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Module 7 > HCLP > Flashcards

HCLP Flashcards

1
Q

Define confidentiality in healthcare?

A

The ETHICAL PRINCIPLE or LEGAL RIGHT that a health professional will hold secret all information relating to a patient, unless the patient gives CONSENT permitting disclosure.

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2
Q

What does common law say?

A

When someone shares personal information in confidence, it must not be disclosed without some form of LEGAL AUTHORITY or JUSTIFICATION.

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3
Q

What is the confidentiality law in the UK?

A
  • Common law.
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4
Q

What is the legal capacity in Scotland? England?

A
  • Scotland: 16.
  • England: 18.
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5
Q

What information is considered confidential?

A
  • Information that (if disclosed) could reasonably be expected to place them at risk of criminal or civil liability, or be damaging to financial standing, employability or reputation.
  • ANY INFORMATION THAT AN INDIVIDUAL WOULD PREFER TO REMAIN PRIVATE.
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6
Q

4 examples of confidential information in dentistry (4)?

A
  • Contact details.
  • Aspects of medical history.
  • Attendance at an appointment.
  • That the patient wears dentures.
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7
Q

3 reasons confidentiality is important?

A
  • Relationship and trust with patients.
  • Valued and expected.
  • Foundation of good dental practice.
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8
Q

What GDC standard concerns confidentiality? What does it say?

A

** GDC STANDARD 4.2.1**.
- Relationship and trust with patients.
- Valued and expected.
- Foundation of good dental practice.

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9
Q

7 times you can breach confidentiality?

A

WITH THE PATIENT’S CONSENT:
- Insurance company.
- Other healthcare professionals.
- Solicitors.
- Parents.
- Carer of an incapacitated patient.
- Partners.
- Schools/ employers.

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10
Q

What type of duty is confidentiality?

A

A RELATIVE duty, NOT AN ABSOLUTE duty.

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11
Q

3 occasions when a dental professional has a statutory duty of breach confidentiality?

A
  • To aid identification of a driver in a road traffic accident.
  • An officer of NHS Scotland or your NHS board.
  • Identification of a missing/ deceased person.
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12
Q

Where can you see advise from when breaching confidentiality in the public interest?

A

Your indemnity.

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13
Q

What does the GDC advise for breaching confidentiality in the public interest (4)?

A
  • Where a patient puts their HEALTH and SAFETY at serious risk.
  • You think that you have confidential information which would help PREVENT or DETECT a serious crime.
  • Public health issues.
  • Child protection/ vulnerable adult.
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14
Q

Do you require patient consent to breach confidentiality in the public interest?

A

No, may have to go against patient wishes.

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15
Q

4 things to do when releasing confidential information?

A
  • Patient consent IF POSSIBLE - ideally in writing.
  • Release the minimum information necessary for the purpose.
  • Be prepared to justify your decisions/ actions.
  • Seek advice if in doubt.
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16
Q

What GDC standard discusses confidentiality?

A

Standard 4

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17
Q

What is the main statement of GDC standard 4?

A

Maintain and protect patient’s information.

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18
Q

4 things patients expect according to GDC standard 4?

A
  1. Records to be up to date, complete, clear, accurate and legible.
  2. Personal details to be kept confidential.
  3. To be able to access their dental records.
  4. Their records to be stored securely.
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19
Q

What is the law concerned with data called?

A

Data protection act 2018.

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20
Q

What does the data protection act 2018 postulate?

A

Law around how personal data is processed including:
- Collection.
- Storage.
- Use.
- Disposal.

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21
Q

What are the 7 principles of the Data protection act 2018?

A
  1. Lawful, fair and transparent.
  2. Purpose limitation.
  3. Data minimization.
  4. Accuracy.
  5. Storage limitation.
  6. Integrity and confidentiality.
  7. Accountability.

SAD PALI

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22
Q

How many years since last visit should dental records of patients be kept?

A

Adults: 11 years after last visit.
Children: till the age of 25.

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23
Q

3 people/ organizations that are responsible for OVERSIGHT according to the data protection act 2018?

A
  • Data protection officer (DPO).
  • Information Commissioner’s Office (ICO).
  • Caldicott Guardian.
24
Q

DPO?

A

Data protection officer.
- Oversees an organization’s data protection strategy to ensure compliance with act.

25
Q

ICO?

A

Information Commissioner’s office.
- Independent authority which upholds information rights in the public interest, BREACHES AND FINES.

26
Q

CG?

A

Caldicott Guardian.
- Protect the confidentiality of health information, all NHS organizations must have one, ONLY THOSE WHO NEED TO SEE THE DATA SEE THE DATA.

27
Q

Define duty of candour?

A

The volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or report about that provision has been made.

28
Q

Which recommendation from the duty of candour report is important to dentists? What does it say (2)?

A
  • FRANCIS REPORT - RECOMMENDATION 181
  • Statutory duty of candour on healthcare professionals where there is a belief/ suspicious that any treatment provided to a patient has caused DEATH or SERIOUS INJURY.
  • Openness, transparency and candour throughout the health care system (including a statutory duty of candour), fundamental standards for health care providers.
29
Q

How has the GDC implemented duty of candour?

A

Implements recommendation 181 - BEING OPEN AND HONEST WITH PATIENTS WHEN SOMETHING GOES WRONG.

30
Q

What type of duty do dental professionals have regarding candour?

A

PROFESSIONAL/ LEGAL duty of candour.

31
Q

What must you do if a patient under your care has suffered harm or distress? (3)

A

a) put matters right (if possible).
b) offer an apology.
c) explain fully and promptly what has happened and the likely short-term and long-term effects.

32
Q

What kind of duty of candour do organizations have?

A

STATUTORY DUTY OF CANDOUR
- organizations = responsible person.
- if you become a dental practice owner, you have a statutory duty of candour as you are the responsible person (and a professional/legal duty of candour as an individual).

33
Q

3 things that need to occur for there to be proof of negligence?

A
  • Duty of care.
  • Breach of duty.
  • Causation of harm.
    ALL 3 THINGS HAVE TO OCCUR TO HAVE PROOF OF NEGLIGENCE.
34
Q

What is the case that discusses breach of duty?

A

Hunter v Hanley (1955)

35
Q

3 things that are required to prove breach of duty?

A

Lord Clyde:
1. It must be proved that there is a usual and normal practice.
2. It must be proved that the defender has not adopted that practice.
3. It must be established that the course the defender adopted is one which no professional person of ordinary skill would have taken if he had been acting with ordinary care.

36
Q

What is causation?

A

The pursuer must be able to show that the negligence of the medical professional caused, or materially contributed to the bad outcome.

37
Q

What is the burden of proof? Who is it on to prove negligence?

A
  • Burden of proof: to provide evidence to support a claim in a dispute
  • Burden of proof (to prove negligence) is on the PURSUER (the patient).
38
Q

What type of standard applies to negligence cases?

A

CIVIL standard
- On the balance of probabilities.

39
Q

What is a complaint?

A

Any expression of dissatisfaction by a patient (or their representative) about a dental service or treatment, whether justified or not.

40
Q

What is a claim for compensation?

A

A claim for something, typically money, in recognition of loss, suffering, or injury.

41
Q

3 GDC standards regarding claims for compensation?

A

1.8 Have appropriate arrangements in place for patients to seek compensation if they suffer harm.

1.8.1 You must have appropriate insurance or indemnity in place to make sure your patients can claim any compensation to which they may be entitled

1.8.2 You should ensure that you keep to the terms and conditions of your insurance or indemnity and contact the provider as soon as possible when a claim is made.

42
Q

What is paramount for claims for compensation?

A

RECORDS.
- Poor records = poor defence.
- No records = no defence.

43
Q

growth areas of claims for compensation (4)?

A
  • Undiagnosed / untreated perio disease
  • Implants and associated procedures
  • Adult Orthodontics particularly short term orthodontics
  • Consent issues across all treatment types.
44
Q

4 outcomes from handling claims for compensation?

A
  • Settled, without admission of liability.
  • Patient/Patient solicitors no longer pursue case.
  • Defend – out of court settlement.
  • Defend – court (win or lose)
45
Q

What 3 elements does dental statutory duty of candour include?

A
  1. Patient.
  2. Process.
  3. Apologies.
46
Q

3 aspects related to the PATIENT and statutory duty of candour?

A
  • COMMUNICATION with non-jargon by method preferred by patient (written, telephone, electronic).
  • Right to be involved in MEETINGS about what went wrong, ask QUESTIONS and be able to EXPRESS VIEWS about the incident.
  • Told if the organisation’s review of the incident > 3months, and the reasons for the delay.
47
Q

3 aspects related to the PROCESS and statutory duty of candour?

A
  • NOTIFY the pt that something went wrong.
  • FACE TO FACE MEETING for explanation, understanding, questions, further investigation.
  • REVIEW, written report and learning points.
48
Q

2 aspects related to the APOLOGIES and statutory duty of candour?

A
  • VERY IMPORTANT.
  • A WRITTEN apology must be offered (both by perpatrator and practice owner).
49
Q

3 steps that trigger a statutory duty of candour?

A
  1. If the patient safety incident one that was ‘unintended or unexpected’ in the context of the care provided?
  2. A registered health professional uninvolved in the patient’s care, did the incident appear to have resulted in, or could result in: death, severe harm or not severe harm but other complications (see other slide), or the patient required treatment to prevent death or the types of harm above.
  3. A registered health professional uninvolved in the patient’s care, is the harm related directly to the patient safety incident rather than the natural course of the patient’s illness or underlying condition?
50
Q

Define severe harm?

A

Permanent lessening of function (ex. removal of the wrong limb/organ, brain damage).

51
Q

Harm which is not “severe harm” but which results in (5):

A
  • An increase in the patient’s treatment (ex. fractured endodontic file).
  • Changes to the structure of the patient’s body (ex. wrong XLA).
  • Shortening of the patient’s life expectancy
  • Impairment of function which lasted (or is likely to last) for at least 28 days continuously (ex. paraesthesia after hypochlorite accident.
  • Pain or psychological harm that has lasted (or is likely to last) at least 28 days continuously (ex. accessed the wrong tooth leaving the patient with irreversible pulpitis).
52
Q

During obturation of tooth 25 you take a post obturation radiograph and most of the gutta percha is in the maxillary sinus. What is your PROFESSIONAL/ DENTAL DUTY OF CANDOUR?

A
  1. Put matters right : Refer to oral surgeon for advice and removal of excess gutta percha and sinus washout.
  2. Offer an apology: In writing and face to face verbal
  3. Explain fully and promptly what has happened: no apical stop kept compacting and the likely short-term: discomfort, sinusitis, additional surgery and long-term: possibly chronic sinusitis effects.”
53
Q

During obturation of tooth 25 you take a post obturation radiograph and most of the gutta percha is in the maxillary sinus. What is the STATUTORY DUTY OF CANDOUR TRIGGERED?

A
  1. It was unintended so passes Stage 1.
  2. It constituted “harm” as increase in patient’s treatment and may cause pain or psychological harm that is likely to last at least 28 days continuously (sinus op/sinusitis) so passes Stage 2.
  3. The harm is directly related to the incident so passes Stage 3.
54
Q

Who has duty of care?

A

If you treat a patient you have DUTY OF CARE.

55
Q

4 things that are compensated after a negligence claim?

A
  • Reimbursement of treatment.
  • Cost to “put right”.
  • Pain, suffering and loss of amenity.
  • Solicitor fees.
56
Q

Who handles claim for negligence in secondary care and PDS?

A
  • NHS indemnity and the central legal office.
56
Q
A

Module 7 (7 decks)

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