MH/Ethics/law/clinical governance Flashcards
(132 cards)
1
Q
What is a notifiable safety incident?
A
Unexpected event that occurs during provision of activity regulated by the CQC and may/has resulted in moderate harm or greater
2
Q
If under 16 years who should be notified of a notifiable safety incident?
A
NOK
3
Q
What are the NHS Never Events?
Surgical = 3
Medical = 5
General = 6
A
Surgical:
1. Wrong site
2. Wrong prosthesis
3. Retained foreign object
Medical:
1. Mis-selection of high strength K+
2. Admin drug through wrong route
3. OD insulin due to abbreviations or incorrect device
4. OD methotrexate
5. Mis-selection high strength midazolam for sedation
General:
1. Fall from poorly restricted window
2. Neck entrapment in bed rail
3. Transfusion of ABO incompatible blood/organ
4. Misplaced NGT/OGT
5. Scalding of patient
6. Unintential of patient requiring 02 to air
4
Q
What is the exception to accidental use of high strength midazolam being used in sedation being a never event?
A
Unless used in area where use of high strength midazolam appropriate and been formally risk assessed in organisation
5
Q
Describe the timeline for incident reporting (PSIRF)(4)
A
- Formally report incident - <2 days
- Ensure level of investigation determined < 3 days
- Investigation concluded < 60 days
- Commissioner review report and action plan < 20 days
6
Q
What is the name of the framework to report never events
A
Patient Safety Incident Response Framework (PSIRF)
7
Q
What are the 7 pillars of clinical governance?
A
- Service user involvement
- HR management
- Personal and professional development
- Clinical effectiveness
- Clinical audit
- Clinical information management
- Risk management
8
Q
What 3 features does the Healthcare Quality Improvement Partnership used to define ‘quality’ with respects to an organisation?
A
- Clinical effectiveness
- Patient safety
- Patient experience
9
Q
If an adult patient lacks capacity to consent to a study what is the law?
A
- Doctor not involved in research, or research ethics committee, can provide consent for a process to follow.
- If time allows seek consent from NOK/POA
- Must seek consent retrospectively
10
Q
What is the law regarding consent into research trials in children?
A
- Non-urgent consent from parents and if child has capacity should be included as well
- Emergency/time critical consent can be gained from child and retrospective consent obtained from parents
- If parents non contactable/child no capacity then treatment can be given if research ethics committee approval in place
11
Q
What are the 5 domains of the Clinical Leadership Competency Framework, as set out by the NHS Leadership Framework?
A
- Demonstrating professional qualities
- Work with others
- Managing services
- Improving services
- Setting direction
12
Q
In terms of the Clinical Leadership Competency Framework, what are the parts of ‘Demonstrating professional qualities?’ (4)
A
- Developing self awareness
- Managing yourself
- Continuing professional development (CPD) - previous question
- Acting with integrity
13
Q
In terms of the Clinical Leadership Competency Framework, what are the parts of ‘working with others?’ (4)
A
- Developing networks
- Building and maintaining relationships
- Encouraging contribution
- Working within teams
14
Q
In terms of the Clinical Leadership Competency Framework, what are the parts of ‘managing services?’ (4)
A
- Planning
- Managing resources
- Managing people
- Managing performance
15
Q
In terms of the Clinical Leadership Competency Framework, what are the parts of ‘improving services?’ (4)
A
- Ensuring patient safety
- Critically evaluating
- Encouraging improvement and innovation
- Facilitating transformation
16
Q
In terms of the Clinical Leadership Competency Framework, what are the parts of ‘setting direction?’ (4)
A
- Identifying context for change
- Applying knowledge and evidence
- Making decisions
- Evaluating impacts
17
Q
What 5 questions do the CQC ask when assessing a service?
A
- Are they safe?
- Are they effective?
- Are they caring?
- Are they responsive to peoples needs?
- Are they well led?
18
Q
What is the name of the test to determine negligence?
A
Bolam test/principle
19
Q
What are the 3 things that must be proven to show negligence?
A
- Medical professional owed a duty of care to that patient
- Care patient received is cause of the harm that occured
- Standard of care falls below that of a reasonable body of peers (Bolam test)
20
Q
What are the 3 aspects of the Good Samaritan act that need to be considered?
A
- Whether individual was acting for the benefit of society
- Whether the individual demonstrated a responsible approach towards protecting the safety or interests of others
- Whether the individual was acting heroically by intervening in an emergency to assist a person who is in danger
21
Q
What is a ‘risk owner’ in an organisation?
A
Responsible point person for an individual risk. Will report to a trust board who are responsible for providing leadership on the management of all risk within an organisation
22
Q
What is the responsibility of the ‘risk owner?’
A
- Identify risk
- Assess risk
- Mitigate risk
- Record risk in the risk register
23
Q
What are the stages of a generic risk assessment?
A
- Identify risk
- Identify who would be harmed
- Decide how likely this is
- Decide level of harm
24
Q
What are the parts of the Quality Governance Framework? (4)
A
- Strategy - quality should drive strategy and management aware of risks to quality
- Capabilities and culture - promotion of quality focused culture and development of quality leadership/skills/knowledge
- Processes and structures - roles and accountability within quality governance, defined processes for escalating quality issues and engagement with stakeholders
- Measurement - information regarding quality should be reviewed and challenged and used effectively
25
Describe the cultural practices re: death in the Hindu community (7)
1. Body should have head pointing north and feet south. Arms by sides, legs staight.
2. Point face up, eyes closed
3. Wrapped in white cloth
4. Any detached body parts treated like whole body
5. Bereavement last 2 weeks
6. Cremated
7. PPM okay
26
Describe the Jewish communities beliefs around death (6)
1. Do not touch/move a dying patient because this is felt to hasten death
2. Body parts treated with respect and kept with corpse
3. Body should have eyes closed, jaw tied shut and fingers straight. Wrapped in white sheet. Feet towards the door.
4. Chevra Kadisha (Holy Brotherhood) informed immediately of death and will arrange funeral
5. Funeral ideally before sunset on day of death but body will not be moved on the Sabbath
6. PPM not allowed unless legally required
27
What are muslims beliefs about organ donation/transplant/blood?
Should consult Imam
28
If a muslim is dying, what should be ensure? (3)
1. Face towards Mecca
2. Head above rest of body
3. Should say prayers if able
29
What are muslim customs around death? (7)
1. Ideally men and women bodies seperate
2. Prefer men to handle male bodies and women for women
3. Body wrapped in white cloth, 3 for men and 5 for women
4. Head turned to right shoulder and face to Mecca
5. NOK/community will make arrangements for buriel
6. Burial ASAP, < 24 hours ideal
7. No PPM unless legal requirement
8. Many mosques have private mortuaries which can be used in emergencies
30
What are the 5 K's in Sikhism?
1. Kesh (uncut hair;)
2. Kangha (a comb to keep the hair neat)
3. Kara (a steel bangle which symbolises the unity of God);
4. Kirpan (a short dagger which symbolises the readiness of the Sikh to fight against injustice)
5. Kachhera (breeches or shorts to symbolise modesty).
31
What should be kept in mind when removing clothes from a Sikh patient?
The Kachhera (Shorts) should only be removed by the patient if at all possible
32
What are Sikh customs with regards to death?
1. 5 K's should be kept on the body and cleaned if possible
2. Deliberate expression of grief discouraged
3. Cremation not burial
4. No specific time limit to cremation
5. Ashes may be placed in flowing water (Ganges is the ideal)
33
What products are the MHRA responsible for?
Statutory responsibility for safety of:
1. Medicines (inc. herbal)
2. Medical devices (inc second hand)
3. Blood and blood products
34
What does the MHRA do? (4)
Regulation: The MHRA regulates medicines, medical devices, and blood products to ensure they meet required standards of safety, quality, and efficacy before they can be marketed.
Licensing: Reviews and grants licenses for new medicines and medical devices
Surveillance: The MHRA monitors the safety of medicines and medical devices on the market, collecting data on adverse effects and taking action when necessary (can force withdrawal of products)
Research and Development: Gives permission for clinical trials relating to safety of new meds
35
How is a drug/device shown to be new by the MHRA?
Black triangle symbol
36
What information is required to report a medication/device using the yellow card scheme? (4)
1. Side effects
2. Age/sex/initials of patient
3. Name of meds/device
4. Reports full name and address
37
What are SABRE and SHOT and what is the difference between them?
Serious Adverse Blood Reactions Events:
MHRA system for mandatory reporting of adverse blood events
Serious Hazards of Transfusion:
Not mandatory and run by NHS Blood and Transplant Service
38
What is the Defective Medicine Report Centre?
Part of MHRA - minimises harm to patient once defective medicine has been distributed
39
What are the 4 class of recalls and timeframes used by the Defective Medicine Report Centre?
1. Immediate Action required - included OOH, National Patient Safety Alert issued
2. Action required within 48 hours - pharmacy and wholesale level recall
3. Action required within 5 days - pharmacy and wholesale level recall
4. Information only - caution in use, defect information distributed to wholesalers and pharmacies.H
40
If breaking confidentiality when should we not inform the patient?
If impracticle or would undermine the reason for disclosure
41
What are the 4 legal justifications for breaking confidentiality? (4)
1. Disclosure is required by law, including by the courts
2. Patient has given explicit consent
3. Disclosure approved through a statutory process that sets aside the common law duty of confidentiality
4. Justified in the public interest
42
What information does the Road Traffic Act state we should give the police?
Information to help identify driver (only)
43
In what 2 circumstances is it an offence not to disclose information about a patient to police?
1. FGM < 18 yrs
2. Anything of 'material assistance' in preventing terrorism
44
Which knife + gunshot wounds should be reported to police?
1. All gunshot wounds including accidental (issues around responsible gun license)
2. Knife wounds from an attack - not self harm or accidental
45
Who do HCPC represent? (15)
1. Arts therapists
2. Biomedical Scientists
3. Chiropodists/Podiatrists,
4. Clinical Scientists
5. Dieticians
6. Hearing Aid Dispensers
7. Occupational Therapists
8. ODPs
9. Orthoptists
10. Paramedics
11. Physiotherapists
12. Pyschologist
13. Prosthetists/Orthotists,
14. Radiographers
15. SALT
46
What is the mandate of the GMC? (5)
1. Set standards of patient care and professional behaviours
2. Ensure education and training good enough
3. Check eligibility / continue to meet requirements
4. guidance to help understand what’s expected
5. investigate where there are concerns that patient safety
47
Who do GMC cover?
Doctors
PAs
Anaesthesia Associates
48
Who governs JRCALC?
Association of Ambulance Chief Executives [AACE]
49
What are exclusive and inclusive trauma networks?
Exclusive = all patients with major trauma go to MTCs and bypass TUs e.g. London, shown to increase survival
Inclusive = larger geographical area/transfer times mean use all 3 tiers of trauma centre. If trauma +ve but >45mins (not hard rule) away will go to TU if needs treatment 'right patient/right time/right care
50
When must HEMS clinicians disclose pregnancy to their employer by law?
At least 15 weeks before baby born
51
Describe the College of Paramedics tier of career progression
Tier 1 Paramedic (BSc)
Tier 2 Specialist & Enhanced Paramedic / Manager (Dip)
Tier 3 Advanced Paramedic (MSc) / Senior Manager
Tier 4 Consultant (PhD)
52
If resusitation is terminated of a child who has been assaulted and the police do not want the body to be conveyed, what is the guidance?
If crime scene declared, leave child at home and inform ambulance control
53
In terms of data protection what is a:
1. Controller
2. Processor
3. Joint controllers
4. Sub-processor
5. Sponsor
1. Person/agency that determines the purposes and means of the processing of personal data.
2. Person/agency that processed personal data on behalf of the controller.
3. Two or more controllers jointly determine the purposes and means of
processing
4. Processor who wishes to sub-contract processing to another processor.
5. Determines what data is collected for the research study, acts as the controller in relation to the research data.
54
Which religion would want minimum handling of a body post death?
Buddhism - family members may request that the body is not touched during this period and that it is available to them to perform religious rights.”
55
What is the defining characteristic of a CCP?
Completed a Masters
56
What is the greatest threat to a lone work?
Physical and verbal abuse
57
What is Lean process?
Lean uses process mapping with associated stakeholders to identify inefficiencies in care, enabling actions for improvement.
58
What type of QIP design works in partnership with patients and families to improve services from their perspective.
Experience Based Co-Design (EBCD)
59
What is are run charts and statistical process charts used for?
Plots data over time in order to show the effect of interventions
60
What is the difference between run charts and statistical process charts?
Run charts simply data plotted over time, SPC uses statistical processes as well.
61
What is a SWOT analysis?
Strengths
Weaknesses
Opportunity
Threats
62
What is a forcefield analysis?
Method of establishing the drivers and resistors for change (and the magnitude), to assist with planning of change process
63
What is a Ishikawa (Fishbone) diagram?
Visual representation of causes and sub-causes and what actions could be considered to affect change (or could have led to an error)
64
What is the '5 whys' method of root cause analysis?
Ask why 5 times, the answer to the fifth is the root cause
65
What is a PDSA cycle?
Plan
Do
Study
Act
66
Which 2 religions require burial ASAP?
Islam and Judaism
67
What is section 2 MHA?
-Assessment up to 28 days
- Recommendation of 2 doctor and application made by Approved Mental Heatlh Professional (AMHP)
68
What is section 3 MHA?
- Allows treatment for up 6 months
-Recommendation of 2 doctor and application made by Approved Mental Heatlh Professional (AMHP)
69
What is section 4 MHA?
- Emergency power of detention for 72 hours
- Recommendation of 1 doctor and application from AMHP
70
What is section 6 MHA?
Authorises applicant (AMHP) or person authorised by AMHP to take patient to hospital following an application for admission
71
What is section 17 MHA?
Patients permitted to leave from hospital, or to receive treatment in community
72
What is section 18 MHA?
If patient AWOL allows any AMHP/hospital staff/police or anyone authorised in writing by managers of hospital to return patient to hospital
Ambulance staff need written authorisation
73
What is section 135(1)
Warrant allowing police to enter and property and remove patient to a place of safety
74
What is Section 135(2)
Warrant authorised by judge allowing a police offiver to enter a property to retain a pateitn already under MHA
75
What is section 136 MHA?
Allows officers to detain for <24hours for assessment:
-where patient appears to be suffering from mental disorder
-AND needs immediate care/contro
-AND in patients best interests.
Not in patients house/garden
76
What is the acronym for doing a MSE?
ASMPTOI - All Silly Medics Try Psych At Once Indeed
77
What are the parts of the MSE? (7)
Appearance and Behaviour
Speech
Mood (both subjective and objective)
Thoughts
Perception e.g. delusion/paranoia
Cognition and Orientation
Insight
78
Which risk assessment tool do NICE advise for suicide?
None
79
What are the 5 P's for risk assessment?
1. Presentation
2. Precipitating factors
3. Perpetuating factors - any ongoing stressors
4. Predisposing factors - FHx. PMHx, Psych hx, social, trauma
5. Protective
80
To what age does the MHA apply?
>16 years
81
What are the 5 key principles of capacity?
1. Assumed capacity
2. All practical steps to help make decision should be made
3. Unwise decisions allowed
4. In patients best interests
5. Least restrictive option
82
What is the definition of lacking capacity?
Unable to make decision for themselves in relation to the matter because of an impairment/disturbance in functioning of the mind
83
When deciding capacity what 4 components should be explored?
1. Time of decision
2. What is the decision
3. Functional test - can they make the decision?
4. Diagnostic test - what is the cause of the impairment/disturbance in functioning of the mind?W
84
What are the parts of the functional test re:capacity?
1. Can they understand information?
2. Can the retain information?
3. Can they weigh up the information?
4. Can they communicate that decision?
85
For an advanced decision to refuse treatment (ADRT), what is needed for it to be valid? (4)
1. Written down
2. Signed by patient
3. Signed by witness
4. > 18 years old
86
Where is LPA recorded?
Office of Public Guardian
87
For LPA to refuse life saving treatment what must be present?
It must have been specifically expressed within authorisation
88
What is the 'acid test' that decides whether a patient is experiencing deprivation of liberty? (2)
1. Are they under continuous supervision/control?
AND
2. Are they free to leave
89
What is the age of:
- consent
- refusing treatment
1. >16
2. >18
90
What 3 parts of law apply to paediatric consent and to what age do they apply?
1. Childrens Act 1989 = < 18yrs
2. Family Law Reform Act 1969 = <16
3. Gillick Competence = no age
91
What are the component parts of AMTS?
What is your age?
Was is your DOB?
What is your address?
What is the year?
Who is the prime minister?
What is the time?
Where are we now?
What is my job?
39 Donnybrook road
Count backwards 20-1
Remember address
92
What is the JRCALC basic suicide assessment risk tool?
IPAP
Intent - still having intent
Plan - do they have a plan
Action - have they carried out anything in preparation
Protective factors
93
What is the mortality of ABD and CV collapse?
10%
94
What factors are associated with an increased frequency of ABD? (3)
1. Male
2. Summer months
3. Stimulant drugs
95
What does 1. NICE and 2. RCEM recommend for rapid tranquilisation.
1. IM lorazepam first line, IM haloperidol and promthezine if no QT prolongation
2. Ketamine IM/IV or droperidol
For exam go with NICE (RCEM in hospital)
96
What do they use in police custody for ABD?
PO lorazepam
97
What do NICE state is the maximum time for physical restraint?
10 mins
98
If physically restraining someone what should be done/avoided? (5)
1. < 10 mins
2. Little force as possible
3. Not prone
4. Avoid airway/chest
5. Have member of staff observing patient (obs/breathing) not involved in restraint. Can reassure patient simultaneously.
99
Describe the SADPERSONS risk assessment tool?
Sex (1pt)
Age 15-15 or >59 (1pt)
Depression (2pts)
Previous suicide attempt (1)
Excess drugs/-OH misuse (1)
Rational thinking loss (2)
Singe/widowed/divorced (1)
Organised/serious attempt 2)
No social support (1)
Stated future attempt (2)
100
What is conisdered:
1. low
2. medium
3. high
risk SADPERSONS score
1. 0-5
2. 6-8
3. >8
101
What pain score is used in non-verbal adults?
Abbey Pain Score
102
At what age does the mental capacity act apply?
16 or over
However parents can over-rule 16-17 yr olds refusing tx if in their best interests.
103
What are the key points from the JRCALC ABD guideline? (4)
1. Verbal de-escalation usual enough
2. Clinical emergency - CV collapse can occur. Needs time critical transfer and pre-alert
3. Once identified ABD request extra clinical support
4. Early management for hyperthermia/hypovolaemia and acidosis with IVI and oxygen
104
Can ambulance staff apply physical restraint if needed?
Yes
105
What is recommended with regards to the management of ABD in police custody? (faculty of forensic and legal medicine
1. Should not be taken toustody
2. Take to ED if develops whilst in custody
3. Oral sedation offered (1-2mg lorazepam with HCP present whilst awaiting ambulance ('pre-rapid tranq, pre-RT')
4. Not IM/IV medications
106
Which of the following does not classically present with visual hallucinations?
1. Acute mania
2. Temporal lobe epilepsy
3. Drug induced psychosis
4. Serotonin syndome
5. Neuroleptic malignant syndrome
NMS - can occur but not classic
(previous question)
107
What agents do NICE recommend for rapid tranquilisation?
1. IM lorazepam
2. IM haloperidol + promethazine second line (not if no ECG/QTc not known)
108
How does GMC define EOL?
Likely to die in next 12 months
109
What is the definition of death?
Irreversible loss of capacity of consciousness and breathing, therefore of cessation of integrative function of brainstem.
110
What can / cannot be done pre-hospital in terms of organ donation?
Unable to initiate organ donation as death certificate cannot be issued immediately
However, tissues maybe viable for up to 48 hours and this can be initiated by coroner
111
What law imparts a duty upon care providers to safeguard vulnerable adults from abuse or neglect?
The Care Act 2014
112
What does the Sexual Offences Act 2003 state
A sexual relationship between carer and a client with mental health issues a criminal offence, regardless of consent.
113
What are the six principles of adult safeguarding are:
1. Prevention
2. Protection
3. Partnership
4. Proportionality
5. Empowerment
6. Accountability
114
What does 'CE' stand for when placed on products?
European conformity (Conformité Européenne
115
Describe the phases of clinical trials
I SWIM
0 - Initial = pharmacokinetics/dynamics
- small group healthy volunteers
1 - Safe?
= safe maximum dose
< 100 health volunteers
2 - Works? (efficacy)
> 100 patients with disease
3 - Improvement?
-Assess efficacy, effectiveness and safety
- 300-3000 patients with disease
- informs labelling
4 - Marketing suitability - post-marketing surveillance
116
How long do new chemicals/vaccines need a black triangle to show they are new?
2 years
117
Re: yellow card scheme
1. Why was it created?
2. How many reports to the get a year?
3. Can patients report to it?
4. Are herbal medicines included?
1. After the thalidimide disaster
2. 20,000
3. yes
4. yes
118
What are schedule 1 drugs?
Illegal drugs
119
What are schedule 2 drugs?
1. High strength opiates
2. Ketamine
120
What are schedule 3 drugs? (6)
Tramadol
Buprenorphine (Butec)
Gabapentin
Pregabalin
Midazolam
Temazepam
121
What are schedule 4 drugs?
1. Benzos apart from midazolam and temazepam
2. Zopiclone
122
What are schedule 5 drugs
1. Codeine
2. Most other drugs
123
Broadly speaking what are:
1. Schedule 17 drugs
2. Schedule 19 drugs
1. Drugs that paramedics can give
2. Drugs EMTS can give, and members of public, IM meds
124
What are the schedule 19 drugs (broadly)?
1. Antidote or CBRN meds
2. Glucose IM
3. Glucagon IM
3. Adrenaline 1:1000 IM
4. Hydrocortisone IM
5. Chlorphenamine IM
6. Promethazine IM
125
What is the regulation that governs paramedics administering meds?
Schedule 17, Part 3 of Human Medications Regulations
126
What are the schedule 17 medications?
1. Diazepam 5 mg per ml emulsion for injection
2. Gelatin 4% intravenous infusion
3. Syntometrine
4. Adrenaline
5. Amiodarone
6. Glucose
7. Benzlypenicillin
8. Hartmanns
10. Ergometrine
11. Furosemide
12. Heparin sodium (only for cannula flushing)
13. Lidocaine hydrochloride
14. Metoclopramide
15. Morphine sulphate
16. Nalbuphine hydrochloride
17. Naloxone hydrochloride
18. Ondansetron
19. Paracetamol
20. Reteplase
21. Sodium chloride
22. Streptokinase
23. Tenecteplase
127
What drugs can midwives give via schedule 17? (5)
1. Vit K
2. Diclofenac
3. Hydrocortisone
4. Miconazole
5. Nyastatin
128
What drugs can podiatrists give via schedule 17? (6)
1. Codeine (any formulation)
2. Amoxicillin
3. Flucloxicillin
4. Erythromycin
5. Antifungal creams
6. Steroid creams
129
What are class A drugs (misuse of drugs act)? (8)
1. Cocaine
2. Any strong opiate
3. MDMA ("ecstasy")
4. methamphetamine
5. opium
6. LSD
7. hydrocodone
8. magic mushrooms
Any class B drug that is prepared for injections becomes a class A substance
130
What are clas B drugs? (misuse of drugs act) (7)
1. Cannabis/cannaboids
2. ketamine
3. amphetamine
4. codeine
5. barbiturates
6. mephedrone,
7. GHB, and GBL.
Any class B drug that is prepared for injections becomes a class A substance.
trolled under the Psychoactive Substances Act 2016 and Medicines Act 1968.
131
What are class C drugs ?(misuse of drugs act)
1. Benzodiazepines
2. pregabalin, and most other non-barbiturate tranquillisers
3. gabapentin
4. tramadol
5. anabolic steroids
6. nitrous oxide
132
Where are all other psychoactive drugs not mentioned in Class A, B + C legislated, and what are the exceptions?
1. Controlled under the Psychoactive Substances Act 2016 and Medicines Act 1968.
2. Alcohol/caffeine/tobacco
