Law Core Concepts & Skills 2

Question 1

What does a clinical check involve?

Answer 1

Identifying potential pharmacotherapeutic problems by collating and evaluating all relevant info. Including patient characteristics, disease states, medication regime, and where possible lab results

Question 2

Where can you obtain/collect patient information from?

Answer 2

Prescription
Patient/Patient rep/carer
Patient's GP
Medical Record
Other records such as Summary Care Records

Question 3

What patient characteristics would you look out for when clinically screening a prescription?

Answer 3

Patient type:
At risk groups - children, elderly, preg/breastfeeding

Certain Ethnic groups - e.g. initial & max dose of rosuvastatin is lower for Asian patients

Gender - e.g finasteride is contraindicated for women

Co-morbidities - e.g renal, hepatic impairment, heart failure

Patient intolerance - e.g. allergies, dietary (lactose)

Question 4

What medication factors should be checked when clinically screening a Rx?

Answer 4

Indication - appropriate/compatible ?

Changes in reg meds?

Dose Freq/Strength

Dosing Formulation

Drug Compatibility

Monitoring Req

Question 5

What is Meds Reconciliation?

Answer 5

Process of identifying an accurate list of patient’s current meds inc. OTC and herbal and carrying out a comparison of these with the current list in use.

Identify any discrepancies, any changes.

Question 6

When should a meds reconciliation take place? give 3 examples

Answer 6

When patient moves from one care setting to another

e.g. admitted to hospital, transferred between wards and on discharge

Question 7

Name the sources of information that can be used when carrying out meds reconciliation? (11)

Answer 7

1. Patient/ Patient rep
2. Patient’s meds
3. Repeat prescriptions
4. GP referral letters
5. GP surgery
6. Hospital discharge summaries or outpatient appointment notes
7. Community pharmacy notes
8. Care home records
9. Drug treatment centre records
10. Other healthcare professionals & specialist clinics
11. Patient medical records e.g Summary Care Records

Question 8

Give examples of incidents where the “wrong culture” contributed to unacceptable failings?

Answer 8

Mid Staffordshire Hospital 2005-2008 (poor care and high morality rates)
Orchid View Care Home (19 deaths due to mismanagement and abuse)
Winterbourne View private hospital (physical and psychological abuse of the disabled )

Question 9

What is a “just culture”?

Answer 9

A culture based upon fairness and is achieved when attitudes, behaviours and practices are fair.

Question 10

What is a punitive culture? and whats wrong with it?

Answer 10

Bases upon assigning blame and punishment.

Contributes to creating a culture of fear as they see what happens to others as draconian or unjust.

Stifles reporting and learning. Leads to a reduction in patient safety and quality of care.

Question 11

What is a no-blame culture and why is it inadequate?

Answer 11

Blanket immunity.

Leads to lack of accountability and this immunity from accountability can be abused.
impact patient safety.

Question 12

Describe what a Just culture promotes and can lead to?

Answer 12

Promotes an
- open culture (transparency and discussion)

• reporting culture (raising concerns)
• learning culture (learning from mistakes)

Leads to:
Safety and quality culture, fair working environment, improved patient experience, safety and care