Management Flashcards
Principles of supporting a drunk colleague
- Patient safety
- Get assistance removing the consultant from the clinical area
- Support the consultant - arrange transport home, arrange cover for them
- Escalate to clinical director
- Support the remaining team members who will have to cover extra duties
Apprehensive theatre team about you completing list
- Seek to understand their feelings
- Be empathetic with their concerns
- Demonstrate competency with your surgical logbook
- Advise the patient safety is paramount
- Seek whether adjacent theatres are running
How do you approach a registrar who refuses to treat a paedophile
GMC guidance advises that if carrying out a procedure conflicts with your beliefs then you should explain this to the patient and arrange for them to see another doctor.
You should find out more about your colleagues views as they may have personal trauma.
Ensure they have appropriate support.
What is the WHO surgical safety checklist?
A checklist designed to improve surgical safety through the use of three checkpoints at critical steps.
What are the 3 stages of the WHO checklist
- Sign-in
- Time-out
- Sign out
What is included in the sign-in?
- Patient confirms identity
- Consent and mark are checked
- Procedure is confirmed
- Allergies checked
- Expected blood loss
What is included in the time-out?
- Confirm introductions
- Surgeon/anaesthetist/scrub confirm patient, site, procedure
- Critical steps
- Patient specific concerns
- Instrument sterility or concerns
- Abx prophylaxis
- Essential imaging
- Ready to start?
What is included in the sign-out?
- Name of procedure recorded
- Instrument, swab, and needle count correct
- Specimens labelled
- Equipment problems
- Concerns for recovery
How do you confirm the site of the operation?
- Check patient name, hospital number, dob
- Compare to consent form and WHO checklist and band
- Check the site and side the patient has been consented for
- Check the mark and confirm with imaging
What has been the overall effect of introducing the WHO surgical checklist?
- Reduced surgical complications by 1/3
- Reduced deaths by 1/2
What is the ASA Grading system
Classification system that quantifies the risk of death whilst under anaesthetic
Define the ASA grades
- Normal, healthy
- Mild systemic disease
- Severe systemic disease
- Severe systemic disease that is a constant threat to life
- Moribund patient who is not expected to survive without the operation
- Brain dead, organ harvesting
What adjustments to the ASA grade is made in emergency procedures
A letter āEā is added
What are the limitations to the ASA grading system
- Subjective with inter-rater variance
- Grey area between ASA2 and ASA3 (i.e. moderate disease)
- Patients with 2 stable diseases of differing severity
- What constitutes systemic disease can be controversial e.g. MI
- No mention of age
What are the advantages of the ASA grading system
- Well known
2. Standardised for audit purposes
What does NCEPOD stand for
National Confidential Enquiry into Peri-Operative Deaths
What recommendations does NCEPOD make?
It has made suggestions to improve surgical safety, particularly during emergency surgery. E.G. avoiding out-of-hours operating where possible
How many CEPOD categories are there?
4
Describe CEPOD 1
Immediate - life, limb, or organ saving e.g. AAA rupture, compartment syndrome, acute MI
Describe CEPOD 2
Urgent - acute onset or deterioration of conditions that threaten life - day-time emergency or out-of hours list e.g. bowel perforation, limb ischaemia
Describe CEPOD 3
Expedited - stable patient who needs operation within days, uses spare list capacity e.g. tendon and nerve injuries, coronary angioplasty
Describe CEPOD 4
Elective - planned procedure booked in advance
How would you resolve a rota dispute
- I would first look over the rota with a colleague to confirm it was unjust
- If I felt the rota was grossly unfair then I would raise my concerns professionally with the rota coordinator
- It may have been a simple oversight and easily rectified
- If not, I would discuss the situation with my colleague to try and resolve it ourselves
- If this was not successful I would contact my ES and HR
When have you made a mistake?
S - sending a patient home with suspected TIA without giving Aspirin
T - Called the patient back. Informed the coordinator. No-harm DATIX. Apologised
A - Gave treatment
R - Anchored on the specific safety net advice. Busy A&E with no rooms. Administering medication on my own due to low staff.
R - checklist. Collect everything required for final consultation.
How can leadership be summarised
Change, people, results
What makes a good leader?
- Person that initiates and implements change
- Develops people and creates a positive environment
- Delivers results
What makes me a good leader?
- Reliable
- Clear and decisive
- Ability to listen and encourage others
- Ability to engage with others and resolve conflicts
What is the difference between management and leadership?
- Leadership is having the vision to set a new direction for a group
- Management is controlling resources to achieve a pre-established goal
What makes a bad leader?
- Lacks clarity and has poorly defined goals
- Means team members lack clear direction and do not work cohesively
- Unable to identify poor practices resulting in inappropriate goals
