Circumstances when error IS reported (x5)
- When mandatory - eg. At a coroners report, peri-operative deaths
- Serious harm has occurred
- When the fault is with system
- Obvious error has occurred
- Another departments fault
Reasons why people do not report errors
“PC DUTCH”
Petty
Consequences (for themselves - careers, others)
Duty - believe that it is someone else’s
Uncertain - whether something does need reporting
Tedious
Changes - will they take place?
Hierarchy - senior colleagues will have to be involved
Elements of an effective reporting system
"FP AEO" Formalise (to discourage informal gossips) Protection for whistle blowing Anybody can report. Early reporting culture encouraged Open reporting system
What is the 2-stage competent assessment?
- A threshold diagnostic test:
A person lacks capacity in relation to a matter if AT THAT MATERIAL TIME they are unable to make a decision for himself IN RELATION TO THE MATTER, because of an IMPAIRMENT OF, OR DISTURBANCE IN THE FUNCTIONING OF MIND OR BRAIN. (Incl. intellectual disability, intoxication, delirium, dementia etc.) - Is unable to make the decision if they:
Do not understand
Unable to retain
Unable to balance pros and cons to make informed choice
Cannot communicate decision back.
Two other notes about capacity
- Capacity is decision specific, and can fluctuate
- We have a duty to MAXIMISE capacity, including using simple language and diagrams etc in a form in which patient is able to understand.
Capacity of children to give consent.
What is under the FAMILY LAW REFORM ACT 1969?
- Young people 16-17y/o are presumed to have capacity, if they demonstrate “Gillick competence”
- REFUSALS of treatment can be overridden by parents, if the parental decision is within the “Zone of Parental Control”, and consistent with:
- what is expected in the society and human rights decisions
- BEST INTERESTS
8 data protection principles of Data Protection Act
- Fairly and lawfully processed
- Processed for limited purposes and not in any manner incompatible with those purposes
- Adequate, relevant, not excessive
- Accurate
- Not kept longer than necessary
- Processed in line with the data subject’s rights
- Secure
- Not transferred to other countries without adequate protection
The 3 occasions where confidential fun formation may be divulged for reasons other than clinical care of the patient.
- With patient’s consent
- Law requires disclosure
- Overriding public interest in disclosure (ie. poses dangerous problem to public, eg. Murder, terrorist etc.)
Things to do when asked to provide information about patients
- Inform patient, and seek consent (unless likely to lead to significant harm), incl when data needed for audits or care etc and they can object.
- Keep info disclosed to a minimum necessary
- Anonymise where possible
- Keep up to date with the requirements of statute and common law
The legal requirements for info disclosure by the law (5 main scenarios)
- Terrorism Act
- Infectious diseases Act
- RTA Act
- Coroners court
- Disclosure for Statutory bodies (eg. GMC)
Two other notes about capacity
- Capacity is decision specific, and can fluctuate
- We have a duty to MAXIMISE capacity, including using simple language and diagrams etc in a form in which patient is able to understand.
Capacity of children to give consent.
What is under the FAMILY LAW REFORM ACT 1969?
- Young people 16-17y/o are presumed to have capacity, if they demonstrate “Gillick competence”
- REFUSALS of treatment can be overridden by parents, if the parental decision is within the “Zone of Parental Control”, and consistent with:
- what is expected in the society and human rights decisions
- BEST INTERESTS
8 data protection principles of Data Protection Act
- Fairly and lawfully processed
- Processed for limited purposes and not in any manner incompatible with those purposes
- Adequate, relevant, not excessive
- Accurate
- Not kept longer than necessary
- Processed in line with the data subject’s rights
- Secure
- Not transferred to other countries without adequate protection
The 3 occasions where confidential fun formation may be divulged for reasons other than clinical care of the patient.
- With patient’s consent
- Law requires disclosure
- Overriding public interest in disclosure (ie. poses dangerous problem to public, eg. Murder, terrorist etc.)
Things to do when asked to provide information about patients
- Inform patient, and seek consent (unless likely to lead to significant harm), incl when data needed for audits or care etc and they can object.
- Keep info disclosed to a minimum necessary
- Anonymise where possible
- Keep up to date with the requirements of statute and common law
The legal requirements for info disclosure by the law (5 main scenarios)
- Terrorism Act
- Infectious diseases Act
- RTA Act
- Coroners court
- Disclosure for Statutory bodies (eg. GMC)
Criteria to detain someone under Mental Health Act (x4)
- Must be diagnosed with a mental disorder (ie. any disorder or disability of the mind, except learning difficulties in isolation)
- DIAGNOSTIC TEST - They are suffering at a degree which warrants detention; Tx in hospital which can only be achieved through detention
- PROPORTIONALITY TEST (ie. how severe they are suffering) - Treatment must be available in hospital (incl. nursing, psych intervention, mental health rehab and care etc.)
- THERAPEUTIC INTENT - Detain in the interest of his own health/safety, or with a view to protect other people.
- RISK TEST
(If to detain because patient does not have capacity, would be performed under the MCA.
Therefore incapacity is not a prerequisite for detaining under MHA, as they probably can “understand, retain, balance and communicate decision”, but decision is crazy.
Patients whom the MHA does not include
Drug or alcohol dependence.
Diagnostic thresholds for:
- MCA
- MHA
- Impairment, disturbance in functioning of mind or brain
- Diagnosed with a Mental disorder, which does not include:
- learning difficulties in isolation
- alcohol or drug dependence.
Proportionality test for:
- MCA
- MHA
- Try to make decisions in LEAST RESTRICTIVE manner
- Suffering the condition to an extent which requires medical treatment only available in hospital. Can only obtain hospital treatment with detention under the MHA
Therapeutic intents for:
- MCA
- MHA
- ? Mainly permits actions without consent for patients HEALTH and WELFARE
- Only medical treatment, which must be available at the hospital in which patient is detained. Includes nurses, psychological experts, medical staff and psychiatric rehab facilities
Considerations of interest in:
- MCA
- MHA
- Patient’s OWN best interests taken into consideration
2. Patients own health and safety, and other people’s health and safety are at interest in detaining under MHA
MHA Section 2
Assessment
Lasts 28 days
No diagnosis needed
2 doctors, one of whom is certified under s12 and other one ideally knows the patient
AMHP (approved mental health practitioner)
- all 3 needs to agree that the patient fulfils the 4 criteria for sectioning.
Can appeal in first 14 days
Can give treatment for assessment, and then treat when a diagnosis is made, but should really be on s3
MHA Section 3
Treatment section
6/12 duration
? Same need 2docs and an AMHP
Renew: lasts another 6/12, then 1yr afterwards
Allowed to appeal
