Definitions

Question 1

What is a never event?

Answer 1

A serious incident that should never occur in place of clinical safeguards and strict protocols

Question 2

What are NatSSIPS and LocSSIps?

Answer 2

National and local safety standards. NHS England have published their own NatSSIPS.

Question 3

Give examples of risk mitigation standards?

Answer 3

NatSSIPS
LocSSIPS
WHO checklist
ERAS (pre op, intra op, post op)

Question 4

What is clinical governance?

Answer 4

a quality improvement framework through which the NHS aims to maintain and improve services whilst maintaining openness and accountability to the public.

a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish - includes quality assurance, improvement and risk and incident management

Question 5

what is duty of candour?

Answer 5

legal duty on hospital, community and mental health trusts to inform and apologise to patients if there have been mistakes in their care which led to harm

Question 6

Give examples of clinical governance?

Answer 6

Training and education: mandatory training
Audit and QI: continual assessment and improvement of clinical practice
Effectiveness: evidence based practice through research
Patient and public involvement: focus groups

Question 7

what is consent?

Answer 7

agreement from the patient having fully considered the information provided from the doctor. generally this can be verbal written or implied

Question 8

when is written consent required?

Answer 8

when an intervention holds significant risk
organ donation
fertility treatment

Question 9

What are the requirements for informed consent?

Answer 9

should be led by an experienced clinician, ideally one performing the procedure.
indications (rationale)
steps (procedure)
benefits
risk (immediate, short and long term)
alternatives
voluntarily provided
informed
has capacity

Question 10

what is capacity?

Answer 10

MCA 2005
patients cognitive ability to make decisions about their care (understand, weigh up, retain, communicate)
time and decision specific

Question 11

what is competence?

Answer 11

legal judgement describes a persons global ability to perform actions that are needed to put decisions into effect.
time and decision specific

Question 12

Key assumptions for capacity

Answer 12

presume capacity
capacity fluctuates (t&d specific)
unwise decisions do not constitute lack of capacity
small and complex decisions

Question 13

what should be done for a patient without capacity?

Answer 13

NOK, IMCA, best interests meetings
consider current wishes and advanced directives
take into account welfare, social, psychological, emotional interests
least restrictive option
re-assess

Question 14

what is the difference between clinical audit and clinical research?

Answer 14

clinical audit: aims to assess current practice against best practice standards (iterative practice driven approach to identify gaps for improvement), local
clinical research: aims to establish best practice by synthesising new evidence (systematic hypothesis driven process), usually needs ethical approval, generalisable to wider population

Question 15

which GMC guidelines does ‘lost notes’ infringe?

Answer 15

Confidentiality: good practice in handling patient information (2017) (‘make sure any personal information you hold or control is effectively protected at all times against improper access, disclosure or loss’).
To a lesser extent Good Medical Practice (2013) states that patients have a right to expect information about them to be held in confidence.

Question 16

what is compartment syndrome?

Answer 16

Acute compartment syndrome of a limb is due to raised pressure within a closed fascial compartment causing local tissue ischaemia and hypoxia
a difference between the diastolic blood pressure and the compartment pressure of less than 30 mmHg suggests an increased risk of compartment syndrome

Question 17

when is breach of confidentiality allowed without consent?

Answer 17

Disclosure required by law e.g. court order/ police officer
Justified in the public interest (and to protect patients and others from serious harm or death)
Sharing information with other healthcare professionals involved in their care
Disclosure to statutory regulatory body i.e. GMC
Treatment of children or incompetent adults
Abuse or neglect of an incompetent person

Question 18

what does the GMC say about bullying?

Answer 18

In the ‘Respect for Colleagues’ section of Good Medical Practice (2013)

You must treat colleagues with respect and must not bully, harass or discriminate against them
You must tackle discrimination and challenge colleagues if they do not meet these standards

Question 19

how to make a formal complaint on bullying

Answer 19

The process would require the SHO to compile verbal and written accounts of instances of bullying. They should also make a log of all the instances of bullying when they occurred and who was present at the time. Other SHOs impacted by the same consultant should also be encouraged to raise a complaint.

The escalation process depends on the Hospital. For example, in my department this is raised to the Antibullying Consultant Lead, however, in some hospitals it is the Clinical Director. If unsure I would check with HR or the hospital Anti Bullying Policy.

The BMA can provide free advice on dealing with bullying in the workplace.

Question 20

what is NCEPOD?

Answer 20

NCEPOD stands for National Confidential Enquiry into Patient Outcome and Deaths and is a government supported scheme which aims to reduce perioperative mortality and morbidity.

The NCEPOD classification is a 4-code system used to determine the level of urgency of a procedure including ‘emergency’, ‘urgent’, ‘scheduled’ and ‘elective’

Question 21

What is P-POSSUM?

Answer 21

Recently, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM)
risk stratification, morbidity and mortality in patients undergoing general surgery

Question 22

what is NELA?

Answer 22

national emergency laparotomy audit, risk of death <30 days of laparotomy

Question 23

what is PALS?

Answer 23

This is a service provided in all NHS hospitals which is a point of contact to patients, families and carers: offering advice and support to answer health-related questions as well as resolving concerns and complaints.

All formal complaints are made via PALS.

Question 24

What are the types of consent form?

Answer 24

Consent form 1 – Patient agreement to investigation or treatment (adults with capacity).

Consent form 2 – Parental agreement to investigation or treatment (i.e. children).

Consent form 3 – Patient/ parental consent for procedures where the consciousness of the patient is not impaired (i.e. alert throughout the procedure for example local anaesthetic).

Consent form 4 – Adult unable to consent for investigation or treatment (i.e. lacks capacity).

NB: the consent form is invalid as a legal document if the incorrect form is used

Question 25

why is audit important in surgery?

Answer 25

Patients: ensure a high standard of care is met.

NHS/ organisation – a key pillar of clinical governance, compliance with guidelines, improves safety locally and nationally, improves teamwork and collaboration.

From a personal perspective – undertaking clinical audits have been useful.

Clinical perspective: learned about national standards on conditions for example hand fractures as well as the local epidemiology.

Academic: experience in dealing with large data sets and statistics, as well as presenting results at conferences.

Management: leading colleagues, meeting different members of the NHS MDT to bring about change.

Personal: satisfaction in bringing about clinical change that should have a positive impact on patient care and experience in my department.

Question 26

how to implement a DOLS?

Answer 26

Escalation: to the registrar/ consultant as well as senior nurses/ Site Nurse Practitioner

Capacity assessment: assess and document the patient’s ability to understand, retain, weigh up information, and communicate decisions relevant to their medical situation.

Processes: Use local DoLS framework within hospitals to grant an urgent DoLS authorisation to allow the patient to be ‘detained’ for medical treatment in their best interests.

Additional information:

The hospital is a ‘managing authority’ and can grant itself an ‘urgent’ authorisation providing a short-term (max 7 days) deprivation of liberty while the standard process is completed. The standard process requires an application to the ‘supervisory body’ (Local authority).
A hospital can implement an urgent DoLS if it deems it to be in the best interests of the patient and should involve next of kin wherever possible. For a standard DoLS (max 12 months) a Relevant Persons Representative (RPR) should be appointed who is usually next of kin or may be an IMCA (Independent Mental Capacity Advocate) in no NOK, as well as best interest assessors (minimum 2). A detailed ‘care plan’ needs to be outlined

Question 27

what is bullying?

Answer 27

when an individual or group abuses a position of power or authority over another person leaving the victim feeling hurt, vulnerable or powerless

Question 28

what is harassment?

Answer 28

any behaviour which has the purpose or effect of violating an individuals dignity or creating an intimidating/offensive environment

Equality act 2010

Question 29

what is unlawful victimisation?

Answer 29

when someone is treated less favourably because they have asserted their rights - making a complaint/supporting a claimant or raising a grievance.