MEP: Patient safety

Question 1

What is a punitive culture?

Answer 1

A punitive culture is based upon assigning blame and punishment. It contributes to creating a
culture of fear. People and organisations see what happens to others and if what they see is perceived to be draconian or unjust, this leads to fear, stifling reporting and stifling the raising of concerns. We lose the opportunity to learn, and patient safety is affected. A single instance of perceived punitive action can have a wide effect on how large groups of people choose to act.

Question 2

Why is a no blame culture inadequate?

Answer 2

A no-blame culture may not be better than a punitive culture. It can breed complacency or nonchalance which can also impact upon patient safety. At its worst it can appear unacceptable
to society overall due to the immunity from accountability which can also be abused.

Question 3

What is a ‘just culture’ and why do we need it?

Answer 3

Instead, the ‘right culture’ or a ‘just culture’
is needed which is a culture based upon the principles of fairness, quality, transparency, reporting, learning and safety. A just culture promotes an open culture (transparency and discussion), a reporting culture (raising concerns), and a learning culture (learning from mistakes).

These cultures support each other to create a safety culture

Question 4

The following just culture principles for patient safety incidents:

Answer 4

1 ) Patient safety is paramount

2 ) Deliberate harm and unacceptable risk impacting on patient safety must not be tolerated

3) Patient safety is maintained by healthcare professionals being candid and raising concerns and learning from incidents to improve systems, standards, policies, legislation and people
4) To ensure that concerns will be raised and learning from incidents occurs, individual accountability must always be fair and proportionate, and viewed in the context of root cause, system deficiencies, mitigating circumstances and the entirety of contributing factors (i.e. the whole picture).

Question 5

RPS error reporting standards

Answer 5

Standard 1:

• Open and honest
• Be honest and open when things go wrong

Standard 2:

• Report
• Report patient safety incidents to the appropriate local or national reporting programme

Standard 3

• Learn
• Investigate and learn from all incidents including those that cause harm and those that are ‘no harm’ or ‘near miss’

Standard 4

• Share
• Share what you have learnt to make local or national systems of care

Standard 5

• Act
• Take action to change practice or improve local or national systems of care

Standard 6

• Review
• Review changes to practice

Question 6

How to handle a dispensing error:

Answer 6

• Whether you are the person who made the error or another member of the pharmacy team, once you become aware, you need to promptly take all reasonable steps to let the patient know and to make things right, unless the circumstances mean it is not necessary or appropriate to.

Keeping records can also help to justify your decision.

• 1) Take steps to let the patient know promptly
• 2) Make things right (this may involve contacting the prescriber)
• 3) Offer an apology
• 4) Let colleagues involved in the error know.

Question 7

legal defences for errors:

Answer 7

Legislation introducing a legal defence to prevent the automatic criminalisation of inadvertent dispensing errors The Pharmacy (Preparation
and Dispensing Errors – Registered Pharmacies) Order 2018 came into force on the 16th April 2018.

Question 8

The legal defence against criminal prosecution can be used when the error has been:

Answer 8

1) Dispensed in a registered pharmacy, and
2) Dispensed by or under the supervision of a registered pharmacist, and
3) Supplied against a prescription, PGD or direction
from a prescriber, and
4) Promptly notified to the patient once the pharmacy team are aware of the error.

Question 9

Safeguarding: Signs of child abuse–>

Answer 9

Physical abuse
Neglect
Emotional abuse
Sexual abuse

If child abuse is suspected, you should follow local child protection procedures where these are available.

Where you consider the nature of the child abuse to be an emergency then the police should be contacted.

You should not attempt to investigate suspicions or allegations of abuse directly.
You should make appropriate records of concerns and suspicions, decisions taken, and reasons whether or not further action was taken on a particular occasion.

Question 10

Can you provide oral contraception to a child or young person under 16:

Answer 10

You can provide contraception (e.g. on prescription or under PGD) or sexual health advice to a child or young person under 16 as long as, in England and Wales, the Fraser criteria are met, i.e. that:
• They have sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
• They cannot be persuaded to tell her parents or to allow the practitioner to tell them
• They are very likely to begin or continue having sexual intercourse with or without contraceptive treatment
• Their physical or mental health is likely to suffer unless they receive the advice or treatment
• The advice or treatment is in the young person’s best interests.

Question 11

Vulnerable adults – signs of abuse or neglect:

Answer 11

Physical abuse
Injuries which are unusual or unexplained. Bite marks, scalds, fingertip bruising, fractures. Repeated injury

Neglect
Failure to thrive – evidence of malnourishment. Poor hygiene, dirty and messy

Emotional abuse
Evidence of self-harm/self-mutilation. Inappropriate verbal abuse. Fear of certain people

Sexual abuse
Indication of sexually transmitted disease. Repeated requests for emergency hormonal contraception

Financial abuse
Sudden changes to their finances, e.g. getting into debt. Inappropriate, exploitative or excessive control over the finances of the vulnerable adult

Additional signs
Delays seeking medical treatment or advice and/ or reluctant to allow treatment of the vulnerable adult. Detachment from the vulnerable adult. Lacks concern at the severity or extent of injury or other signs. Is reluctant to give information. Aggressive towards the vulnerable adult.

Question 12

Note that any person, including those who do not fall within the groups below, could be a vulnerable adult. There are various types of abuse or neglect and while the following lists may be helpful but are not exhaustive. The presence of one or more of these signs may not necessarily be caused by abuse or neglect.
They may fall into one of the following groups:

Answer 12

• Suffers from mental or physical disability
• Has learning difficulties
• Is frail or elderly
• Is in an abusive relationship
• Is a substance misuser.