CotE and PH past paper questions Flashcards
Pressure ulcers - Predisposing factors
Immobility Smoking Dehydration Poor nutrition Sensory impairment
Alzheimer’s
Parkinson’s
Pressure ulcers - Risk assessment
Warterlow tool
Braden tool
Pressure ulcers - Prevention
SSKIN
Supportive surfaces - Mattresses and cushions made of viscoelastic foam
Skin assessment - Barrier creams, pressure redistribution, repositioning, regular skin assessment
Keep moving
Incontinence and moisture management
Nutrition and hydration
Osteoporosis risk factors
SHATTERED
Steroids Hyperthyroidism. hyperparathyroidism, hypocalcaemia Alcohol Thin Testosterone LOW Early menopause Renal failure Erosive - IBD Dietary intake and drugs
Fracture risk assessment
FRAX score
Osteomalacia
Softening of bones
Due to impaired metabolism
Calcium and phosphate deficiency
Osteoporosis non-pharmacological treatments
Increase calcium intake
Vitamin D supplements
Exercise and weight bearing
Stop smoking
Falls prevention
Home OT assessment
Osteoporosis medical treatment
Bisphosphonates Strontium ranelate Raloxifene Calcitonin Denosumab
Discharge planning
Care package OT and PT assessment Social worker assessment Follow-up with community OT and PT Active recovery
Healthcare evaluation - Donabedian
Structure - What is available
Process - What happens
Outcome - 5Ds
- Death
- Disability
- Disease
- Discomfort
- Dissatisfaction
Qualitative methods of healthcare evaluation
Focus groups
Interviews
Surveys and questionnaires
Observations
Never event reporting
National Reporting and Learning Systems - NRLS
Strategic Executive Information Systems - SEIS
System approach to error
Focus on working conditions
Errors are commonplace
Adverse events are the product of many causal factors
Person approach to error
Focus on the individual
Errors are the product of wayward mental processes
Theory of planned behaviour
Intention is the best predictor of behavioural change
- Perceived behavioural control
- Subjective norms
- Individual’s attitudes towards the behaviour
Ways to help turn intention into behaviour
BRIDGING THE GAP
Perceived control Anticipated regret Preparatory actions Implementing intentions Relevance to self
Theory of planned behaviour - Limitations
Lacks temporal element
Does not consider emotions
Assumes attitudes and subjective norms can be measured
Theory of planned behaviour - Advantages
Considers social pressures
Useful for predicting intention Can be applied to a variety of behaviours
Capacity assessment
Understand
Retain
Weigh-up
Communicate a decision
Libertarian principles for resource allocation
Each individual is responsible for their own health and wellbeing
Rule of rescue
Perceived duty to save an endangered life wherever possible
Epidemiological health needs assessment
Define problem Size of the problem Services available - Prevention, treatment and care Evidence base Models of care Existing services Recommendations
Comparative health needs assessment
Compares services received by a population with services received by others
Health status
Provision
Utilisation
Outcomes
Corporate health needs assessment
Consider the opinions of people living within the population
What do they want
Epidemiological health needs assessment advantages and disadvantages
Advantages
- Uses existing data
- Evaluates trends over time
Disadvantages
- Data may not be useful
- Does not consider the opinions of the people
Comparative health needs assessment advantages an disadvantages
Advantages
- Quick an cheap if data is available
- Gives a measure of relative performance
Disadvantages
- Difficult to find a comparable population
- Does not indicate the correct level of provision
Corporate health needs assessment advantages and disadvantages
Advantages
- Based on felt expressed needs
- Recognises the knowledge and experience of those working within the population
Disadvantages
- Need vs demand
- May be influence by political agendas
Criteria for negligence
Duty of care
Breach in the duty of care
Somebody came to harm
Harm was caused by the breach
Two causes of confusion and agitation
UTI
Hypercalcaemia
Two nursing strategies for a confused patient
Side room
Sleep hygiene
Clocks
One-to-one nursing
Medical treatment for confusion and agitation
Haloperidol
Screening criteria
Condition - Important health problem, with a known natural history and pre-clinical phase
Test - Sensitive, specific, inexpensive and acceptable
Treatment - Effective, with an agreed policy on who to treat
Organisation - Facilities in place, with the cost of screening economically balanced in relation to healthcare spending
Prevalance
Number of existing cases at a set point in time
NPV
Proportion of people with a negative result who DO NOT have the disease
d / d + c
PPV
Proportion of people with a positive result who DO have the disease
a / a + b
Sensitivity
Proportion of people WITH the disease who are correctly identified
a / a + c
Specificity
Proportion of people WITHOUT the disease who are correctly excluded
d / d + b
Incidence
Number of new cases which occur in a set period of time
Attributable risk
Rate of disease in exposed that can be attributed to the exposure
Incidence in exposed - Incidence in unexposed
Relative risk
Risk in one group relative to another
Incidence in exposed / incidence in unexposed
Confounding variable
A factor which is associated with the exposure in question and independently influences the outcome
Reasons for apparent association between dependent and independent variables
Bias
Chance
Confounding
Reverse causality
TRUE CAUSALITY
Underlying factors for failure of patient care
System failure
Judgement failure
Human factors
Neglect
Poor performance
Misconduct
Swiss cheese model
Defence against hazard is a series of barriers
Each barrier represented by a slice of cheese
Each cheese contains holes of various sizes and positions
These holes momentarily line up
Creates a trajectory of accident opportunity
Hazard passes through all of the holes
Leads to FAILURE
Falls - Predisposing factors
Neurological disease Cognitive decline Muscle weakness Visual deficit Incontinence Postural hypotension Dehydration Malnutrition
Falls - Complications
Rhabdomyolysis
Hypothermia
Pressure sores
Falls - Investigations
ECG
CK
FBC
Bone biochemistry - Serum calcium, phosphate and vitamin D
Lying/standing BP
Medications causing postural hypotension
ACE-I Diuretics Nitrates Beta-Blockers Alpha-Blockers
Human rights in healthcare
Article 2 - The right to life
Article 3 - The right to be free from inhuman and degrading treatment
Article 8 - The right to respect for privacy and family life
Article 12 - The right to marry and found a family
Resource allocation theories
Egalitarian principles
- Provide all care that is necessary and appropriate
Maximising principles
- Maximise public utility
Libertarian principles
- Everyone is responsible for their own health and well-being
Requirements for a DoLS application
- Patient is in hospital or care home
- Under continuous supervision and not free to leave
- Lacks mental capacity
What are the DoLS
Deprivation of liberty safeguards
- A representative who is given certain rights and is responsible for looking out for and monitoring the person receiving care
- Right to challenge a DoL through the court of protection
- Provide a mechanism for a deprivation of liberty to be reviewed and monitored regularly
What must happen before a DoLS is put in place
Age assessment - Patient must be over 18
No refusals assessment - Proposed treatment cannot contradict valid decision made by LPA, deputy, or advanced directive
MCA - Patient must lack capacity
MHA - Different rules apply for MHD
Eligibility assessment - Confirm whether there person is eligible to be deprived of liberty under DoLS
Best interests assessment
DoLS guidelines
Should be avoided wherever possible
Should only be authorised when in the patient’s best interests and the only way to keep them safe
Should be for as little time as possible
Should be for a particular reason
There is no suitable alternative that would not deprive them of their liberties
Advanced care planning
Enables a person to make decisions about their future health and social care in the event that they lose capacity
- Advanced statements
- Advanced decision to refuse treatment
- Lasting power of attorney
Advanced statements
Not legally binding
Should be taken into consideration
Serve as a guide to inform best interests decisions
Can cover any element of future care
Written or verbal
Does not require witness or signature
Advanced decision to refuse treatment
Legally binding
Enables patient to refuse a particular treatment
Cannot refuse basic care such as food and water
Must be specific to specific interventions
Must be written, signed and witnessed
Lasting power of attorney
Can refuse treatment BUT cannot demand treatment
Health and welfare
Property and affairs
Advantages of advanced care planning
Enables better informed best interests decisions
Relatives are more likely to be comfortable with the care of an individual if it was their own choice
Disadvantages of advanced care planning
Cannot request specific care
Cannot request assisted suicide
Cannot refuse treatment under the MHA
IMCA
Independent mental capacity advocate
Makes decisions for an individual who does not have friends or family
