L5 - Clinical Governance

Question 1

What is clinical governance?

Answer 1

A framework ensuring NHS organisations are accountable for improving service quality, safeguarding high standards of care, and fostering an environment where clinical excellence flourishes.

Question 2

What are the three pillars of healthcare quality?

Answer 2

• Safe: Avoidable harm is eliminated.
• Effective: Appropriate treatments are provided at the right time.
• Person-Centred: Care respects individual needs and values, with clear communication and shared decision-making.

Question 3

What are the stages of the medication process?

Answer 3

• Prescribing.
• Dispensing/Preparation.
• Administration.
• Monitoring.

Question 4

What are some examples of prescribing errors?

Answer 4

• Incorrect dosage adjustment for underweight patients (e.g., IV paracetamol toxicity).
• Failure to prescribe pre-admission medicines (e.g., lansoprazole omission causing ulceration).

Question 5

What are examples of administration errors?

Answer 5

• Incorrect preparation due to miscalculation.
• Wrong patient (ID not checked).
• Wrong drug due to selection errors.
• Missed doses due to supply delays.
• Wrong route of administration (e.g., IV instead of IM).

Question 6

What are some examples of dispensing errors?

Answer 6

• Dispensing propranolol instead of prednisolone.
• Incorrect strength of liquid medicines (e.g., phenobarbitone overdose).

Question 7

Why do errors occur in healthcare systems?

Answer 7

• Human factors (e.g., fatigue, inexperience, poor communication).
• Complex systems and overwhelming information.
• Inconsistent processes and lack of standardisation.

Question 8

How can healthcare systems improve reliability and safety?

Answer 8

• Simplify and standardise processes.
• Use protocols and checklists.
• Provide access to information at the point of need.
• Improve communication, such as during handovers.

Question 9

What are high-risk medicines in NHSGGC?

Answer 9

• Insulin.
• Vancomycin/Gentamicin.
• Opioids.

Question 10

What are best practices for insulin use in hospitals?

Answer 10

• Continue basal insulin in Type 1 diabetes, even if fasting.
• Ensure basal insulin is given before discontinuing IV insulin.
• Do not draw insulin from a pen using a syringe.
• Be aware of concentrated and combination insulins (e.g., Tresiba, Xultophy).

Question 11

How should omitted or delayed medicines be handled?

Answer 11

• Assess urgency and document actions.
• Check availability and resolve issues promptly.
• Follow up before the next dose is due.
• Avoid missing multiple doses of any prescribed medicine.