HaDSoc- 1.1 quality and safety

Question 1

Why have quality and safety become so important?

Answer 1

• 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

Question 2

In terms of healthcare, define safe:

Answer 2

No needless deaths

Question 3

In terms of healthcare, define effective

Answer 3

no needless pain/sufffering

Question 4

In terms of healthcare, define patient centered-

Answer 4

Focus is on the patients needs and priorities (What that want is taken into account)

Question 5

In terms of healthcare, define timely

Answer 5

There is no unwanted waiting

Question 6

In terms of healthcare, define efficient

Answer 6

no waste

Question 7

In terms of healthcare, define equitable

Answer 7

no one is left out (Not the same as treating everybody the same, which is equality)

Question 8

How do we know that quality is not optimal?

Answer 8

There are variations in health care being received, therefore not everyone can be getting the best care.

Question 9

Define equity

Answer 9

Everyone with the same needs, gets the same care.

Question 10

What is an adverse event?

Answer 10

an ijury produced by medical management (instead of an underlying disease) which results in hospitalization, disability or both.

Question 11

What’s a preventable adverse event?

Answer 11

An adverse event which could have been presented given surrent medical knowledge.

Question 12

What’s an unavoidable adverse event?

Answer 12

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.

Question 13

Give examples of preventable adverse events

Answer 13

• operation on the wrong body part
• some infections
• retained objects
• wrong type of medication
• failure to rescue (eg not recognizing vital signs)

Question 14

How common are adverse incidents?

Answer 14

around 9.2%, of which 7.4% are lethal.

In surgery, this is even higher

Question 15

What is a never event?

Answer 15

One which never should have happened, under any circumstances, e.g. operating on the wrong body part.

Question 16

Why do some problems regarding harm and safety happen?

Answer 16

systems no taking human factors into account.
-long hours, inadequate training, lack of checks, different methods in different places, drug containers looking the same.

Question 17

What is an active failure?

Answer 17

Acts that lead to direct harm to a patient, occur closest to the patient, eg giving an accidental overdose.

Question 18

What are latent conditions?

Answer 18

conditions which predispose to an active failure, making it more likely to happen.

Question 19

Gives examples of latent conditions

Answer 19

• poor staff training
• understaffing
• poor supervision
• syringes looking the same, ability to be used with multiple different drugs.

Question 20

what is the swiss cheese model?

Answer 20

successive layers of ‘swiss cheese’ with many holes, caused by latent conditions and active failures, if the holes line up, you get a mistake.

Question 21

How can we make the health care system safer?

Answer 21

• avoid reliance on memory
• make things visible (cues)
• review, simplify process’
• made procedures standard
• use checklists
• decrease reliance on vigilance.

Question 22

What is clinical governance?

Answer 22

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.

Question 23

What are the 6 NHS quality improvement mechanisms

Answer 23

1. standard setting
2. commisioning
3. financial incentives
4. disclosure
5. regulation, registration and inspection
6. clinical audit and quality improvement.

Question 24

Discuss standard setting

Answer 24

NICE standards, define what high quality care should look like,

Question 25

Discuss commisioning

Answer 25

commission services for local populations, drive quality through contracts (people want them to commission them, so will strive to provide higher quality care)

Question 26

Discuss financial incentives

Answer 26

Used to reward and penalise, quality outcomes framework points earn money
-National tarrif, incentive to improve quality for commissioners to chose you.

Question 27

discuss quality of outcomes framework

Answer 27

used in primary care to set standards, GPs score points based on how well they perform.
Results get published online.

Question 28

What’s a national tariff?

Answer 28

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.

Question 29

Discuss disclosure

Answer 29

Making the public aware of how trusts and individuals are doing. Should improve quality.

Question 30

Discuss registration and inspection

Answer 30

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.

Question 31

What’s clinical audit or quality improvement?

Answer 31

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.

Question 32

What are tjhe 6 characteristics that make up quality?

Answer 32

• accessibility
• equity
• acceptibility
• effectiveness
• efficiency
• relevance