General Flashcards
Define an audit
The systematic critical analysis of the quality of medical care, including the procedures used for diagnosis & treatment, the use of resources & the resulting outcome & quality of life for the patient
5 stages of an audit
- 1: identify current standards
- 2: measure current performance
- 3: compare performance vs standards
- 4: make improvements
- 5: re-evaluate
3 benefits of an audit
improve patient care, financial benefits, assess progress against national standards
5 limitations of an audit
only as good as national standard, may have no improvement, costs time/money/resources, only focusses on one thing at a time, improvements focus on current standards and not what might actually be best
How long do you have to complain
12 months
3 steps for complaints
1st: PALS
2nd: NHS directly or commissioner
3rd: Parlimentary and health service ombudsman
What is PALS
Patient advise and liaison service
Independent complaints advocacy service in every trust
Complaining about mental health act?
Directly to CQC
Commissioner for hospital and GP
Hospital: NHS England
GP: CCG
4 common reasons for complaints
Ineffective/unsafe clinical practice
Poor information
To have bad practice investigated & changed
Bad attitudes/ lack of dignity and respect.
Define medical indemnity
: legal exemption from liability for damages done to patients under treatment in NHS
4 responsibilities of doctors
discuss everything in non-jargon way, recommend alternative treatments, keep good records, ask for second opinion when knowledge is limited
Define adverse effect
Undesired harmful effect resulting from medication/procedure.
e.g. prescribing error, surgical error, communication failure, delayed diagnosis
Most common adverse effect in primary and secondary care
Primary: delayed diagnosis
Secondary: negligence
Define near miss / active failure
can be errors (knowledge/rule/skills based) or violations (routine, reasoned (thought in patient’s best interest), reckless/malicious)
How many near misses are preventable
50%
Why are near misses important
They’re common, have consequences and we can prevent them by reporting them
Role of the national patient safety agency
responsible for handling adverse events, and they can be reported to them e.g. reporting drug reactions/side effects with yellow card at back of BNF
5 barriers to effective learning
lack of communication, lack of responsibility, focus on event not root cause, pride/rigid attitude, poor monitoring
7 steps to patient safety
Build safety culture, support staff, integrate risk management, promote reporting, communicate public, implement solutions, lean and share
Consent for clinical trials
Must be informed and reviewed by ethics committee
3 ethical issues of clinical trials
Subjecting some people to risk for the benefits of others: does risk-benefit analysis is main job of ethics committee (non-maleficence and beneficence
Not knowing long term damage so is consent informed
If paid money are they taking advantage of pooper populations, will they provide false information to join, removes altruism
What are the 4 stages of a trial
1: researchers test a new drug or treatment for the first time in small number of people (20-80) (usually normal, healthy volunteers, to evaluate its safety, determine dosage range, side effects
2: larger groups (100-300) to further assess clinical safety
3: larger groups (1000-3000) to look for s/e
4: performed after drug or treatment has been authorised for medical prescription and has been marketed. Look for long term use.
Ethical dilemmas towards healthcare problems in the elderly
Conflict of interest, Euthanasia, DNACPR
Consent and capacity
Define medically unexplained symptoms
Illness or symptom where there is no detectable physical pathology
Common MUS
Chronic fatigue syndrome
Fibromyalgia
IBS
Repetitive strain
pain, palpitations, fatigue, headache
3 ways of dealing with medically unexplained symptoms
Rejecting: denies reality of symptoms, patients needs not met
Collusive: sanctioning patients beliefs about symptoms
Empowering: tangible, opportunities for self management, patient understands, removes blame from patient and allies doctor and patient
issues for the individual living with MUS
Lack of social support and information Relationships strained Often told it's psychological Guilt and isolation (wasting doctors time and resources) Iatrogenic harm from investigations Patients needs often not met
Role of the post-mortem
Insight into pathological process of disease
Prevention of future patient deaths
Aids teaching and research
Legal requirements for a post mortem
Sudden/unexpected death Unknown cause of death Unnatural death Death from industrial disease Death from negligence Death during surgery/anaesthesia Death within 24hrs of admission Not seen by a doctor in 14 days Patient detained under mental health act
4 criteria to certify a death
pupils fixed and dilated
No ventilation/breath sounds for (3 minutes)
No central pulse for (1 minute)
No heart sounds on auscultation (1 minute)
Also look for verbal stimuli, response to pain
Reasons to refer to the coroner
In hospital less than 24 hours Unknown cause In custody Suspicious circumstances Drugs or alcohol involved Industrial death Blame Accident Operation
When can you fill out a death certificate
Seen the patient in the last 14 days
Provided care in the last illness before death
Registered medical practitioner
Knowledge and belief of the cause of death
What is the calman-hine framework
Highlighted the need to develop strategic cancer networks incorporating primary care, cancer units and cancer centres
Monitors effectiveness of the changes resulting from recommendations
Aims of strategic cancer networks
Reduce incidence of cancer Maximise survival of cancer patients Enhance QOL of patients Improve patient experience Provide a high quality service
Role of a cancer unit
Diagnose and treat common cancers
Diagnose intermediate cancer and refer to specialists
Provide drug therapy and treatment
Role of cancer centres
Provide cancer unit services for large areas
Specialist diagnoses and treatment to allow better management of less common conditions (disadvantage of travel and barriers to accessing care)
Role of partnership groups in cancer care
Combine users of cancer services to improve services
Role of cancer registeries
Collect analyse and disseminate cancer data to the region
Submit to office of national statistics
Implement the cancer plan through provision of reliable data of incidence, prevalence and survival rates
National cancer research network
Supports recruitment of patients for trials and improves speech, quality and integration of research into care services
Integrates and supports work from cancer charities
Role of the national cancer research institute
Promote co-operation between government, charities and industry for patient and public benefit
Maintains a research database that analyses current research and informs future research
How are the quality of cancer services measured
Clinical service quality measures (CSQM)
Care quality commission (CQC)
National audits
Survival and mortality rates
Psychological consequences of cancer treatment for patients and relatives
Diagnosis: stressful, family dynamics change, shock, anger, guilt, blame, treated as a death sentence
Treatment: relationship problems, change in identity, scars, unable to work/exercise
Family: relationship, distressing for child, concern for relatives
Expectation of a medical student
Develop skills and behaviour
Commitment to maintain knowledge and skills for life
Develop skills needed to maintain a strong professional relationship
Work effectively with colleagues
Honest and integrity
Attitudes to mental illness in the elderly
Presumptions e.g. technology Sx put down to old age Treatments prioritised to younger people (not looking at physiological age) Less screening Different attitude to healthcare
Role of social workers
Support families through difficult times, review environments and help financially and legally
Child protection
Define advocacy
Getting support from another person to help you to express your wishes and views and help you to stand up for your rights
- they will listen, explore options, provide information for informed decisions, accompany you and contact relevant people
- they will not give you their opinion, solve problems or make judgement
Define stigma
Something which exists through social relations
Explain the social process of labelling
Labelling (the label X) > Stereotyping (people who are X are) > othering (us vs them) > stigmatising (devaluing X based on attribute) > discrimination (acting differently to X)
Explain the 5 types of stigma
Discreditable: keep stigmatising conditions hidden except to close family (HIV)
Discrediting: cannot be hidden e.g. wheelchair, aspegers.
Felt: by patient (shame in STI clinic)
Enacted: by others (schizophrenia removed from bus)
Courtesy: felt by someone who is with someone open to stigma e.g. parent of autistic child, spouse of alzhiemer patient
Define internalising
absorbing social views of being lower status and the impact on personal beliefs and behaviour
How to cope with stigma
Passing (pretend like normal)
Covering (non disclosing, blind wear sunglasses)
Withdrawal: social acknowledge and withdraw
Resisting: contesting the stigma
Implications of stigma
Depression/anxiety
Schizophrenia: people avoid them
Mental retardation: stigmatised as unwanted
Eating disorder: stigmatised as their fault
