Definitions Flashcards
What is a never event?
A serious incident that should never occur in place of clinical safeguards and strict protocols
What are NatSSIPS and LocSSIps?
National and local safety standards. NHS England have published their own NatSSIPS.
What it is:
A national framework introduced by NHS England in 2015 to standardize patient safety practices for all invasive procedures across healthcare settings.
Aims to reduce the risk of never events (serious, preventable patient safety incidents).
Why It Matters:
Ensures consistent safety measures across different specialties.
Promotes a multidisciplinary approach to patient safety.
Reduces errors such as wrong-site surgery, retained foreign objects, and incorrect implants.
Core Components of NatSIPPs:
Pre-procedure verification: Ensuring correct patient, procedure, and site.
Standardized safety checklists (e.g., WHO Surgical Safety Checklist).
Team briefings and debriefings before and after procedures.
Use of “Stop Before You Block” in regional anesthesia.
Clear communication and documentation throughout the procedure.
Application in Surgery:
Ensuring correct patient identification and procedure site.
Using structured preoperative safety huddles.
Reducing human error and surgical complications.
Give examples of risk mitigation standards?
NatSSIPS
LocSSIPS
WHO checklist
ERAS (pre op, intra op, post op)
What is clinical governance?
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
what is duty of candour?
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
Give examples of clinical governance?
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
what is consent?
agreement from the patient having fully considered the information provided from the doctor. generally this can be verbal written or implied
when is written consent required?
when an intervention holds significant risk
organ donation
fertility treatment
What are the requirements for informed consent?
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
what is capacity?
MCA 2005
patients cognitive ability to make decisions about their care (understand, weigh up, retain, communicate)
time and decision specific
what is competence?
legal judgement describes a persons global ability to perform actions that are needed to put decisions into effect.
time and decision specific
Key assumptions for capacity
presume capacity
capacity fluctuates (t&d specific)
unwise decisions do not constitute lack of capacity
small and complex decisions
what should be done for a patient without capacity?
NOK, IMCA, best interests meetings
consider current wishes and advanced directives
take into account welfare, social, psychological, emotional interests
least restrictive option
re-assess
what is the difference between clinical audit and clinical research?
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
which GMC guidelines does ‘lost notes’ infringe?
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.
what is compartment syndrome?
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
when is breach of confidentiality allowed without consent?
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
what does the GMC say about bullying?
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
how to make a formal complaint on bullying
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.
what is NCEPOD?
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’
What is P-POSSUM?
Recently, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM)
risk stratification, morbidity and mortality in patients undergoing general surgery
What it is:
A risk prediction tool used in surgery to estimate post-op mortality and morbidity.
Factors Considered:
Physiological factors:
Age, heart rate, blood pressure.
White cell count, hemoglobin, urea, sodium.
ECG abnormalities.
Operative severity factors:
Blood loss, peritoneal contamination.
Malignancy, urgency of surgery.
Why It Matters:
Helps in informed consent and explaining risks to patients.
Supports decision-making in high-risk surgical patients.
Used in audit and benchmarking surgical performance.
Application in Surgery:
Risk stratification before major surgery.
Predicting mortality and planning post-op care.
Used alongside clinical judgment for high-risk patients.
what is NELA?
national emergency laparotomy audit, risk of death <30 days of laparotomy
what is PALS?
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.
What are the types of consent form?
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
why is audit important in surgery?
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 for personal evaluation and skill development
VTE assessments and TEP proforma for clerking SHO’s
Increased adherence,
Prevention of complications such as DVT and PE’s
Better standards of care for patietns
how to implement a DOLS?
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
what is bullying?
when an individual or group abuses a position of power or authority over another person leaving the victim feeling hurt, vulnerable or powerless
what is harassment?
any behaviour which has the purpose or effect of violating an individuals dignity or creating an intimidating/offensive environment
Equality act 2010
what is unlawful victimisation?
when someone is treated less favourably because they have asserted their rights i.e. made a complaint/supporting a claimant or raising a grievance.
What is ERAS?
ERAS (Enhanced Recovery After Surgery) is a multidisciplinary evidence-based protocol designed to improve recovery and reduce complications following major surgery.
It focuses on optimizing perioperative care, from preoperative preparation to postoperative recovery, aiming to get patients back to normal function as soon as possible.
Why It Matters:
Improves patient outcomes by reducing complications (e.g., infections, blood clots, delayed recovery).
Reduces length of hospital stay and enhances cost-effectiveness in healthcare.
Focuses on patient-centered care, emphasizing early mobilization, nutrition, and effective pain management.
Core Components of ERAS:
Preoperative Optimization:
Patient education and counseling about what to expect.
Nutritional support (e.g., carbohydrate loading) and prehabilitation (improving fitness before surgery).
Minimizing fasting times (patients allowed to drink clear fluids up to 2 hours before surgery).
Anesthesia and Analgesia:
Use of multimodal analgesia (minimizing opioids).
Regional anesthesia when appropriate (e.g., epidurals or nerve blocks).
Minimally Invasive Surgery:
Use of laparoscopic or robot-assisted surgery to reduce tissue damage and accelerate recovery.
Postoperative Care:
Early mobilization (getting patients out of bed as soon as possible).
Early enteral feeding (introducing oral intake soon after surgery).
Minimizing narcotics and encouraging non-opioid pain management.
Continuous Monitoring and Support:
Early identification of complications (e.g., through enhanced recovery pathways and monitoring).
Use of multidisciplinary teams including physiotherapists, dietitians, and nurses for holistic recovery.
What is a standard?
A standard is defined as an agreed level of care that must be adhered to.
For example, in my audit where I compared my unit’s local practice to a BSSH standard stating that hand fractures should be reviewed within 72 hours of injury.
What is a guideline?
Guidelines are statements designed to assist clinicians in decision-making (and may be interpreted according to individual patient needs). For example, NICE guidelines.
What is an LPA?
- Lasting Power of Attorney (LPA)
An LPA is a legal document that allows a person (the donor) to appoint one or more trusted individuals (attorneys) to make decisions on their behalf if they lose mental capacity.
Types of LPA:
Health and Welfare LPA – Covers decisions about medical treatment, care, daily routines, and life-sustaining treatment.
When is an LPA Valid?
The donor must have mental capacity at the time of making the LPA.
The LPA must be registered with the Office of the Public Guardian (OPG) in England and Wales before it can be used.
A Health and Welfare LPA is only valid when the person loses mental capacity.
A Property and Financial Affairs LPA can be used while the person still has capacity, if specified.
When is an LPA Invalid?
If the donor was pressured or coerced into signing it.
If the donor didn’t have mental capacity when making it.
If it was not registered with the OPG.
If an attorney acts outside their authority (e.g., making medical decisions under a Financial LPA).
If the donor revokes the LPA while still mentally capable.
If an attorney loses capacity or is removed.
What is an Advanced Directive?
- Advance Decision (Living Will)
An Advance Decision to Refuse Treatment (ADRT) is a legally binding document where a person states which medical treatments they want to refuse if they lose capacity in the future.
When is an Advance Decision Valid?
The person must have mental capacity when creating it.
It must be clear and specific about which treatments they are refusing.
If refusing life-sustaining treatment, it must be signed and witnessed.
It must not have been revoked since being made.
It must still reflect the person’s current wishes.
When is an Advance Decision Invalid?
If the person was pressured or lacked capacity when making it.
If the person made a later Health and Welfare LPA that contradicts the Advance Decision.
If the person clearly changed their mind after making it.
If medical circumstances change significantly (e.g., a new treatment is available that was not considered in the document).
What Can an Advance Decision Be Used For?
Refusing specific medical treatments, such as ventilation, resuscitation (CPR), or feeding tubes.
It cannot demand treatments—only refuse them.
It cannot request anything illegal (e.g., assisted dying/euthanasia).
What is a near miss?
A near miss in healthcare, including surgery, refers to an event that could have resulted in harm to a patient but was prevented or did not occur due to chance, timely intervention, or corrective action. It is often considered a learning opportunity to improve patient safety and prevent future errors.
What is the importance of the WHO checklist?
is a critical tool designed to improve patient safety by providing a standardized approach to key safety checks before, during, and after surgery.
Improves patient outcomes
Prevent Infection risk
Decreases chances never events
