HLCP (healthcare, law & professionalism) Flashcards
Data Protection Act 2018: seven principles
- Lawful, fair & transparent
- Purpose limitation
- Data minimisation
- Accuracy
- Storage limitation
- Integrity & confidentiality
- Accountability
Data Protection Act 2018: Principle 1; “lawful, fair & transparent”
Processed lawfully, fairly and in a transparent manner in relation to individuals.
Data Protection Act 2018: Principle 2; “purpose limitation”
Collected for specified, explicit and legitimate purposes
Data Protection Act 2018: Principle 3; “data minimisation”
Adequate, relevant and limited to what is necessary in relation to the purposes for which they are processed.
Data Protection Act 2018: Principle 4; “accuracy”
accurate and kept up to date
Data Protection Act 2018: Principle 5; “storage limitation”
Data limitation - kept in a form which allows identification of the individual, but not than is longer than necessary for the purpose.
Data Protection Act 2018: Principle 6; “Integrity & confidentiality”
Protected against accidental loss, destruction or damage, using appropriate technical or organisation measures.
Data Protection Act 2018: Principle 7; “Accountability”
Processed within an organisation by a controller who is responsible for and able to demonstrate compliance.
Data Protection Act 2018: Data Protection Officer (DPO)
Oversees an organisation’s data protection strategy and its implementation to ensure compliance with the Act.
Data Protection Act 2018: Information Commissioner’s Office (ICO)
An independent authority which upholds information rights in the public interest, promoting openness by public bodies and data privacy for individuals.
Data Protection Act 2018: Caldicott Guardian
Person responsible for protecting the confidentiality of people’s health and care information and making sure it is used properly - all NHS organisations must have one.
“only those who need to see the data, see the data”
Which GDC standard is most relevant to data protection?
Principle 4 “maintain and protect patients information”
Duty of confidentiality
When someone shares personal information in confidence it must not be disclosed without some form of legal authority or justification.
What is an important GDC standard regarding confidentiality?
Standard 4.2.1 “Confidentiality is central to the relationship and trust between you and your patients.
Confidentiality may be breached with the patient’s consent to…
Insurance companies, other healthcare professionals, parents etc
When is it your statutory duty to breach confidentiality?
To aid identification of a driver in a road traffic accident.
An officer of NHS Scotland or your NHS Board.
Identification of missing/deceased person.
When is breaching confidentiality in the public interest?
Where a patient puts their health and safety at serious risk, or if you think that you have confidential information which would help prevent or detect a serious crime.
Public health issues
Child protection/vulnerable adult
If you are breaching confidentiality, what should you aim to do…?
- 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
What is GDC standard 3?
Obtain valid consent
Why is recording of a diagnosis so important?
Making the correct clinical diagnosis ( or
differential diagnosis) is essential to show that
the patient provided informed consent to any
subsequent treatment.
Autonomy
Every human being of adult years and sound mind has a right to determine what shall be done with their own body.
If an adult of sound mind does not consent, even if the decision is IRRATIONAL or DETRIMENTAL, or for NO REASON, this should be respected.
Three requirements for consent
- Competent - the ability to understand
- Knowledge - sufficient information needs to have been provided on the nature, consequences, benefits etc.
- Voluntary (without coercion) - the patient must freely agree to treatment.
What factors may affect competence?
Age, maturity, intoxication (drugs/alcohol), illness, innate or acquired cognitive impairment
The Adults with Incapacity (Scotland) Act 2000
• Any decision must benefit the person
• Any action should be the minimum necessary to achieve the purpose
• Account must be taken of present and past wishes of the person
• Account must be taken of the views of others with an interest in the persons welfare such as a primary carer, nearest relative, named person, attorney or guardian
• If capacity to consent is lost the dentist must seek the consent of the welfare attorney when it is practical and reasonable to do so
AWI Act: Section 47
A certificate allowing a dentist or other healthcare professional to provide non-emergency treatment to an adult who lacks capacity to give or refuse consent.
- need training.
- Valid not for more than 1 year typically.
Mental Capacity Act 2005
ENGLAND equivalent of AWI act = provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions.
What treatment has a statutory requirement for written consent forms?
GA and sedation
What is vital to document to prove consent is valid?
DISCUSSIONS taken place
if you haven’t documented that you discussed different options/risks etc then as far as the law is aware, these conversations didn’t happen and you haven’t obtained valid consent.
Bolam Test —> Prudent Patent Test
Shift from medical paternalism to patient autonomy.
Patients’ MUST be made aware of risks/alternatives etc.
You should find out what your patients want to know as well as what you think they need to
know. Things that patients might want to know include: options for treatment, their risks and
potential benefits.
Warning a patient of material risk and theoretical risk.
There is a requirement to warn patients of material risk but not theoretical risks.
What percentage of claims are initiated at the suggestion of another healthcare professional?
Up to 50%
How does the NHS Scotland Complaints Handling Procedure (CHP) 2017 say complaints should be managed?
In England how does the ‘Good Practice Standards for NHS Complaints
Handling’ (Sept 2013) outlined by the Patients Association suggest complaints should be dealt with?
• Acknowledge in 3 working days
• Give details of independent advocacy services
• Target response in 40 days
• If miss target keep informed EVERY 10 days
• Give a quality response with assurance that action has been
taken to prevent a recurrence.
• Inform of any learning.
Duty of candour
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 a report about that provision has been made.
Francis Report Recommendation 181
Says there should be a statutory duty of candour
What are the key components of the statutory duty of candour?
- Explaining and telling the patient
- Organisation must review the incident (why did it happen i.e. how can it be prevented)
- Apology
What are the three stages triggering of a statutory duty of candour?
- Care provider involved in patient safety incident “unintended or unexpected”
- Uninvolved care provider believes the incident could or did result in death or permanent lessening of function (someone maybe had to step in to prevent this from happening).
- Uninvolved care provider believes the incident is harmful in the sense of patient safety not the natural course of the patients’ illness.
What are some examples of dental incidences that may trigger a Statutory Duty of Candour in Dentistry?
What is negligence?
- Duty of care — you treated the patient
- Breach of duty — there is normal practice that you didn’t adopt. Tx you gave, no other trained dentist acting with ordinary care would have taken.
- Causation of harm — what you did caused or materially contributed to the bad outcome.
Proxy
A proxy can be a person who acts on behalf of another.
Power of Attorney
A power of attorney or letter of attorney is a written authorization to represent or act on another’s behalf in private affairs, business, or some other legal matter. The person authorizing the other to act is the principal, grantor, or donor.
Valid consent (3)
Informed
Given freely
Capable patient
What does incapacity mean? (5)
Incapable of…
ACTING; or
MAKING a decision; or
COMMUNICATING a decision; or
UNDERSTANDING a decision; or
RETAINING memory of the decision
AMCUR
Documenting a patient’s understanding is a
GDC standard
Adults with Incapacity (Scotland) Act 2000
The Act safeguards the welfare and manages the finances of people aged 16 years and over who lack capacity
In Scotland, there is a presumption ‘in favour’ of capacity
Capacity is NOT ‘all or nothing’ It is action or decision specific
5 Key principles from Section 47: if a person lacks capacity
BENEFIT
LEAST restrictive of freedom
The person’s past and present WISHES should be taken into account
CONSULT relevant others
Encourage RESIDUAL capacity
Office of the Public Guardian (Scotland)
Search the OPG to see if this person is the POA.
Welfare power of attorney
- Made whilst the patient is capable
- No expiry date
- Dormant until called upon
- Not more powerful than the capable patient
- In writing from OPG
- Can be substituted for if death/illness.
- CHECK what powers are granted.
Adult guardians
Granted when an adult either:
No longer has capacity to choose who they wish to make decisions for them
Or
The adult has never been able to make their own decisions
What is the main differences with the POA vs the Guardians?
POA has no expiry date, whereas guardians do (~3 years).
Both need OPG certification.
Guardians granted by the court - NOT the individual.
Guardians used when capacity already lost or patient never able to make their own decisions and can USE FORCE if granted.
Who can consent for dental treatment?
- Patients with capacity
- WELFARE PoAs/Guardians
- The dentist (section 47 of AWI act)
What’s important to do regardless if there’s a proxy in place?
Have an AWI (S47) certificate issued.
Dentists can only complete AWI certificates if they…
have done the relevant training
Capacity is…
is action or decision specific
Allowing (non-emergency) treatment to be given if a patient is incapable – even when they have a proxy - requires a….
An Adults with Incapacity certificate is ALWAYS required to allow (non-emergency) treatment to be given if a patient is incapable – even when they have a proxy
The GDC says… “If you have information that a patient is or could be at risk of significant harm, or you suspect that a patient is a victim of abuse, you must…______”
If you have information that a patient is or could be at risk of significant harm, or you suspect that a patient is a victim of abuse, you must inform the appropriate social care agencies or the police.
The Adult Support and Protection Act 2007
Protects adults aged 16 or over who are considered “at risk” due to their inability to protect themselves from harm, including physical, psychological, financial, sexual abuse, neglect, or self-neglect.
Adults at risk: who does the legislation support and protect?
Three-point criteria
1. At risk of harm
2. Unable to safeguard their own wellbeing, property, rights or other interests
3. More at risk because they are affected by disability, mental disorder, illness or physical or mental infirmity.
Intervention in an adults affairs should only occur when:
- It will provide BENEFIT to the adult, which could not reasonably be provided without intervention.
- The chose intervention is likely to succeed and it the LEAST RESTRICTIVE OF THE ADULT’S FREEDOM.
Reporting concerns (3 Rs)
Recognise - signs of harm
Record - believe, listen, take notes
Report - tell someone
What is it NOT the responsibility of the dentist to do?
Confront an abuser
Investigate harm
Seek proof
Put themself at risk
Who should you report concerns to?
Immediate danger = the police (999)
Speak to line manager/colleague/principle
Follow workplace adult protection policy
Can speak to defence union/society for advice an support
Call local Health & Social Care partnership
What resource can you use for advice for concerns about proxies?
Mental Welfare Commission
6 Principles of Adult Safeguarding
Empowerment
Prevention
Proportionality
Protection
Partnership
Accountability
Domestic Abuse (Scotland) Act 2018
Any form of Physical, Verbal, Sexual, Psychological, Financial.
What makes Domestic Abuse different from Assault?
Criminalising physical/emotional abuse as one continuing offence by establishing one of the following behaviours:
Making victims dependent upon perpetrator
Isolating victims from friends/relatives/support
Controlling/regulating/monitoring day to day activities
Depriving them of or restricting freedom of action
Frightening/humiliating/degrading or punishing victims
What is coercive control?
Controlling behaviour designed to make a person dependent
- isolation from support
- exploiting them
- depriving them of independence
- regulating behaviour
Coercive control creates a sense of fear that pervades all elements of a victims life
It works to limit the victims human rights by depriving them of their liberty and reducing their ability for action
Reporting domestic abuse
999 - threat to life
101 – ongoing situation
Report to local police station
The Domestic Violence Disclosure Scheme
Clare’s Law allowing people to find out if their partners have a history of domestic abuse from the police.
Human Trafficking and Exploitation Act 2015
Includes provisions for:
Offences and sentencing
Victim support
Reducing activity related to offences
Using children or vulnerable adults to provide services
Radiotherapy - how it works
Uses ionizing radiation
Radiation kills DNA of cancer cells
‘Blunt tool’
Healthy cells destroyed too
Salivary glands very sensitive
Types: conventional, IMRT, ‘Rapid arc’
General side effects of Radiotherapy
- Fatigue
- Nausea
- Burns
- Pain
Oral side effects of radiotherapy
Mucositis
Xerostomia
Radiation caries
Periodontal disease
Dysgeusia/ ageusia
Trismus
Osteoradionecrosis
Dysgeusia/ageusia
Loss of one or more taste sensations
May recover after 9-18 months
May be permanent
Osteoradionecrosis
drastic changes to bone tissue as a result of DNA damage and cell death caused by radiation treatment
H&N oncology: Therabite
Can be used for patients to help mouth opening and overcome trismus
Low level laser therapy
In general, studies suggested that LLLT can be used for therapeutic and preventive applications in the management of osteoradionecrosis.
What is vital before a patient goes under radiotherapy?
They have a dental screening!!
H&N oncology: dental interventions required
Extract all teeth with dubious prognosis, AS early as possible.
If at risk of ORN, consider preventive prophylaxis.
Make fluoride trays, use duraphat etc.
Chemotherapy: how does it work?
Using drugs to kill rapidly dividing cells
Interferes with mitosis
Interferes with apoptosis
Interferes with tumour cell DNA
‘Blunt tool’
Chemotherapy drugs
Cisplatin
Cetuximab
TPF
Chemotherapy: general side effects
Fatigue
Nausea
Vomiting & diarrhoea
Skin rash
Hair loss
Thrombocytopenia - reduction in platelets
Neutropenia - reduction in WBCs
Chemotherapy: oral side effects
Mucositis
Infection
Bleeding
Temporary xerostomia
What can be useful for patients with mucositis?
Soft splints
Caphosol (mouth rinse for dry mouth)
LLLT?
HPT before chemo starts
What is the sub-group of specially considered patients for antibiotic prophylaxis in the prevention of infective endocarditis for an invasive dental procedure?
- Prosthetic valve
- Previous infective endocarditis episode
- Congenital heart disease
Ischaemic heart disease
“result of progressive myocardial ischaemia due to persistently reduced coronary blood flow”
Cause: atherosclerosis and hypertension
Atherosclerosis linked to:
- smoking
- lack of exercise
- obesity
IHD -> angina (stable v unstable) and/or Myocardial Infarction
What type of LA should you use for a pt taking beta-blockers and why?
Using local anesthetic containing adrenaline can be dangerous because beta-blockers inhibit the vasodilatory effects of adrenaline, leaving only its vasoconstrictive effects unopposed, which can lead to a significant rise in blood pressure, potentially causing serious complications like a hypertensive crisis.
Citanest plain (Prilocaine 4% plain)
Scandonest (Mepivacaine 3%)
Cardiomyopathy
“ a group of conditions that affect the structure of the heart muscle and its ability to pump blood around the body”
Cause: Genetic? Viral infections? Autoimmune? Medications?
Treatment:
- Medications: B Blockers, anticoagulants, diuretics
- Pacemakers or ICD’s
- Surgery
- Transplant
Tx: DOACs
Direct Oral Anticoagulants; Apixaban, dabigatran, rivaroxaban.
High bleeding risk from tx? = miss/delay morning dose
Tx: Vitamin K Antagonist
Warfarin
INR is below 4 = treat without interrupting medication
Tx: Antiplatelets
Aspirin, Clopidogrel etc
Treat without interrupting medication.
Dental considerations for pts undergoing a organ transplant
Dental assessment pre-surgery essential
Lifelong immunosuppression therefore:
- Extract grossly carious
- Extract severely periodontally involved teeth
- Extract any teeth with PA pathology
Definitions: Fear
the physiological reaction to actual threat/danger
“Fred was fearful of the poisonous frog”
Definition: anxiety
is the physiological reaction to PERCIEVED threat/danger
Anne was anxious about choking on an apple when eating
Definition: Phobia
a persistent and excessive fear of an object or situation that is not in fact dangerous
“Phoebe has a phobia of getting blinded by the flash from photos”
Best time to treat a patient undergoing renal dialysis?
Day after
What drugs should you avoid for renal patients?
Aspirin and other NSAIDs
Dental considerations for patients with CKD (chronic kidney disease)
CKD
Bleeding tendency
Increased risk of infections
Poorly controlled infections may spread
and cause septicaemia
Types of dementia (5)
- Alzheimer’s disease
- Vascular
- Mixed
- Levy-body
- Fronto-temporal
Most common type of dementia
alzheimer’s disease (62%)
Dementia —> 17% of cases are _______
Vascular dementia
Due to ischaemic attacks from reduced blood flow to the brain.
A - alzheimer’s slope
B - Vascular slope
C - Combination slope for alzheimer’s and vascular
Lewy-Body dementia
4% of cases
Lewy Bodies are small deposits of protein in nerve cells.
Unpredictable changes in attention and alertness.
Associated with Parkinson’s disease
Fronto-temporal dementia
Generally affects people slightly younger (45-60 yrs)
Personality change
Short temperedness, aggression, mood swings.
Lecanemab
1st drug to convincingly slow progression of early stage Alzheimer’s disease
World Federation of Haemophilia guidelines: dentistry
Haemostatic cover therapy required for
- Extractions
- oral surgery
- periodontal surgery
- implant surgery
- IDBs, lingual infills
NOT for
- other infiltrations
MRONJ: bisphosphonates
Osteoporosis —> Bisphosphonates (to reduce bone resorptions by hindering osteoclasts) —> MRONJ as old bone is not being turned over becomes necrotic
Equality Act 2010
UK law
Against the law to discriminate against someone because of:-
age
disability
gender reassignment
marriage and civil partnership
pregnancy and maternity
race
religion or belief
sex
sexual orientation
Proportion of the UK that are disabled
19%
