Introduction to Clinical Governance

Question 1

Define clinical governance

Answer 1

A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish

Question 2

Why is Clinical Governance Important?

Answer 2

1) It is about being accountable, taking professional responsibility, having the right systems and processes in place and continuously improving what we do
2 It is a fundamental element of healthcare practice. It is a continuing process, not an event.
3) It is relevant to everyone

Question 3

what is clinical governance

Answer 3

Clinical Governance is quality assurance for the NHS:
Setting standards and monitoring them, Learning from-
What went well-sharing good practice, What went wrong
-Developing quality staff-quality service

Question 4

outline the Development of Clinical Governance

Answer 4

1) Clinical Governance in the new NHS. HSC 1999/065. Department of Health (DoH) 1999
2) The Health Act, 1999: Quality a legal responsibility for management
3) Standards for Better Health. DoH 2004
4) Building a Safer NHS for Patients. : Implementing an Organisation with a Memory DoH 2007
5) Safeguarding patients. DoH 2007:Post-Shipman report.

Question 5

Why govern clinical work?

Answer 5

To improve the standard of patient care

Question 6

is clinical governance an essential service?

Answer 6

yes - Community Pharmacy Contract 2005-

Clinical Governance is an Essential Service

Question 7

list the 7 pillars of clinical governance

Answer 7

1) patient and public involvement
2) clinical audit
3) risk management
4) clinical effectiveness
5) staff and staff management
6) use of information
7) premises standards

Question 8

Patient & Public Involvement is a Contractual obligation. outline how a community pharmacy can achieve this

Answer 8

involve patients in Service improvement & redesign:

1) Display practice leaflet
2) Notify public of NHS services provided (poster/website)
3) Annual patient satisfaction survey
4) Monitor medicines owed & out of stock items
5) Complaints/errors procedures
6) Make ‘reasonable adjustments’ in line with Disability Discrimination Act (DDA)
7) Co-operate with inspections/ reviews from NHS England

Question 9

what is a clinical audit and how many audits does a pharmacy need to do each year?

Answer 9

1) A process of improving the care of patients by looking at what you are doing, learning from it and, if necessary, changing practice.
2) Community Pharmacy NHS Contract
At least one practice based (completed in the pharmacy) and one NHS England based (organised for all pharmacies in a geographical area) audit annually.

Question 10

describe the audit cycle

Answer 10

1) Decide criteria, agree standards
2) (Audit design) just before Data collection
3) Analyse data
4) Identify cause(s) of non-achievement
5) Implement changes
6) Monitor progress

Question 11

list a few examples of practice based and NHS England based audits

Answer 11

practice based:
1) Advice on inhaler technique audit
2) Health promotion travel health audit
3) Lung cancer awareness audit
4) Near Misses Audit
NHS England:
1) Audit on introduction to stop smoking services
2) How much do you drink?
3) Know your waist measurement and risk of diabetes audit

Question 12

Risk Management is an important part of clinical governance. explain the possible risks to staff

Answer 12

1) Health and Safety issues
2) Financial loss (fridge failure/ stock loss/ prescription charges loss)
3) Needle stick/ chemical injury
4) Violence in the workplace

Question 13

Risk Management is an important part of clinical governance. explain the possible risks to patients

Answer 13

1) Health and Safety issues
2) Poor standards of care/ advice
3) Poor service
4) Dispensing errors
5) Infection from pharmacy
6) Confidentiality breach

Question 14

in order to be effective at managing risks it might be suitable to appoint a Clinical Governance Lead. list the attributes the lead must possess in order to be effective at risk management

Answer 14

1) Knowledgeable about clinical governance issues
2) Knowledgeable about other local NHS services
3) Authority to make decisions or report to a person with authority to make decisions on CG issues

Question 15

effective risk management requires a robust system in place. list what a robust system ensures

Answer 15

1) stock integrity:
- Stock expiry date checks 3 monthly minimum
- Reputable suppliers and premises suitable for medicine storage
3) Equipment maintenance:
- Fridge temperatures (2-8)
- Thermometer calibration
- blood pressure/cholesterol monitor service contract/ recalibration
3) Appropriate waste disposal arrangements
- Patient returned waste medicines procedures
- Clinical waste, sharps and needle stick injury procedures
- Confidential waste -shredders

Question 16

Risk Management also requires the need to be compliant with Health & Safety regulations. list some of the H&S issues in a community pharmacy

Answer 16

1) fire
2) handling sharps
3) handling large or heavy objects
4) slips, trips and falls
5) dealing with dangerous chemicals
6) electrical safety
7) display screen equipment: risk assessments, equipment testing, safe practice training
8) Compliance with child protection/ vulnerable adults legislation
9) Risk reduction to patient/customers and also staff

Question 17

Incident Reporting is part of risk management. what types of incidents would have to be reported with regards to medicines and where would you report them.

Answer 17

1) Error and Incident Reporting- dispensing error , near miss log
2) Critical (Significant) Event Analysis
3) Send incidents to National Reporting and Learning Service (NRLS)
4) Timely response to patient safety communications from National Patient Safety Alerting System (NPSAS)

Question 18

following Standard Operating Procedures (SOPs) is a vital part of risk management. what are SOPs and why are they important?

Answer 18

1) SOPs are very detailed documents describing the routine method to be followed for a specific operation, service, analysis, or action. SOPs describe what we do and how we do it.
2) Important for: safety, quality, delivery, training, cost control

Question 19

you would have to ensure a SOP is legally correct. what else would you have to ensure before using the SOP?

Answer 19

Make sure SOP is: following best practice, following current clinical and operational guidelines,up to date

Question 20

clinical effectiveness is a contractual obligation and is one of the pillars of clinical governance. what is meant by clinical effectiveness and how can it be improved?

Answer 20

1) includes arrangements for ensuring that appropriate advice is given by a pharmacist in respect of repeatable prescriptions or to people caring for themselves or their families
2) Systems to ensure appropriate self care advice
3) Improve clinical effectiveness of prescribing:
- Medicine Use Reviews
- New Medicines Service
- Patient counselling
4) Flag poor prescribing to prescriber:
- Awareness of current evidence e.g. NICE guidance
- Monitor patient care

Question 21

what is a MUR and which patient groups are targeted?

Answer 21

1) Pharmacists undertaking structured adherence-centred reviews with patients on multiple medicines, particularly those receiving medicines for long term conditions.
2) 50% of MURs must be on patients in 3 target groups:
- patients taking high risk medicines: NSAIDs, Anticoagulants, Antiplatelets, Diuretics
- patients recently discharged from hospital who had changes made to their medicines.
- patients with respiratory disease.

Question 22

what is NMS and what conditions/ therapies are included?

Answer 22

1) A new medicine is dispensed and patient counselled on the medicine through a 3 step process.
2) Conditions/therapies included in the NMS: Asthma and COPD, Diabetes (Type 2), Anti-platelet / Anticoagulant therapy, Hypertension.
3) Pharmacist follows up patient at agreed time(s) to assess adherence, identify problems and patient’s need for further information and support

Question 23

staff and staff management is one of the pillars of clinical governance. explain how staff can be managed effectively

Answer 23

1) Appropriate induction for new staff/locums:
- Confidentiality/security/health & safety/SOPs etc
2) Appropriate staff training
- All staff are trained or undergoing training
- Competency assessment e.g. ACT dispensing validation
- Annual development/performance review
3) Qualifications, identity & references checked
4) Identify & support development needs
5) Remedying underperformance

Question 24

staff and staff management involves Identifying and supporting developmental needs. how do pharmacists ensure they are continually developing?

Answer 24

1) ) Commitment to (CPD)
2) Mandatory CPD (inspected by GPhC)
3) Complete necessary accreditation:
- Essential/Enhanced/Advanced services
- National Centre for Smoking Cessation and Training
4) Clinical governance is all about continual improvement

Question 25

Use of Information is another pillar of clinical governance. outline this pillar

Answer 25

1) Data protection and confidentiality
- Procedures for information management and security-Information Governance (IG)
- Annual assessment of compliance via IG toolkit

Question 26

with regards to Premises Standards, which is the final pillar of clinical governance discuss the following :

1) cleanness of premises
2) Appropriate environment

Answer 26

1) Cleanliness of premises
- Cleanliness level needs to be appropriate to services provided-cleaning rotas/handwashing
2) Appropriate environment
- Safe, tidy working environment with enough space
- Professional healthcare environment
- Demarcation of prescription reception area
- Buffer area between medical/ non medical goods
- Seating area quality
- Appropriate levels of privacy/consultation room standards

Question 27

with regards to Premises Standards, which is the final pillar of clinical governance discuss the following :
1) Opening Arrangements

Answer 27

1) Pharmacy must be seen to be open by members of the public during core and supplementary hours.
2) If the pharmacy is locked during opening hours, arrangements must be made to Provide limited public access-e. g. member of staff at the door/ hatch
Allow access inside if needed for confidentiality etc.

Question 28

outline the Baseline assessment of Clinical governance

Answer 28

1) How am I / my staff / my pharmacy doing?
2) What must we do to meet the expected standards of practice?
3) What difference will this make to patient care?
4) What can I do that will have the biggest impact on patient care?
5) What near misses have I had and how can I learn from these?
6) How can I share my experiences with my colleagues?
7) Where can I get help and support?

Question 29

why is clinical governance important to pharmacists?

Answer 29

Clinical governance helps pharmacists continue to improve their practice and enhance their reputation as experts in medicines, managing risks and improving quality in the interests of patients and the public.