HCAIs

Question 1

what is an HCAI?

Answer 1

healthcare associated infection

Question 2

how do trusts learn from each other?

Answer 2

through the national learning system

Question 3

what can reduce the incidence of HCAIs?

Answer 3

root cause analysis - allows the causal factors of an incident to be identified - means that the solutions can be identified and that these events can be prevented int he future

Question 4

according to WHO 2008 what is RCA?

Answer 4

RCA is the systematic analysis of all the factor that predisposed to or had potential to prevent an error

Question 5

what are the basic principles of RCA?

Answer 5

react, record, respond:
critical problems
main contributory factors
what needs to be done

Question 6

why are tools designed?

Answer 6

to capture and share the actionable learning from investigations

Question 7

what are 3 examples of tools used in RCA?

Answer 7

5 Whys
fishbone analysis tool
tabular timeline - what happened, what should have, problem, further problems, good practice

Question 8

what are examples of outbreaks of HCAIs?

Answer 8

stoke mandeville - 2005

Maidstone - 2006

Question 9

briefly outline examples of outbreaks of HCAIs?

Answer 9

high number of cases of C difficile and deaths
maidstone >500 cases and 60 deaths
both due to design of service, journey and number of encounters, breaches to asepsis

Question 10

how can these be overcome?

Answer 10

challenge visitors, wear PPE where appropriate, bare below elbows, zero tolerance, healthy challenge culture

Question 11

what is the healthy challenge culture?

Answer 11

being able to take up issues with colleagues without feeling negative - graded assertiveness
probe, alert, challenge, escalate

Question 12

what is QI?

Answer 12

quality improvement - a commitment to continuously improve the quality of healthcare - focusing on the needs and preferences of the people who use the service

Question 13

what does QI address?

Answer 13

the healthcare that is being delivered compared to what should be being delivered - it focuses on changing one of the characteristics of quality - product, environment or service to make it sustainable

Question 14

what is the set of methods and set of values?

Answer 14

values: learning, partnership, theory, context, leadership, self reflection
methods: measurement, tools, techniques, variation, cyclical change and benchmarking

Question 15

what is change?

Answer 15

it is an attempt to improve an aspect of the system we work in

Question 16

what are the basic principles of change?

Answer 16

eliminate any inappropriate variation and document any change

Question 17

what model can be used for change?`

Answer 17

from Kaiser Permanente - triangle - bottom (point) is executives - set goals. Then the operational leaders who identify problems, then the clinical leaders who sequence change and then the front line staff who carry out - all surrounded by experts

Question 18

what is SMART?

Answer 18

the criteria to set an aim
Specific 
measurable 
achievable / attainable 
realistic / relevant 
time bound

Question 19

what are the 4 key improvement themes in change?

Answer 19

involving patients, carers, staff and public, organisational and personal development, systems and process thinking and initiating, sustaining and spreading - habit

Question 20

how would you produce an aim?

Answer 20

you need to assess how you will improve quality of care

Question 21

how would you ensure confidentiality of data?

Answer 21

ensure the data is only used for that improvement

Question 22

how is a hypothesis flexible?

Answer 22

it changes with learning

Question 23

what sample size is used?

Answer 23

just enough

Question 24

how would you test strategy?

Answer 24

sequential tests

Question 25

why would you run charts?

Answer 25

to check if the change is an improvement

Question 26

what should a method be?

Answer 26

observable

Question 27

what are QI improvements?

Answer 27

clinical audit - test against a predefined standard - ensure you complete the whole clinical cycle
PDSA - repeated, rapid, small scale tests of change - audit a step further by development, testing and implementation

Question 28

what does QI framework do?

Answer 28

uses QI methodology and a structured framework - realistic and dynamic change - makes clinical audit robust and visible

Question 29

what is the PDSA cycle?

Answer 29

plan, do, study, act

Question 30

what are the disadvantages of averages?

Answer 30

the give you a point on a graph but nothing variation or distribution

Question 31

what is the term for achieving an endpoint?

Answer 31

outcome measures

Question 32

what are balance measures?

Answer 32

checking that a change has not caused a new problem

Question 33

what is statistical performance control?

Answer 33

display data where performance is visible to ensure that change is resulting in improvement - helps us to determine if there are gains in respect to the baseline data