be used to reduce or remove risks?

A

Eliminate the need
Safer versions
Change the process
Enclose emissions
Extract emissions
Reduce staff levels
PPE
Specialist equipment
Maintain equipment
Adequate cleaning
Manage risks
Adequate disposal

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18
Q

Give five ways in which ecposure can occur, I relation to COSHH?

A

Breathing
Skin contact
Swallowing
Contact with eyes
Skin puncture

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19
Q

When looking at the COSHH of a new chemical or process, what should you consider?

A

What is harmful
How is it harmful
Can the risk be reduced
Alternatives
Reduce exposure
Is it essential
Local exhaust ventilation

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20
Q

What does PPE stand for?

A

Personal protective equipment

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21
Q

What does LEV stand for?

A

Local exhaust ventilation

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22
Q

What does WEL stand for?

A

Workplace exposure limits

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23
Q

What is the WEL of formalin?

A

2ppm over 8 hrs
2ppm over 10 mins

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24
Q

What does RIDDOR stand for?

A

Reporting of injuries, diseases and dangerous occurrances regulations

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25
Q

Under RIDDOR what must employers do?

A

Recort incidents and near misses that involve employees, visitors and the public

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26
Q

Under RIDDOR what events need recording?

A

Death
Accidents that result in death
Accidents that result in 7days + abscence
Accidents that result in hospitalisation
Illness caused by hazards as work
Occurances that are not reportable but have the potential to cause serious harm

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27
Q

What information should be in a RIDDOR report?

A

Date
Time
Plaxe
Nature of event
People involved
Injury
Description of the event

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28
Q

If an event leads to loss of work that is >3 days but <7, what should employers do?

A

Record the details but it doesn’t need reporting

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29
Q

How long are RIDDOR records kept?

A

3 years

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30
Q

How does RIDDOR help organisations?

A

Allows patterns to be seen
How events occur
Helps find preventative or reductive measures

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31
Q

Give 8 examples of events reportable under RIDDOR?

A

Carpal tunnel syndrome
Occupational dermatitis
Occupational asthma
Sharp injuries contaminated with Hep B, C and HIV
Fractures
Amputation
Loss of sight
Mesothelioma
Loss of consciousness

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32
Q

Give 2 examples of event not reportable under RIDDOR?

A

Suicide
Self harm

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33
Q

What is the purpose of fixatives?

A

Prevent autolysis and purification whilst preserving clear and consistent morphology.

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34
Q

What is an occupational exposure limit

A

The maximum allowance of an airborne concentration of a reagent over a set time, that an employee can be exposed to.

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35
Q

What kind of disposal is require?

A

Specialist

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36
Q

What hazards can be found with fixatives?

A

Severe eye and skin irritants
Toxic by inhalation
Carcinogens
Corrosive to most metals

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37
Q

Safety signs - what does a circle with a diagonal line through it, usually red mean?

A

Prohibited

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38
Q

Safety signs - what does a yellow triangle mean?

A

Warning

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39
Q

Safety signs - what does a sign that states a specific behaviour mean? Often blue

A

Mandatory behaviour

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40
Q

Safety signs - what do emergency signs look like?

A

Often green examples are first aid or fire exit.

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41
Q

What is the aim of PPE?

A

Protects users and reduces risks from:
Particles
Gases
Falling objects
Splashes
Contact with eyes/skin
Sharps
Extreme temperature

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42
Q

How do you know if PPE meats the required standard?

A

It is CE marked

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43
Q

If wearing more than one item of PPE what is important?

A

They must work together

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44
Q

Important considerations for PPE?

A

Staff should be trained in their use
They require maintaining or replacing regularly

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45
Q

What PPE is regularly used within a Histology lab? 8 items

A

Lab coats
Gloves
Safety glasses
Apron
Respirator
Insulated gloves
Ear protection
Wellington boots

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46
Q

What are the universal precautions for specimens?

A

Treat all specimens the same
Avoid sharps
Cover wounds
Wear PPE
Use fixatives to reduce the risk of infection

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47
Q

How long should high risk specimens be left to fix?

A

At least 24 hours (CJD is always high risk - sent to specialist centre)

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48
Q

What can chemicals harm?

A

Employees and the environment

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49
Q

How long does it take for a chemical to cause harm?

A

It depends on the chemical, some are immediate whilst others increase with prolonged exposure

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50
Q

Give two examples of a disease caused by exposure to carcinogens/mutagens/biological agents

A

Nasal cavity cancer - caused by wood dust
Mesothelioma - caused by asbestos

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51
Q

What is the hierarchy of control?

A

Substitute
Control exposure
Local ventilation
General ventilation
Good housekeeping
Limit exposure
Training
PPE
Good welfare facilities
Health surveillance

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52
Q

What are the minimum requirements for ID checks?

A

Specimens must have a request
At least 2 matching identifiers
Specimen types must match
Specimen orientation must match
Specimen numbers must match

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53
Q

Give 5 events that should have an incident log made ?

A

Miss matched specimen
Lost tissue
Specimen in wrong container
Spillage
Computer downtime

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54
Q

What are the consequences of transposing patients and samples?

A

Wrong patient receives treatment
Patient misses treatment
Wrong part of the patient receives treatment in paired organs
Disease continues unchecked
Psychological harm to both patients

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55
Q

When are checks for ID required?

A

Every time the specimen changes pot, cassette, slide
Upon receipt
Before being entered into the LIMS
Before being sent to the Consultant
Before being reported

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56
Q

What checks are needed on the specimen before dissection?

A

Specimen type
Number of specimens
Specimen site
Orientation
Clinical information correlation

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57
Q

What checks are needed on the specimen before dissection?

A

Specimen type
Number of specimens
Specimen site
Orientation
Clinical information correlation

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58
Q

There are any doubts with a specimen what should you do?

A

STOP
Speak with a consultant or colleague
Contact the clinician

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59
Q

What information should appear on a request form?

A

Patient identifiers
Patient demographics
Clinician details
Specimen type
Site of lesion
History of lesion
Recent changes
Previous relevant history
Clinical impressions

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60
Q

What are the consequences of errors in the lab?

A

Most specimens are irreplaceable
Missed diagnoses
Incorrect diagnoses
Missed treatments
Further invasive procedures
Further psychological distress
Unable to confirm complete excision

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61
Q

Where can errors occur in the lab?

A

Labelling errors
Miss-matched specimens
Dictation errors
Carry over
Loss of tissue
Orientation errors
Deviation from procedures
Poor processing
Oblique cuts
Under staining
Over staining
Inappropriate staining
Reporting errors
Inappropriate containers
Spillages
LIMS entry errors

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62
Q

How do we learn from errors made in the lab?

A

Understand how they occured
Assess the risk
Put in place any necessary precautions /changes
Train/educate staff

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63
Q

Why are errors at dissection so disruptive?

A

Early in the specimens journey so they stay during the remainder
Dissection is disruptive
Never see the specimen intact again
Consultants often never get to see specimen at this stage do they are relying on this stage for a lot of information

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64
Q

Why are Histology samples important to healthcare?

A

Allows for visualisation of tissue structure and changes that have occured.
Can be used in diagnosis, research, autopsy or forensic investigation

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65
Q

What factors contribute to errors?

A

Untidyness
Lack of concentration
Noise
High/low workloads
Poor handwriting
Poor handover
No secondary checks
Solo working
Lack of training

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66
Q

What steps should you take with sharps?

A

Assess the risk
Provide adequate training
Are they necessary
Alternatives that don’t compromise patient care
Easy to use
Controls on the procedure
Precautions
Monitor and maintain
Safe storage
Safe disposal

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67
Q

What steps should you take with sharps?

A

Assess the risk
Provide adequate training
Are they necessary
Alternatives that don’t compromise patient care
Easy to use
Controls on the procedure
Precautions
Monitor and maintain
Safe storage
Safe disposal

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68
Q

What first aid steps are taken following a sharps injury?

A

Never suck the would
Make the wound bleed
Rinse thoroughly
Cover
Seek treatment if needed

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69
Q

What is the aim of cleaning?

A

To remove foreign material

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70
Q

What is the aim of cleaning?

A

To remove foreign material

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71
Q

Is the aim of disinfectant?

A

To destroy microorganisms (not usually spores) on inanimate surfaces and objects

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72
Q

What is the aim of sterilisation?

A

To destroy all organisms on a surface

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73
Q

What do you do in the event of a reagent spillage (not formalin)?

A

Shut of sources of ignition
Respirator use
Spillages absorption granules
Open windows
Signage to prevent entry
Allow dispersal of fumes
Sweep up granules
Safely dispose of granules
Clean area
Monitor WELs

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74
Q

What do you do in the event of a formal spillage?

A

If >50mls evacuate immediately
Signage to prevent entry
PPE and Respirator
Formalin control granules, start at edge and work inwards
Ventilate area
Sweep up
Safely dispose
Clean area
Monitor WELs

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75
Q

What does a safety cabinet - class I do?

A

Protects against aerosol release

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76
Q

How does a safety cabinet - class I work?

A

Air drawn through the front, over the working area, through a HEPA filter, to a duct outside.

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77
Q

What does a safety cabinet - class II do?

A

Protects the samples from contamination, not the operator

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78
Q

How does a safety cabinet - class II work?

A

Recirculates the air
Filters the air

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79
Q

What is the aim of LEV?

A

To carry away particles etc before they can be inhaled

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80
Q

Ventilation must be…?

A

Fit for purpose
Maintained
Operated by fully trained staff
Used when a hazard cannot be removed, substituted, or the exposure time cannot be reduced

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81
Q

How do we deal with high risk specimens?

A

Extra 24hrs in formalin
All specimens treated as such
PPE
Dissinfect equipment, PPE, area after use
Clean hands and exposed areas after completion

82
Q

What do hazard group 1 organisms do?

A

No harm/ risk to hunans

83
Q

What do hazard group 2 organisms do?

A

Can cause harm/risk, unlikely to spread to the community, treatment available

84
Q

What do hazard group 3 organisms do?

A

Can cause harm, unlikely to spread to the community, treatment available

85
Q

What do hazard group 4 organisms do?

A

Cause severe harm, likely to spread to the community, no effective treatment available

86
Q

What category are TB, Hep B and C and HIV?

A

Category 3
HSE says can be treated as cat 2 as long as microbiological safety cabinet is used, area is clean, PPE, reduced staff exposed, open wounds covered, avoid sharps, full decontamination

87
Q

What specimen types require respectful disposal?

A

Ectopic pregnancy
Miscarriage
Terminations
Early interuterine fetal death (<24 weeks)

88
Q

What pregnancy related specimens are not covered under respectful disposal?

A

Still births (>24 weeks)
Neonatal deaths
Placentas

89
Q

Pregnancy related specimens up yo 24 weeks are considered to belong to…?

A

The mother

90
Q

Is consent needed for disposal of specimens relatinging to pregnancy?

A

No but it is obtained due to the sensitive nature.
Religious, personnel and cultural needs are followed when possible

91
Q

How can specimens relatinging to pregnancy be disposed of?

A

Incineration
Cremation
Burial

92
Q

Do the blocks and sales of pregnancy related specimens respectful disposal?

A

No

93
Q

What does a patient need to know when discussing the pregnancy related specimen?

A

What tests will be carried out,
What answers can hoped to be found
What will happen next
If multiple or single services will occur

94
Q

Why are clinical audits important?

A

Heart of clinical governance
Review wuality
Builds good clinical practice
Improves care
Highlights areas for improvement
Confirms good practices

95
Q

What is the audit cycle?

1➡️2➡️3➡️4➡️5➡️

A

1 aim, how will it be monitored and to what standards/measurements
2 do we, data collection and analysis
3 why not, change management
4 how to improve, redesign and further benchmarking
5 did it improve, monitoring

96
Q

How can we carry out the best clinical audits?

A

Specific questions
Specific data
Accurate findings

97
Q

What is the HTA 2004?

A

The human tissue act

98
Q

What does the HTA regulate?

A

Removal, storage, use and disposal of human tissue

99
Q

What are the fundamental principles of the HTA?

A

Consent
Dignity
Honnesty and openness
Quality

100
Q

Consent is required, unde the HTA, in order to…?

A

Anatomical examination
cause of death
Establishing drug deficiencies
Obtaining information that may benefit others in the future
Public display
Research
Transplantation
Information required for clinical audit/education/assessment/monitoring/quality assurance
Store post-mortem tissue

101
Q

List 5 offences under the HTA when done without consent?

A

Analyses DNA
Remove tissue
Store for longer than required
Traffic tissue for Transplantation
Carrying out activities without a HTA licence

102
Q

What is considered human tissue?

A

Anything removed from the body, from cells to organs

103
Q

Who is responsible under data protection?

A

Everyone

104
Q

What does data protection do?

A

Controls how personal information is used

105
Q

Information must be…?

A

Used fairly, lawfully and transparently
Used only for specific reasons
Used in an adequate, relevant and necessary way
Accurate and up-to-date
Kept for no longer than necessary
Handled securely

106
Q

What are the retention periods for records, blocks, slides, photos, request cards, non-permanant specimens and records for lab accreditation?

A

Records 30 years
Blocks 30 years
Slides minimum of 15 years
Photos 30 years
Request cards 1 month after verification
Non-permanent specimens until verification
Accreditation documents 8 years

107
Q

What is a SOP?

A

Standard operating practice

A set of practices to be followed when completing a task

108
Q

What must SOPs include?

A

All relevant legislation and steps in order to carry out the set task

109
Q

SOPs ensure…?

A

Safety and quality of results when followed

110
Q

What changes have been made in the recent update to ISO 15189:2022?

A

Risk based standards
Patient focused
Encourages continual improvement
Shall = mandatory
Should = strong recommendation
Option to prove certain standards are irrelevant to departmental practices must be justified

111
Q

What are the aims of the new ISO 15189:2022

A

Facilitates inter departmental/trust cooperation
Assists in the exchange of information
Contributes in waste production
Minimlises repetition of testing
Increases confidence in the service
Strengthens risk management

112
Q

What is the aim of networking pathology departments?

A

To consolidate pathology services
29 networks across England
Provide consistent, clinically appropriate TATs
Make better use of the workforce
To deliver earlier diagnostic services

113
Q

Give 5 piece of information that should be in an incident log?

A

Case number
Specimen type
Description of incident
Corrective action taken
Scoring of the risk involved

114
Q

What is the key to networks in pathology?

A

Digital pathology

115
Q

What is required before networks can work well?

A

Common standards and procedures
Interoperability of systems
Sharing of data

116
Q

Networking will lead to…?

A

Advanced roles in dissection and reporting
Bulk buying
Saving of money

117
Q

What is required in a report?

A

Precise clinical information from request form
Macroscopic description
Microscopic findings

118
Q

What are the aims of a dataset?

A

Layout the minimum required information and guidance
Enable grading and staging of lesions
Enable accurate and consistent reports
Comply with international standards
Ensure clinicians receive prognostic information

119
Q

What are the 5 steps of risk assessment?

A

Identify hazard
Identify people
Evaluate
Review controls
Findings

120
Q

What risks are found in dissection?

A

Sharps
Chemical
Fumes
Cross-contamination
Specimen mix ups
Loss of tissue
Electrical
Biological

121
Q

What is the aim of risk assessments?

A

Remove, or reduce if not, any risks identified

122
Q

What is a hazard?

A

Anything that can cause harm

123
Q

What is a risk?

A

The chance/likelihood of a person being harmed by a hazard and how serious that harm can be

124
Q

What is an incident report?

A

A record of what has happened and how it was resolved

125
Q

What is the purpose of an incident report?

A

Demonstrates assurance of good governance
Facilitates the sharing of learning from the incident at a local, regional or national level

126
Q

What are the key steps of an incident report?

A

Incident description
Identification of the cause
Learn
Try to prevent or minimise in future

127
Q

What is an RCA?

A

Root cause anylysis

A structured investigation used to identify the source of the error and determine preventative actions

128
Q

What is the aim of an RCA?

A

To identify the reason the incident happened

129
Q

What is an RCA?

A
130
Q

What does a RCA include?

A

Details of the investigation
Concise description of the incident
Where
Who
Severity
Findings
Recommendations

131
Q

How indepth are RCAs?

A

They can be concise, comprehensive, indepth or independent.
More severe incidents require more thorough investigations

132
Q

How are RCAs scored?

A

Scored for likelihood and impact

133
Q

When is validation used?

A

For a completely new method, reagent etc

134
Q

When is verification used?

A

Confirming an expected outcome

135
Q

What is Klob’s learning cycle?

A

Concrete evidence➡️reflective observation➡️concrete experience➡️reflective observation

136
Q

Give 2 examples of reflection cycles?

A

Klob’s learning cycle
Gibb’s model

137
Q

What is Gibb’s model of reflection?

A

Feeling➡️evaluation➡️analysis➡️
conclusion➡️action plan➡️
description

138
Q

Reflection is…?

A

Crucial for continual learning
Can be a positive or negative experience

139
Q

If someone is unable to give informed consent, which act of Parliament is needed to be considered?

A

Mental capacity Act 2005

140
Q

What are the 7 components to clinical governance?

A

Education and training
Clinical audit
Clinical effectiveness
Clinical information/clinical governance
Staff management
Service user/patient involvement
Risk management

141
Q

What does HSE stand for?

A

Health and Safety Executive

142
Q

What are the principles behind gross examination?

A

Formal documentation of tissue
Measurement of lesion/staging
Diagnosis of lesion
Selection of appropriate blocks
Description of atypical features
Audit of surgeons practice
Influence further surgery

143
Q

How does a report help clinicians?

A

Provides diagnostic information
Provides prognostic infornation
Guides possible further treatment
Allows them to give a high standard of care and appropriate management

144
Q

What is the purpose of tissue pathways?

A

Enable Pathologists to deal with routine specimens in a consistent manner and to a high standard
Ensures accurate diagnostic and prognostic information is included in the report
Allows clinicians to provide optimal patient care and appropriate management

145
Q

What are the IBMS codes of conduct?

A

Maintain and uphold professional standards
BMSs must display the highest standards of professionalism
Commitment to ethical conduct
Due careand consieto others
Putting the needs of the patient first
Respect confidentiality
Work within their limits
Never deligate to untrained colleagues
Communicate effectively
Do not allow bias, conflict of interest or undue influence override professional judgement
Take action if patient safety is compromised
Co-operate with employers and proffesional bodies to endure a high standard of care

146
Q

What is CPD?

A

Continual proffesional development

A record of activities that demonstrate learning and development throughout their career

147
Q

CPD must be….?

A

Accurate
Up to date
Varied
Recent to current and future practice
Explain how it benefits the servuce

148
Q

Give 10 examples of CPD activities?

A

Case studies
Reflection
Audits of personal practice
Peer review
Journals
Gaining experience
Courses
Training
Teaching others
Maintaining and developing skills
Conferences

149
Q

What are the 7 principles (concepts) of clinical governance?

A

Education and training
Clinical audit
Evidence based care and effectiveness
Information governance /clinical information
Staff and management
Risk management
Public and patients

150
Q

How do you fulfill your role inline with education and training?

A

Attending courses
Exams
CPD
Appraisals
Training new staff
Competency checks of colleagues

151
Q

How do you fulfill your role inline with clinical audits?

A

Part of the department audit cycle
Audit my own practice against standards

152
Q

How do you fulfill your role inline with evidence based care and effectiveness?

A

Ensure high standards in practice
Follow up to date guidelines

153
Q

How do you fulfill your role inline with staff management?

A

Appropriate recruitment
Staff development
Staff competency checks

154
Q

How do you fulfill your role inline with information governance?

A

Provide accurate details for the patient record
Protect confidentiality

155
Q

How do you fulfill your role inline with service users and patients?

A

Questionnaires
Feedback

156
Q

How do you fulfill your role inline with risk management

A

Robust systems to minimise the risk to the patient
Learn from mistakes
Follow procedures to reduce risks
Report risks

157
Q

What should be included in a clinical history?

A

Specimen type
Previous procedures/meducations/ results
Clinical impressions
Surgical procedures
Number of pots
High risk
Cancer oathways
Specific requests

158
Q

How can the clinical history affect dissection?

A

Previous history of DCIS - more extensive sampling
Specimen type - incisional versus excisional
Clinical impression of endometriosis on an appendix - put all through
Orientation - ink it
High risk - longer fixation, PPE safety cabinet
Cancer pathway - priority case

159
Q

What are the general principles of Macroscopic examinations?

A

Safety
Accuracy
Quality
Reproducability
Timely

160
Q

Give examples of the general principles of Macroscopic examinations?

A

Safety - trips, slips, PPE, sharps
Accuracy - 1 specimen at a time
Quality - competent, high quality work
Reproducability - datasets and tissue pathways
Timely - prioritise cancer pathway cases

161
Q

What are the five attributes of a clinical governance system?

A

Responsibilities
Standards and performance monitoring
Quality assurance
Quality improvement
Risk and incident management

162
Q

What are the key performance indicators?

A

Well defined performance measure that is used to observe, analyse, optimise and transform.

In the NHS - mortality, stroke care, inpatient and outpatient performance, infection prevention, patient safety, patient feedback and complaints.

163
Q

What should be considered when setting key performance indicators?

A

Easily measured
Realistic
Add value to monitoring
Help improve relevant areas

164
Q

What should be considered when setting jey performance indicators?

A

Easily measured
Realistic
Add value to monitoring
Help improve relevant areas

165
Q

How can key performance indicators be used?

A

Maintain standards
Pin point areas for improvement
Guides better decision making

166
Q

Who can give consent?

A

Patient
Nominated person
Qualifying person - spouse, parent, partner, power of attorney

167
Q

How can you ensure staff comply with legislation, policies etc?

A

Provide effective documentation to explain
Train staff
Monitor performance /knowledge

168
Q

What is a BMS’s role in clinical governance?

A

Carry out audits against standards
Ensure high quality results
Stay up to date on practices
CPD/training
Teach colleagues to a high standard
Risk assessment
Competency checks on staff
Hiring

169
Q

What should be considered when creating a document to ensure the correct result goes to the correct patient?

A

Request form and specimen labelling
Packing of specimen
Transport of specimen
Minimum dataset requirements
Safe and secure
How to order tests
Rejection policy
Staff responsibilities for every stage
SOPs
Acceptance procedures
Handling of specimen in clinic/theatre/lab
Audit trails
Risk management
Incident logs
Communication
Time frames
Fulfilment of tissue pathways
Transfer of results back to requestor
Confidentiality
Urgent specimens
Staff training
Staff competency
Overall responsibilities
Audit cycle

170
Q

What is duty of candour?

A

The requirement that healthcare professionals are open and honest with the people under their care, when something goes wrong and causes, or has the potential to cause, harm or distress

171
Q

What are the guiding principles of duty of candour?

A

Openness
Transparency
Candour

172
Q

Give 5 examples of LEV?

A

Microbiological safety cabinet
Fumes cupboard
Dissection down draft benches
High risk infectious disease rooms (cat 4)
Post mortem tables
Woodworking machinery duct collectors

173
Q

What questions does Histology hope to answer?

A

Is it normal, benign, neoplastic, malignant
Where does it originate from
Will a certain treatment be sucessful

174
Q

What does Histology examine?

A

Tissue obtained from biopsy, surgery, autopsy, exfoliation
Aspirated single cells
Cells that loose their architectural context
Examination to establish cause of death
Extent of a previously known or unknown disease

175
Q

What ancillary tests are available in Histology?

A

IHC
ISH
special stains
Molecular testing
Genomic studies
Proteomic studies

176
Q

What is important when considering a piece of underfloor ventilation for the dissection room?

A

Wipe clean
Non-porous
Running water below
Adjustable height
External extraction
Easy maintenance
Drainage
Easy access to drains

177
Q

What would you include in a SOPs for the dissection bench?

A

Cleaning procedure
Maintenance procedure
Decontamination procedure
Troubleshooting
Use protocol
Responsibilies for each staff grade
References including standards

178
Q

How can you ensure the correct specimen ID is maintained throughout?

A

ID checks at all stages
Double checks (2 staff)
Case numbers that are unique and simple
All slides, pots Cassettes are fully labelled
Barcodes and tracker system
Printed labels not handwritten

179
Q

How do you deal with a miss match between request form and pot?

A

Double check with a colleague
Contact Clinician, ask them to attend the lab and identify the specimen and correct any errors made
Clear audit trail of all steps
Correct information used going forward

180
Q

What is the purpose of clinical audit?

A

To ascertain if healthcare was s being provided in line with clinical governance and following guidelines
Let’s service users know if service is performing well
Evidence of ongoing competence
Identifies areas where improvement is needed

181
Q

What are the four main stages of clinical audit?

A

Agree/review standards, plan
Collect data
Compare data
Implement change
Re-audit

182
Q

Give examples of an examination audit?

A

Audit of SOP
Compliance against standards

183
Q

Give examples of horizontal audit?

A

Extra blocks required
Audit of cases against datasets

184
Q

Two cases are mixed up at dissection, how is this rectified?

A

Seperate specimens and place in specifically labelled cassettes.
Process and embed as normal
Explain situation to a consultant
Review slides ? Different tissue types, clear features that distinguish
Clinician and patients informed
Difficult to repeat most procedures
Patients can be reassured if both negative but not if one or both are diagnostic for disease
Incident report completed
? RCA

185
Q

How can we reduce the risk of miss matches?

A

Check IDs
2 pairs of eyes
Label everything correctly

186
Q

How can we reduce the risk of chemical inhalation?

A

LEVs
Only required amounts on the bench
Clean up Spillages immediately

187
Q

What are examples of biological risks?

A

Hazard group organisms

188
Q

What are examples of chemical risks?

A

Fornalin
Decal
Alcohol

189
Q

What are examples of mechanical risks?

A

Bone saw
Downdraft
Trolleys for large specimens

190
Q

How can you mitigate biological risks?

A

Fixation
PPE
downdraft
Respiratory mask

191
Q

How can you mitigate chemical risks?

A

COSHH assessments
Workload exposure limits
Monitoring
Maintenance
Fumes cabinets

192
Q

How can you mitigate radiation risks?

A

Extended fixation

193
Q

How can you mitigate mechanical risks?

A

Training
Maintenance

194
Q

How can you mitigate sharps risks?

A

Cut resistant gloves
Sharps bins
Needle stick injury protocol
Mandatory training

195
Q

How can you mitigate environmental risks?

A

Monitoring
Chemical workplace limits
Safety cabinets

196
Q

How can you mitigate environmental risks?

A

Monitoring
Chemical workplace limits
Safety cabinets

197
Q

How can you mitigate the risk of specimen errors ?

A

Work with a colleague
Check all details
Check previous history

198
Q

What legislations and codes of practice need to be considered if dealing with case notes?

A

Data protection
Caldicot

199
Q

What considerations are needed when dealing with case notes?

A

Confidentiality
If it necessary
Be specific in reading

200
Q

Who monitors and manages the clinical process?

A

Nationally the health service commissioner
Locally the chief exc has overall responsibility
Most trust have a clinical governance manager to assist, support and advise staff

201
Q

What is the aim of clinical audit?

A

To improve the quality of patient care and clinical outcomes through peer led review.

DEP Paper 1 (5 decks)

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