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done pharmacy practice > Hannah Family and Kathleen > Flashcards

Hannah Family and Kathleen Flashcards

1
Q

Name the 6 stages in the ‘stages of change’ model

A
  1. Pre contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse/termination
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2
Q

Why might people not want to change?

4

A

Unrealistic optimism e.g

  • Lack of personal experience of problem
  • Belief that behaviour preventable
  • Belief that as problem has not yet occurred, it will not happen
  • Belief that problem is infrequent
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3
Q

Does evoking fear work?

A

NO - if in pre contemplation stage then may cause avoidance and fatalism reactions e.g going to die anyway so might as well

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4
Q

How may fear appeals be improved?

A
  • By informing patients of ways to reduce the threat

- By emphasising that the threat is imminent by providing information

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5
Q

What may a patient be doing in the contemplation stage?

A

Weighing up pros and cons

- perceived benefits and threats of action

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6
Q

What is ambivalence?

A

Being unable to decide after weighing up pros and cons

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7
Q

What is the ‘reactance theory’?

A

‘Nobody tells me what to do’ attitude

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8
Q

List 4 things that can make patients disengage with our advice…

A

1) Assessing (tick boxing)
2) Telling
3) Power differential ‘I’m the expert’
4) Labelling ‘smoker’ (judgmental)

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9
Q

What is ‘motivational interviewing’?

A
  • Collaborative
  • Goal orientated
  • Language of change
  • Strengthen personal motivation
  • Atmosphere of acceptance and compassion
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10
Q

What should you do during motivational interviewing if resistance occurs?

A

ROLL WITH IT and AVOID ARGUING!

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11
Q

How can a discrepancy be developed?

What questions can be asked?

A

1) Why do you want to make the change?
2) What are the best reasons to do it?
3) How might you go about doing it?
4) Scale 0-10 how important to make the change
5) Scale 0-10 how confident that you will make change

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12
Q

How can you support preparation stage and reinforce self efficacy?

A

1) Discuss how cope with future challenges/what to do if feel may lapse
2) Where to find guidance/ideas/social support
3) Clinical advice e.g NRT and support from healthcare professional trained in smoke cessation

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13
Q

Setting SMART goals can bridge the intention - behaviour gap.

What does SMART stand for?

A 
S - Specific
M - Measurable 
A - Achievable 
R - Relevant 
T - Time dependant
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14
Q

What is the different between a LAPSE and a RELAPSE?

A 
Lapse = just a slip 
Relapse = Back round to start of cycle
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15
Q

Stage 5 maintenance.

For the behaviour to be classed as ‘maintained’ what time period does this behaviour need to be maintained over?

A

6 months or longer

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16
Q

Define ‘Termination’ Stage

A
  • Some time after maintenance
  • Completely free of old behaviours
  • Not feel tempted back into old behaviours
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17
Q

When talking about a patient centred approach what does ICE stand for?

A

Ideas
Concerns
Expectations

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18
Q

What are the 5 steps in the Calgary-Cambridge guide to consultation skills?

A

1) Initiating the session
2) Gathering information
3) Physical information (examination)
4) Explanations and planning
5) Closing the session

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19
Q

When gathering information, what type of questions should be used? (3)

A

OPEN questions, PROBING questions and NON leading questions

20
Q

What are the 4 E’s when it comes to patient counselling?

A

Explore - what do you know already?
Educate - inform about what they don’t know
Empower - anything that you would like to know/do?
Enable - how will you fit these tablets into your day?

21
Q

What is an error of COmission?

A

Incorrect drug/Incorrect dose

22
Q

What is an error of Omission?

A

Omitting dose or failure to monitor e.g INR

23
Q

What is a ‘never event’

A

A serious, largely preventable patient safety incident

24
Q

What does the NRLS stand for?

and what is it?

A

National Reporting and Learning System

- reporting of safety incidents to here

25
Q

Using the Swiss Cheese model, explain how patient safety incidents occur…

A

Patient safety incidents occur when holes in barriers/defences line up

26
Q

Where do latent failures occur?

A

At the management level

27
Q

Give an example of a slip…

A

Failure of attention

28
Q

Give an example of a routine violation…

A

Cutting corners to save time e.g not properly checking a an item that has been dispensed

29
Q

What are the 5 contributing factors/psychological precursors in reasons accident causation model?

A
  • Work environment
  • Team
  • Individual/staff
  • Task
  • Patient
30
Q

Define a ‘Root cause analysis’

A

A structured investigation that aims to identify the true cause of a problem and the actions necessary to eliminate it

31
Q

What are the 6 steps of a Roote Cause Analysis

A

1) Gathering information
2) Information mapping
3) Identifying problems
4) Analysing problems for contributory and causal factors
5) Determining the root cause
6) Developing recommendations

32
Q

What is a way of proactively managing errors?

A

Failure Modes and Effects Analysis (FMEA)

33
Q

When does the GPHC state that a Root Cause Analysis must take place?

A

When an error occurs that causes patient harm

34
Q

The Health Belief Model looks at Socio-demographic factors such as… (2)

A
  • Perception of health threat (susceptibility and severity of threat)
  • Evaluation of action (expectations - benefits of actions and perceived barriers to action AND self efficacy)
35
Q

What is self efficacy?

A
  • Persons belief in ability to undertake a behaviour
36
Q

Health belief model looks at…

1) Perception of health threat
2) Evaluation of action
3) _____ __ _____

A

3) CUES TO ACTION e.g Media, Personal, Reminders

37
Q

The are 6 steps in a FMEA.

What are they?

A

1) Graphically describe process
2) Identify failure modes
3) List causes of failure modes and categorise according to Reasons accident causation model
4) Design interventions for failure modes
5) Identify outcome measure for interventions
6) Implement and monitor interventions

38
Q

When conducting step 1 and 2 of FMEA, what must be done?

A

1) Graphically describe process:
- Flow diagram describe each step

2) Identify failure modes;
- What could go wrong at each step
- Rank on scale how likely is to happen, how severe this will be and how detectable

39
Q

What is an ‘ACTIVE FAILURE’?

A
  • Unsafe act committed by people who are in direct contact with the patient/system
40
Q

Unsafe acts can be either INTENDED or UNINTENDED. These categories can be split into two more categories each, what are they?

A

UNINTENDED:
Lapse (omission)
Slip (commission)

INTENDED:
Mistake
Violation

41
Q

Step 3 of an FMEA states that causes of failure modes must be listed and categorised according to Reason’s accident causation model. What are the categories?

A

1) Latent failures
2) Unsafe acts
3) Error provoking conditions

42
Q

How do we identify and document errors?

A

1) Near miss, prevented and unprevenbted error logs

2) Tally charting

43
Q

List some strengths of FMEA…

A

1) Detailed
2) Systematic
3) Emphasises team involvement
4) Proactive identification of error provoking conditions

44
Q

List some weaknesses of FMEA…

A

1) Time consuming
2) Different teams won’t always produce same analysis of task
3) Ratings of severity, probability of occurring and ease of detection may be unreliable depending on personal opinions e.g lack of experience in area
4) Not much guidance on how to design and evaluate interventions

45
Q

Why might a patient safety alert be made?

A
  • Potential for patient safety issue to cause death or severe harm but most healthcare providers will not have knowledge or experience of risk and unaware could occur locally

done pharmacy practice (10 decks)

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