Health Care Policy Flashcards
1
Q
Describe the 4 overall functions of the clinical record
A
- support patient care
- improve future care
- social purposes at the request of the patient
- medico-legal document
2
Q
- Name 6 medical functions of the clinical record
- name non-clinical purposes of the clinical record
- Name emerging purposes of the clinical record
A
- support method of, and structure to history and examination
ensure clarity of diagnosis
record treatment plans
ensure comprehensive monitoring
maintain a consistent explanation for the patient
ensure continuity of care
2. providing medico-legal evidence providing legal evidence in respect of claims by a patient against a third party support claims for benefits record patient preferences provide evidence of workload assist service planning support clinical research
- management of cost effective prescribing
read-only shared record
3
Q
Name 7 things that need to be recorded on a clinical record
A
- presenting symptoms, and reasons for seeking health care
- relevant clinical findings
- diagnosis and important differentials
- options for care and treatment
- discussion about risk and benefits of treatment
- decisions made
- action taken and outcome
4
Q
- Name 4 advantages of handwritten records
- name 3 disadvantages of handwritten records
- name advantages of computerised records
A
- continuous
writer is identified
contemporaneous
portable - legibility issues
structural issues
must be dated and signed
3. problem orientated audit trail searchable patient safety focus clinical decision support
5
Q
Name 6 potential causes for poor UK performance in the Eurocare report
A
- differences in data collection
- age differences (but rates were age standardised)
- differences in stage of presentation
- differences in social class
- differences in access to treatment
- more delay in pathway to diagnosis
6
Q
What were the 7 propositions of the Calman Hine Report to improve cancer care
A
- all patients have access to uniformly high quality of care
- education to aid early recognition
- clear information about treatment options and outcomes
- development of patient centred cancer services
- emphasis on primary care
- recognise psychosocial needs of cancer suffers
- MDTs would be key to managing patients
7
Q
- What were the 4 aims of the NHS cancer plan 2000?
- What did this plan broadly cover?
- What are cancer networks?
A
- save more lives
ensure people with cancer get the right professional support, care and best treatments
tackle health inequalities
invest in cancer workforce - prevention, screening, diagnosis and treatment
- health service commissioners, providers, voluntary sector and local authorities
8
Q
What were the 6 key areas for action outlined by the cancer reform strategy 2007?
A
- prevention
- earlier diagnosis
- ensuring better treatment
- living with and beyond cancer
- reducing cancer inequalities
- delivering care in most appropriate setting
9
Q
Name contributing factors to delayed diagnosis
- patient factors
- system factors
- disease factors
A
- demographic, co-morbidities, psychosocial, social, cultural, previous experiences
- access, policy, delivery
- site, size, growth rate, symptoms
10
Q
What are the diagnostic intervals of cancer care
- referral
- between referral and start of treatment
- from treatment plan to start of treatment
A
- 2 week wait
- 62 days
- 31 days
11
Q
What were the four aims of the “Improving outcomes: a strategy for cancer” report?
A
- prevention and early diagnosis
- quality of life and patient experience
- better treatments
- reducing inequalities
12
Q
- What were the findings of the Mid Staffordshire Scandal?
- What was the Bristol Royal Infirmary Scandal?
- What were the findings of an enquiry into this?
A
- large number of patient deaths as a result of poor care between 2005 and 2009
- high death rates in paediatric cardiac surgery
- staff shortages, lack pf leadershop, old boys culture and lax approach to safety
13
Q
- When is a patient’s death judged as avoidable
Define the following:
- Acts of omission
- Acts of commission
A
- when a problem in care contributed to death
- failure to treat according to best evidence
- incorrect treatment or management
14
Q
Why are high error rates not necessarily a bad thing?
A
means that errors are being reported
15
Q
What is the Summary Hospital Level Mortality Indicator?
A
actual mortality rates within 30 days of discharge, compared to expected mortality, given the hospital’s characteristics
16
Q
- What are hospital episode statistics?
2. What are patient recorded outcome measurement?
A
- dataset including diagnoses, consultant responsible, referring GP, procedures give, duration of stay and discharge/death
- assess the quality of care delivered to NHS patients from the patient perspective. Currently covering Knee and Hip replacements, PROMs calculate the health gains after surgical treatment using pre- and post-operative surveys
17
Q
What is the role of the CQC
A
Regulates quality of all health and social care providers, public and private
Licensing all providers of health and social care
Policing - unannounced visits and use of hospital episode statistics
18
Q
Name 6 other agencies (apart from CQC) involved in consumer protection
A
- NHS improvement
- NICE
- Department of Health
- Heath Protection Agency
- GMC
- Royal Colleges
19
Q
Define the following:
- Adverse Event
- Near Miss
- Serious Incident
- Never Event
A
- an unintended event, resulting from clinical care, that cause patient harm
- a situation in which events or omissions, arising during clinical care, fail to develop further, thus preventing harm
- events where the potential for learning is so great, or the consequences to patients, families and carers, staff or organisations are so significant that they warrant using resources to investigate and act
- serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at national level, and should have been implemented by all healthcare providers
20
Q
Why is the Hospital Standardised Mortality Ratio a poor measure of hospital care (4)
A
- higher proportion of deaths in hospital
- hospital may be in area where there is good or poor hospice care, which influences death rate
- choice of case mix adjustment model
- relationship with quality of care has not been demonstrated
21
Q
Describe the swiss cheese model
A
hazards are prevented from causing human losses by a series of barriers.
Each barrier has unintended weaknesses, or holes
When by chance all holes are aligned, the hazard reaches the patient and causes harm
22
Q
- What are active failures?
2. Name the two types of active failures
A
- unsafe acts committed by people in direct contact with the patient
- errors and violations
23
Q
Give examples of:
- Knowledge based errors
- rule based errors
- skills based errors
- routine violations
- situational violations
- reasoned violations
- malicious violations
A
- forming wrong plans as a result of inadequate knowledge or experience
- encounter a relatively familar problem but apply the wrong rule
- attention slips and memory lapses
- violation that has become normal behaviour within a peer group
- contact dependent - e.g. time pressures, low staffing
- deliberate deviation from protocol thought to be in the patient’s best interest
- deliberate act intended to harm
24
Q
- What are latent errors?
- What is blame culture?
- What is normalisation of deviance?
A
- conditions that develop over time and lay dormant until they combine with other factors or active failures to cause an adverse event
- individuals cover up errors for fear of retribution
- failings because staff become blind to what is going on around them and assume that the practices being tolerated are normal
25
Q
What is designing out error?
A
designing things in the workplace to try and minimise the likelihood of error or its consequences
26
Q
Name 6 ways to improve patient safety
A
- increase staffing
- create patient safety culture
- electronic early recognition of deteriorating patient
- standardise approaches to high risk patients
- promote safer prescribing
- promote hand hygiene
27
Q
- What is palliative care?
2. what does palliative care involve?
A
- the active holistic care of patients with advanced progressive illness
- management of pain/symptoms; provision of psychological, social and spiritual support
28
Q
- What is general palliative care?
2. What does it include? (3)
A
- core aspect of care for all patients and their families with advance disease by ALL HEALTH PROFESSIONALS
- holistic needs assessment
provision of basic symptom control
referral to specialist palliative care if necessary
29
Q
- Who is specialist palliative care provided for?
2. who is specialist palliative care provided by?
A
- patients and carers with unresolved symptoms and complex psychosocial issues
- healthcare professionals for whom palliative care is their core work
30
Q
- Describe 4 GENERALIST palliative care services
2. Describe 4 SPECIALIST palliative care services
A
- primary care team
nursing homes
secondary care
social services - clinical nurse specialists
specialist physicians in palliative care
hospices
marie curie nurses
31
Q
Name 5 services that hospices provide
A
- medical clinics
- complimentary therapies
- bereavement services
- benefits advice
- out of hours service
32
Q
Name the services involved in determining preferred place of care/death (6)
A
- hospice consultant
- community palliative care nurse specialist
- hospice out of hours advice phone line
- GP
- district nurse
- Community OT
33
Q
Describe the following strategies at implementing waiting times:
- Targets
- Choice and Competition
- Prioritisation
A
- agree on a maximum waiting time; monitor whether services are meeting this and apply sanctions to those who are not
- if a patient is waiting longer than the maximum waiting time, they can go elsewhere, including private, at the expense of the original provider
- you are seen sooner if your condition is more serious
34
Q
- Why are waiting lists important? (5)
2. Why are waiting lists a problem? (2)
A
1. patients condition may deteriorate whist waiting; effectiveness of proposed treatment may be reduced experience of waiting can be distressing adverse effects on family life adverse effects on employment inefficiencies in healthcare system
- major source of dissatisfaction
used to prioritise patients which raises ethical issues
35
Q
- What is the maximum waiting time for non-urgent, consultant led treatments?
- what is the sanction of this target is breech?
- Name 5 instances where this sanction doesn’t apply
- What is the maximum waiting time for suspected cancer?
- What is the waiting time for admission, transfer or discharge from A&E?
A
- 18 weeks
- reduction of up to 5% of revenues
- patient choses to wait longer
delaying start of treatment is in best clinical interests
clinically approrpate for condition to be
actively monitored in secondary care without clinical intervention
DNA
treatment is no longer necessary - 2 weeks
- 4 hours
36
Q
- What was the Targets and Terror Policy?
2. Name 5 problems with this policy
A
- Hospitals receive an overall performance score, and managers could lose their jobs if targets are missed.
- sacrifice to professional autonomy
- unmeasured performance suffers
- adverse behavioural responses (e.g. patients waiting in ambulances as they technically haven’t been admitted yet)
- data manipulation
- mis-prioritisation (target has already been missed, so patient stays on waiting list)
- sacrifice to professional autonomy
37
Q
- What is “Duty of Care”
2. What is “negligence”
A
- legal obligation imposed on an individual requiring adherence to a standard of reasonable care whilst performing acts that could foreseeable harm others
- failure to exercise the care that a reasonably prudent person would exercise in like circumstances
