Difficult Situations Flashcards
Complaints / angry pt
Patient and department safe (PIDS)
Information gathered
Private location
Introduce
Check pt/relative details
Acknowledge concern; summarise
Apologise
Act; immediate then lessons to learn
Make a plan together; History and exam
Lessons to learn; DATIX, PALS
Difficult referral
Patient safe? PIDS
Introductions
ATMIST
Listen to their concerns
Apologise
Acknowledge
Act; focus on patient
Plan; if unsuccessful d/w Consultant
Document
Difficult conversation (colleague)
Patient safe? PIDS
Information gathered
Private location
Introduction you and them
Explore; alcohol, drugs, life (money, relationships), work (bullying, failing)
Support; sorry this has happened, anything I can do to help
Plan; patient safety, ?go home, anyone at home, call someone?, upcoming shifts, educational supervisor; you or me, other consultants
Close; happy with plan, concerns, anything else I can do to help?
Breaking bad news (new Dx)
Patient safe (PIDS)
Info gathered
Private location
Other member of staff
Introductions, confirm
Anyone with them
Clarify history, current understanding
I’m afraid I have some bad news
Dx
Questions
Follow up
Resources
Breaking bad news (death of a patient)
Patient safe (PIDS)
Info gathered
Private location
Other member of staff
Introduction and confirm
Anyone with them
Clarify what they know
I’m afraid I have some awful news
X was very unwell and despite everything we do x died
Anyone we can contact
Bereavement information
Care after death team
Coroner, medical examiner, death certificate
Major incident
Introductions; check: names and roles
METHANE
Confirm with ambulance control
Switch; declare major incident
- d/w consultant in charge, silver command
Major incident plan box
Scribe to note actions
Bring staff together for brief
I will be bronze command
Clear ED; tannoy to waiting room, board round safe discharges vs patients direct to specialities
?decontamination, ?security lock down
Triage P1,2,3
1 trauma team per patient
Needle stick injury
Introduction; check name and role
PC
First aid?
Recipient; Hep B, immunisations, antibodies?
Donor; BBV? Risk; IVDU sex worker
Management
Donor - consent for testing
Recipient; blood for save, Hep B, PEP
- barrier contraception,
- F/U 3 and 6 months (occi health/GP)
If upset, home from shift (hand over patient)
Educational supervisor
Consultant on shift
DATIX
How getting, anyone at home, support
Overcrowding
Introductions; check name and role
Situation; number in department, awaiting beds, time to be seen
Patients; immediate concerns?
Incoming
Escalate to site team and silver
- update on beds and transfers
?boarding on wards
- need x number of bed sim next 30mins to make ED safe
Walk around with NIC any moves?
Staff; move to area of strengths, ensure breaks
Announcement to waiting room
Capacity and best interest
- disorder of mind
And - unable to understand/retain/weigh/communicate
Attempt to persuade, options
Duty of care; best interests
Least restrictive alternative
Mental capacity act
Consenting
Introduction; name and role
Check their name
Check understanding of situation
Management plan
Risks vs benefits
Alternatives
+- written information
Questions? Time to think
Who can provide valid consent
Adult capacitors patient
LPA welfare
Court appointed deputy
Children
Over 16 can consent without parental involvement
Gillick competent child without parental involvement
Parental consent for child under 18
Under 18s cannot refuse treatment
