H&S Flashcards
What is 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
Benefits of an audit?
- to improve pt care by identifying short comings
- opportunity for clinical education
- assess progress against national standards
- financial benefits
- builds relationships between clinicians, clinical teams, managers and patients
Limitations of an audit?
- comparing current best practice
- may not always help
- costs time, money and resources
- measures at fixed intervals, assumes conditional stability
Stages of audit cycle?
- Identify issues
- Obtain or define standards
- Collect data
- Compare performance with standards
- Implement change
- Re-audit
Role of audit in quality improvement?
often the first step in the improvement process, used to identify improvement opportunities
eg: compliance to known standards for high quality patient care
- does not improve care above current well defined standards
Outline complaints service in the NHS
2 step:
1. local resolution
acknowledgement offered within 3 working days, with offer to discuss handling of complaint
2. escalation to independent ombudsman
PALS: confidential advice and support, point of contact and information
PALS can help resolve issues informal with the hospital before an official complaint is made
the right to complain is written in the constitution of the NHS common complaints: safety of clinical practice poor/insufficient information given to patients ineffective clinical practice poor handling of complaints lack of dignity and respect poor attitudes of staff
Define an adverse event
an event, preventable or non-preventable that caused harm to a patient as a result of medical care. Includes never events, events that required life-sustaining intervention and events that cause prolonged hospital stays, permanent harm, or death.
Eg: Primary care: adverse drug reactions: beta-blockers, statins
Secondary care: falls, med errors, malnutrition, incontinence, Hospital acquired pressure injuries/infections
Define a near miss event
an error that occurs in the process of providing medical care that is detected and corrected before a patient is harmed
Define a never event
serious patient safety incidents that should not occur if the available preventative measures have been implemented
How to report an adverse event and why is reporting important?
National Patient Safety Agency: collects information from staff, patients and careers
National Reporting and Learning System: anonymous system run by NPSA
Yellow Card Scheme: adverse drugs reaction, includes non-prescription herbal etc.
online or yellow cards in back of BNF
adverse events are common and have important consequences
- up to 50% are preventable
- important learning opportunities to introduce preventable measures
Give some barriers to learning from an adverse event?
lack of communication
lack of responsibility (especially at top level)
focus on immediate event does not root cause
pride and rigid attitudes of staff
Ethical issues and practical aspects of clinical trials
informed consent is required, must be reviewed by ethics committee (Protection of Trial Subjects)
subjecting some people to risk for the benefits of others: risk-benefit analysis is main job of ethics committee (non-maleficence and beneficence)
creates ethical tension between the interests of current patients and acquiring new knowledge to guide the care of future patients
unknown long term effects
Equity of resources
Ethics of privatisation: If paid money are they taking advantage of pooper populations, will they provide false information to join, removes altruism
End of life issues
Clinical Trial Process and regulatory body
Phase 1: PRE-CLINICAL TESTING: safety and pharmacology in healthy volunteers (20-100)
Phase 2: examine efficacy (dosage regime and delivery) in volunteers with condition
uses lowest number of patients possible to provide significant statistical data (100-500)
most drugs fail here, ineffective? intolerable?
Phase 3: testing in larger population (1000-5000)
reconfirm phase 2 findings in larger population, overall risk/benefit, side effects
Phase 4: Post marketing studies and surveillance
long term effectiveness and safety, cost-benefit analysis
eg: Yellow Card scheme
Regulatory body: COMMISSION ON HUMAN MEDICINES (CHM) - 2005
Advice a patient on reducing or abstaining from smoking
Smoking & CVD: Active smoking and second-hand smoking exposure determine more than 30% of coronary heart disease mortality
In heavy cigarette smokers cessation can reduce CVD risk by up to 40% within 5 years
3 broad options:
- Group therapy
- One to one therapy
- drug therapy
Describe the barriers to rapid diagnosis and Rx of STEMI
- expected and experienced symptoms may differ so delay seeking help (education)
- Time taken to decide if symptoms require hospital treatment (education)
- Personal (encourage discussion of past experiences and to end the stigma
- Geographical, not near a primary PCI centre (more efficient transport, fairer distribution of resources)
- Cultural (use of interpreters)
- Socio-economic (political, ensure sick pay etc, reduce cost of public transport)
- Organisational (ambulance to identify STEMI and go straight to appropriate hospital, reduce waiting times with more staff?
What are the merits of publicly available performance indicators?
- Focusses attention on improving patient care
- Public reassurance about effectiveness and safety
- Competition will boost performance
- Facilitate informed consumer choice
What are the disadvantaged of publicly available performance indicators?
- may have negative impact on public trust
- Case-mix: may not be representative as some places will receive more complex cases = poorer prognosis
- data manipulation: only treating healthy pts, send more complex cases elsewhere
- measured performances will take precedence, those that are not measured will suffer
Risk factors for CVD
Modifiable: smoking, hypercholesteremia, obesity, excess alcohol consumption, poor diet, CKD, diabetes, rheumatoid arthritis
Non-modifiable: male, FHx, ethnic background (south asian)
Explain the difference between primary, secondary and tertiary prevention in CVD
Primary: prevention in those who do not yet have the disease (eg: smoking cessation, diet modification)
Secondary: prevention of MI/Stroke in those who have CVD (detect disease early and prevent it from getting worse, eg: lifestyle modifications, low dose statin)
Tertiary: prevention of further MI/Stroke in patients who have already had a CVD event (eg: cardiac rehab, anti-thrombotic therapy)
Outline a strategy to reduce CVD in the community
- Identification of at risk patients earlier in course of disease (CVD risk)
- many people with HTN, diabetes and CKD are undiagnosed (47%, 25% and 31% respectively)
- Routine appointments to screen for other CV conditions once one diagnosed
- Screen families of those with inherited conditions (familial hypercholesterolemia)
- Focus on high risk (most likely to benefit patient) and population strategy for lower risk (to benefit NHS)
- Example: Smoking cessation programs, posters etc. Opportunistic counselling in GP/Pharmacists. NRT on NHS
Define Risk Ratio
compares the risk of a health event (disease, injury, risk factor, or death) among one group with the risk among another group
Risk of disease (incidence proportion, attack rate) in group of primary interest
divided by
Risk of disease (incidence proportion, attack rate) in comparison group
RR of 1 = identical risk
>1 = greater risk in the exposed group (group at top of division)
<1 = decreased risk for exposed group (group at top of division)
Define Rate Ratio
compares the incidence rates, person-time rates, or mortality rates of two groups.
Rate for group of primary interest
divided by
Rate for comparison group
1 = identical >1 = increased risk <1 = decreased risk
Define Odds Ratio
quantifies the relationship between an exposure with two categories and health outcome
(a/c)/(b/d)
a= cases exposed b= controls exposed c = cases not exposed d = controls not exposed
1 = no relationship
> 1 = greater odds
< 1 = lower odds
define risk difference/attributable risk
the difference between the risk of an outcome in the exposed group and the unexposed group.
Difference between absolute and relative risk
Relative risk = used to compare the risk in two different groups of people.
Absolute risk = your risk of developing the disease over a time period.
Define NNT
NNT = number needed to treat
eg: the number of patients you need to treat to prevent 1 additional bad outcome
eg: if a drug has NNT = 5
you need to treat 5 patients with the drug to prevent 1 bad outcome
Approaches to controlling the spread of TB
Patient based: (contagious up to 2 weeks into treatment)
- stay away from work, school or college until your TB treatment team advises you it’s safe to return
- always cover your mouthwhen coughing, sneezing or laughing
- carefully dispose of any used tissues in a sealed plastic bag
- open windows when possible to ensure a good supply of fresh air in the areas where you spend time
- avoid sleeping in the same room as other people
Friends/Family: should get tested (blood test, x-ray, Mantoux test)
BCG Vaccine: given on NHS to those at risk under 35
- children living in areas with high rates of TB
- people with close family members from countries with high TB rates
- people going to live and work with local peoplefor more than 3 months in an area with high rates of TB
Stigma: educate and encourage patients to seek help, reduce the stigma.
- address HIV issues as higher risk
Screening of new entrants to country from areas of high risk: Africa, South Asia, Russia, China, South America
Epidemiology of lung cancer
47,838 new cases of lung cancer 2015-2017 in UK
35,137 deaths from lung cancer 2016-2018 UK
79% of cases are preventable (2015)
1 in 13 UK males and 1 in 15 UK females will be diagnosed with lung cancer in their lifetime.
79% of lung cancer cases in the UK are preventable.
72% of lung cancer cases in the UK are caused by smoking.
5% of lung cancer cases in the UK are caused by ionising radiation.
13% of lung cancer cases in the UK are caused by workplace exposures.
8% of lung cancer cases in the UK are caused by air pollution.
Risk factors of lung cancer
Occupational exposure: Asbestos: Mesothelioma Arsenic Silica: Silicosis (stone masonry, mining, quarrying, sand blasting) Smoking: very rare for someone who has never smoked to get SCLC passive smoking Family History Radon gas exposure
What is consent?
Must be voluntary (no coercion)
Must be informed
Patient must have capacity
Can be given in 3 ways:
- verbal
- non-verbal
- written
Informed consent:
- basic overview of their condition
- likely outcome of their decision
- treatment options, including second opinion
When is consent not required?
Additional procedures
During an operation
Emergency treatment
- to save life if unable to consent
Mental Health Condition
- Under section
Risk to public health
- Rabies, TB
