Management Flashcards
Questions on ethics
Framework for Management
SPIES S - Seek information P - Patient Safety I- Initiative E - Escalate S- Support
Patient wishes to make a complaint
- Patient advice liaison service (PALS) offers advice to patients on making complaint
- Free to do so
Duty of candour
Duty of healthcare professionals to
- Inform patients of mistakes
- Apologise for such mistakes
WHO Surgical Checklist
Pre-anaesthetic
Before skin incision
Before patient leaves theatre
Preparing a patient for theatre
Mark Consent Fasted Pre op investigations (inc. ECG) Bloods inc. Group and Save x 2 Discussed with anaesthetist Booked
NCEPOD Stands for?
National Confidential Enquiry into Peri-operative Deaths.
CEPOD Categories
Immediate
Urgent
Expedited
Elective
Probity
Being honest, acting with integrity
Define Bullying
Where a person or group abuse a position of power over another person leaving them feeling hurt, powerless or angry
Examples of bullying
Aggressive behaviour
Exclusion from activity or events
Malicious rumour
Aggressive or rude communication
Unlawful victimisation
Where someone is treated unfairly or less favourably because they asserted their rights e.g. making a complaint
Examples of unlawful victimisation
Refusing requests
Blocking career progression
Refusing training
Subjecting a person to unwarranted disciplinary action
Age of consent
16
Can someone under 16 consent?
Yes, they may have capacity depending on ability to understand the information given.
Gillick Competence
Related to giving contraceptive advice to under 16s in 1982 leading to Fraser Guidelines
Fraser Guidelines
Doctor can give advice and treatment provided:
- Patient (although under 16) will understand advice
- Cannot persuade her to inform parents or allow the doctor to do so
- Likely to continue having intercourse
- That unless contraceptive advice is given patient mental or physical well being will suffer
- Best interests require advice with or without parental consent
DNACPR
Not to attempt CPR
Applies to scenario where patient “heart stops”
Up to that point patient given treatment that is felt provides benefit for them
Can family’s refuse DNACPR
No, decision lies with medical team but best practise is for family to be kept informed of decision
Ultimately rests with the patient if they have capacity to have such discussions
Capacity
Presumed in all adults
- Ability to retain Information
- Understand the information
- Weigh up options
- Communicate
How often can a patient self discharge?
As often as they wish, ultimately
Important to treat the patient the same way and not to feel unwelcome
Explore why patients self discharge
Why might patients self discharge?
Fear
Anxiety
Drugs and alcohol
Safety check pre-op?
WHO Checklist
Can identify concerns pre-op, identify patient and operation to be undertaken
Can voice concerns
Equipment check done by scrub nurse towards end of op
Sign out at the end
Drunk Colleague?
S - Witnessing provides enough information
P - Remove from the clinical area, quiet room, with supervision. Check any patients he may have come into contact with.
I - Contact consultant on call, or clinical director. Provide consultant water, and find a way to get them home safely
E - Escalate to appropriaste level as before
S - May need support, need to explore why event occurred, may need counselling
Colleague in the mess - White powder falls out of pocket
S - What exactly is substance, if concerned and feel not innocent, raise with seniors early to investigate.
P - Patient safety is at stake hence the need to investigate and clarify what is going on
Does this affect colleagues performance
Colleague has been late every day for past 4 days
S - Discuss with colleague. Anything causing them to be late. Transport issue? Personal problems? Burnout?
P - May not impact patients so early, but may hinder the on call team, patient information isn’t being handed over effectively. may be some night issues, may be patients waiting to be seen, puts strain on other members of team
I - Help cover initially. Discuss with colleague and find alternatives.
E - Escalate to senior if concerned, also discuss any change in plans or accommodating features, perhaps discuss with rota coordinator
S - Colleague may need support either via supervisor or counselling if personal problem, may need amended hours, colleagues can help temporarily
Consequence of Going against parent wishes
- Damage to doctor patient relationship
- Need to emphasise that was in patient best interests
- Ongoing communication needed
When is a child competent to refuse treatment?
- Complex
- Refusal under age 18 not necessarily binding
- Legal advice should be sought
- If life at stake can still be given
- Balance of treatment vs. irrevocable damage of doctor patient relationship
Consent form 1
Patient agreement to investigation or treatment (full capacity)
Consent form 2
Parental agreement to investigation or treatment for child
Can be signed by child themselves
Consent form 3
Form for patient/parental agreement to investigation or treatment where consciousness NOT impaired
i.e. procedure where anaesthetist is not present
Consent form 4
Best interest decision
Treatment or intervention for patients unable to provide consent
Forms of abuse
- Physical
- Emotional
- Psychological
- Financial
- Neglect
Define research
- Seeking new knowledge
- Helps establish best practice
- Develop new standards of treatment
Breaking Confidentiality
- Sharing with other healthcare professionals
- Clinical Audit
- Disclosures required by law
- Court order
- Disclosure to statutory regulatory body
- Public Interest e.g. HIV, Epilepsy + Driving
- Treatment of Child
- Abuse or neglect of incompetent person
GMC Guidelines on handling Patient information
1) Patient involvement
2) Share the minimum necessary
3) Manage and protect information
4) Comply with the law
5) Ask for consent
6) Support patients in accessing their information
7) Share information for direct care
8) Be aware of responsibility
IMCA
Independent Mental Capacity advocate
Role of IMCA?
Represent patient regarding decisions in which they lack capacity when there is nobody independent of service available e.g. family member
Qualities of a good leader
- Drive change
- Inspiring
- Managerial ability
- Listen to feedback
- Approachable
- Act with integrity
Examples of good leadership
Major trauma call
- Vocal
- Delegated
- Formulated a management plan quickly
- Took control of the situation and acted quickly based on the situation
Examples of poor leadership
- See multiple examples in small ways rather than one big example
- Quiet
- Does not receive comments well
- Unwilling to relinquish managerial control
- Unable to remain calm under pressure
