HaDSoc- 1.1 quality and safety Flashcards
Why have quality and safety become so important?
- There is evidence that some patients have been harmed or received sub-standard care.
- there are variations in health care
- direct costs, and costs of legal action regarding care
- policy
In terms of healthcare, define safe:
No needless deaths
In terms of healthcare, define effective
no needless pain/sufffering
In terms of healthcare, define patient centered-
Focus is on the patients needs and priorities (What that want is taken into account)
In terms of healthcare, define timely
There is no unwanted waiting
In terms of healthcare, define efficient
no waste
In terms of healthcare, define equitable
no one is left out (Not the same as treating everybody the same, which is equality)
How do we know that quality is not optimal?
There are variations in health care being received, therefore not everyone can be getting the best care.
Define equity
Everyone with the same needs, gets the same care.
What is an adverse event?
an ijury produced by medical management (instead of an underlying disease) which results in hospitalization, disability or both.
What’s a preventable adverse event?
An adverse event which could have been presented given surrent medical knowledge.
What’s an unavoidable adverse event?
one which happens which you couldn’t avoid, for example a reaction to a new drug, you’d have no way of knowing it was going to happen.
Give examples of preventable adverse events
- operation on the wrong body part
- some infections
- retained objects
- wrong type of medication
- failure to rescue (eg not recognizing vital signs)
How common are adverse incidents?
around 9.2%, of which 7.4% are lethal.
In surgery, this is even higher
What is a never event?
One which never should have happened, under any circumstances, e.g. operating on the wrong body part.
Why do some problems regarding harm and safety happen?
systems no taking human factors into account.
-long hours, inadequate training, lack of checks, different methods in different places, drug containers looking the same.
What is an active failure?
Acts that lead to direct harm to a patient, occur closest to the patient, eg giving an accidental overdose.
What are latent conditions?
conditions which predispose to an active failure, making it more likely to happen.
Gives examples of latent conditions
- poor staff training
- understaffing
- poor supervision
- syringes looking the same, ability to be used with multiple different drugs.
what is the swiss cheese model?
successive layers of ‘swiss cheese’ with many holes, caused by latent conditions and active failures, if the holes line up, you get a mistake.
How can we make the health care system safer?
- avoid reliance on memory
- make things visible (cues)
- review, simplify process’
- made procedures standard
- use checklists
- decrease reliance on vigilance.
What is clinical governance?
a framework in which NHS organisations are accountable and continuously improving the quality of their services and safeguardinghigh standards of care by creating an environment in which excellence in clinical care will flourish.
What are the 6 NHS quality improvement mechanisms
- standard setting
- commisioning
- financial incentives
- disclosure
- regulation, registration and inspection
- clinical audit and quality improvement.
Discuss standard setting
NICE standards, define what high quality care should look like,
Discuss commisioning
commission services for local populations, drive quality through contracts (people want them to commission them, so will strive to provide higher quality care)
Discuss financial incentives
Used to reward and penalise, quality outcomes framework points earn money
-National tarrif, incentive to improve quality for commissioners to chose you.
discuss quality of outcomes framework
used in primary care to set standards, GPs score points based on how well they perform.
Results get published online.
What’s a national tariff?
treatments are given a set price, which commissioners pay. This incentivises trusts to improve quality so commissioners invest in them
Efficient trusts can make a surplus, inefficent trusts can lose money.
No money for a never event.
Discuss disclosure
Making the public aware of how trusts and individuals are doing. Should improve quality.
Discuss registration and inspection
NHS trusts are registered with care quality commission, which can make unnanounced visits and issue warnings, fines, or even close places if they arent satisfied with the quality.
What’s clinical audit or quality improvement?
a way of improving health care, a way of identifying area of improvement, trying to change it, and then seeing whether it has changes.
Often done by medical students and junior doctors.
What are tjhe 6 characteristics that make up quality?
- accessibility
- equity
- acceptibility
- effectiveness
- efficiency
- relevance
