Ethics 2 Flashcards
Drunk colleague what would you do?
1 - seek information - establish if my suspicisions were correct - talk to colleague in a private place
2 - patient safety - this is the first priority - make sure they are kept away from the clinical environment - I could ask them in a non confrontational way - if I don’t feel comfortable I could raise this with a senior member of my team to speak with them
Initiaitive - make sure the CT1s shift is covered - help with covering their duties, make sure the patients they have seen are ok
E- escalate to my registrar to my consultant - try to keep the people who know about it to a minimum
Support - establish if this is a one off or recurrence - do they need help, do they have dependency.
Reflect on the situation
Drunk colleague - who could give advice on how to deal with this situation?
Senior colleague whom you would escalate to
Medical Indemnity organisations e.g. MPS, MDU and the BMA provide anonymous advice over the phone
Educational supervisor – although ideally the number of people aware of this issue should be kept to the minimum.
drunk college offers you a bribe to not tell anyone - what would you do?
I would decline this bribe and discuss the matter in a non-confrontational manner, explaining why you would have to escalate the matter to a senior. This is a difficult situation as the colleague is at my level.
Explain that patient safety is at risk in this situation, and that reporting to a senior is in their best interests and that you are duty-bound to do so. Explain you would not share this information with anyone else other than your senior, at this time.
The colleague becomes very upset and admits that a close friend was recently diagnosed with terminal cancer, how would this change your management of the situation?
I would be very concerned about the CT1’s emotional and psychological well-being, and they clearly require support. I would deal with the situation as sensitively as possible and offer my sympathies. If they are intoxicated, it may not be the most appropriate time to have a long discussion with them about their emotional state, but it clearly needs addressing at some point.
Their alcohol excess may be a form of self-medication/ coping with depression related to this recent news. They may benefit from some compassionate leave.
I would offer my support to them, while also suggesting they seek support from their GP for counseling, notify occupational health and raise this issue with their educational supervisor/ discuss in meeting with clinical supervisor.
They may also need support from alcohol dependency services.
drunk colleague - What would the likely outcome of escalation be?
The CT1 would have a professionalism meeting with their clinical supervisor. The decision for further escalation (anything from clinical director to GMC) would be made by the consultant/ CT1’s clinical supervisor, and this would based on the severity of the situation.
Likely outcomes are: formal warning, referral to GMC for review and/ or suspension.
The colleague would definitely require referral for appropriate services for psychological and addiction support.
DNAR
it is a document that formalises decision making about whether an individual should be treated with CPR in the event of cardiac arrest
A form of Advanced directive
What is CPR - attempts to restart a person’s heart in the event of a cardiac arrest. It involves chest compressions, respiratory ventilation, defibrillation, and intravenous drugs. Invasive process and has a low successs rate as well as carrying risks such as rib fractures, hypoxic brain injury
It is not appropriate for every patient who has a cardiac arrest.
A DNACPR is appropriate in cases where it is likely the potential risks of CPR outweigh the potential benefits.
DNACPR - can ensure a dignified death for patients
Initiating DNAR
It is generally helpful to frame the discussion about resuscitation as part of a broader conversation about the patient’s care and treatment preferences.
It is crucial when explaining a DNACPR to be very clear on what it means, and that having this conversation does not necessarily mean that you expect the patient to decline rapidly.
These conversations should be done somewhere in private in the presence of family
A DNACPR is a decision about medical treatment made by clinicians and therefore does not technically require patient consent.
However, the guidance states that resuscitation should be discussed with a patient or representative before the form is signed and that they should be informed of the decision. This is in line with the General Medical Council’s good medical practice.1,3
Explaining a DNAR?
Explain purpose of DNAR
Gain consent
Establish if they want anyone else there
Explore prior understanding of their current health state
Introduce concept of planning for the future
Explore their understanding of a DNACP ad resuscitation
As your illness progresses, you may become so unwell that your heart stops beating, this is called a cardiac arrest”.
Explain that CPR is - emphasis on invasive procedure with low success rate
why is DNACPR appropriate?
CRP is likely to be futile
likely to lead to poor outcomes for the patient
CPR is a specific treatment and it does not apply to other interventions or treatments.
Standard part of advanced care planning.
Tell us abut a time you have made a mistake?
I was looking after a patient who had been in for a few days - It was the first day I had met them.
There had been a plan over the past couple of days that his apixaban was to be held due to low platelets and bleeding
The plan from the mornings ward round was to discuss with haematology and consider starting prophylactic enoxaparin.
I spoke with heematology and prescribed LMWH as per their advice.
The pharmacist noticed that he was prescribed both apixaban and LMWH and informed me of this error.
I immediately went to speak to the nursing staff to see what medication he had received.
The patient had only received his morning medication of apixaban
I discussed this with my senior - plan to hold both for the day and then start LMWH from tomorrow.
I documented clearly and submitted a data report to highlight the error.
To prevent similar mistakes I have become more cautious when prescribing - always checking what medication a patient is on before prescribing something new.
Fortunately, the patient did not experience any adverse effects from the prescribing error, and their anticoagulation regimen was corrected promptly
However as duty of candour I did explain to the patient he had been reconvening apixaban when he should not havee been
This experience taught me the importance of vigilance when prescribing, especially for high-risk medications like anticoagulants. It also reinforced the value of transparency and escalation in mitigating potential harm
Feeding through an NG that is placed incorrectly - what would you do ?
Immediate concern is patient safety - stop the feed, assess that patient in an A-E way, they may need repeat CXR, Abx and blood tests
The scenario is a never event.
I should immediately escalate this with a senior.
I would complete a clinical incident report form about what has happened and escalate to my senior colleagues.
I would make sure nurse in charge is aware.
Duty of Candour - make sure the patient is aware of the situation, and the steps I have put in place to rectify it. Apologies to them. Ask if there is anyone else they would like me to inform
What is clinical Incident reporting?
Clinical incident reporting refers to the process of documenting and reporting any unintended or unexpected event in healthcare that could have, or did, lead to harm to a patient, staff member, or others.
Why is clinical incident reporting important?
Promotes a culture of safety and transparency in healthcare.
Allows systemic issues to be identified and addressed.
Reduces the risk of repeat incidents by learning from errors.
Ensures compliance with governance and regulatory standards
Improves patient safety, promotes and learning culture, supports continuous improvement, enhances accountability.
What is a Never event?
Never Events are patient safety incidents that are wholly preventable where guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and have been implemented by healthcare providers.
Each Never Event type has the potential to cause serious patient harm or death. However, serious harm or death does not need to have happened as a result of a specific incident for that incident to be categorised as a Never Event.”
what is the patient safety incident response framework?
it has 4 key aims
- Compassionate engagement and involvement of those affected by patient safety incidents
- Application of a range of system based approached to learning from patient safety incidents
- considered and proportionate responses to patient safety incidents
- supportive oversight focused on strengthening response system functioning and improvement
What is patient safety incident?
Patient safety incidents are any unintended or unexpected incident which could have, or did, lead to harm for one or more patients receiving healthcare.
