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CS INT > Mx > Flashcards

Mx Flashcards

1
Q

Framework for clinical scenarios

A 
SPIES
Seek info
Patient safety
Initiative 
Escalate 
Support
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2
Q

How can patient make a formal complaint

A

PALS

patient advice and liaison service

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3
Q

What is the process after a PALS complaint

A

Have 15 days to respond
Normally closes by writing an apology letter/explaining the events
If patient not satisfied could escalate to clinical director
If not satisfied after that could go through the legal system

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4
Q

Capacity assessment

A
  1. Pt can understand and retain information
  2. Pt can weigh up risks
  3. Pt can communicate these back to you
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5
Q

Complaint process within the NHS

A

Complaint handed over to provider (GP/dentist) or commissioner (CCG, NHS England) of the health service.
If failed to arrive at satisfactory resolution, could be escalated through: parliamentary and health service ombudsman (PHSO)

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6
Q

How are complaints about a person and an organisation dealt with differently in the NHS

A

Organisation: through PALS
Person: could be escalated to the GMC

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7
Q

Options if under investigation by GMC

A

Inform the medical defence organisation (MDU MPS)

Inform the BMA

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8
Q

Duty of candour

A

Be open and honest with patients if things go wrong

  • put matters right
  • offer apology
  • explain fully and promptly what happened and likely short-term and long-term effects
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9
Q

Do you need patient’s consent for audit

A

No as long as you dont include patient identifiable in the report

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10
Q

When are you allowed to break confidentiality

A

When required by law eg police or court
Patient consents
Public interest

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11
Q

Consent age

A

16 or above can give consent to accept a treatment
18 or above can give consent to refuse a treatment
16 > can give consent if deemed competent

In scotland, parents cant override a competent child’s decision
In the rest of UK, parents might be able to, seek legal advice

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12
Q

Parenteral responsibility

A

Legal concept: authority to make decisions on behalf of children

Children born after 1st Dec 2003, whoever is on the birth cert will have parenteral responsibility
Before: mother by default, father by agreement or order, unless married at the time, in which case both have it by default

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13
Q

Process of going against parents consent

A

Second opinion will be needed + legal advice + court

If emergency, can go ahead

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14
Q

Gillick competence

A

Mrs Gillick took department of health to court for not prescribing contraception for under 16 without parents consent (1982)
First lost, then appealed and won, then house of lords passed a law and lost again (1985)

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15
Q

Types of consent form

A

Consent form 1: pt with capacity
Consent form 2: parent for child
Consent form 3: pt/parent for procedure without GA
Consent form 4: adults who lack capacity: 2 clinicians, involve NOK, patient’s best interest

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15
Q

Types of consent form

A

Consent form 1: pt with capacity
Consent form 2: parent for child
Consent form 3: pt/parent for procedure without GA
Consent form 4: adults who lack capacity: 2 clinicians, involve NOK, patient’s best interest

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16
Q

RIF differentials

A

Gen Surg:

  • appendicitis
  • meckels diverticulitis
  • perforated viscous

O+G:

  • R ovarian torsion
  • ectopic pregnancy
  • PID

Urological:

  • renal stone
  • UTI
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17
Q

Bullying def

A

individual abusing power or authority over another that leaves them feeling victimised

eg humiliation, aggression, shouting abuse

18
Q

Dealing with bullying

A

Seek information? is your colleague ok ? have they raised this with anyone ?is it affecting them ?their support network
Apologise to patients if they witnessed
Initiative: investigate if affecting other people ? is it to do with age/race/ethnicity/etc
Offer support to colleague
Escalate: Educational supervisor, encourage colleague to speak to theirs, if ES not appropriate: clinical director, post-grad department eg dean. Consider formal complaint: BMA/HR/Incident reporting

19
Q

Can pt request for a different clinicians

A

Yes if it a reasonable cause, eg second opinion

But it is not reasonable based on gender or race

20
Q

How to deal with verbally abusive angry pt

A 
Take to a nice quiet room, 
explore concerns, 
let them know you are here to help
Abusive behaviour not tolerated
Remember they could be emotional as distressed
Escalate: registrar/consultant/security
21
Q

NCEPOD

A

National confidential enquiry into post op death

Came to conclusion operations should be avoided at night

22
Q

CEPOD categories

A

Immediate
Urgent
Expedited
Elective

23
Q

How to avoid mistakes in the long term

A

Audits and QIPs
M&M meetings
Incident reporting using datix

24
Q

Reflect on your experience of leadership when working as a team member and how this will be useful as a core trainee

A

Intro:

One year ago, set up organisation medprojecthub, to address inequalities in career progression, related to gender, race, socio-economic status

  • We are now a team of 15 doctors and junior doctors nationally working to achieve this
  • I have been very successful and we have organisations such as RCSEng, etc supporting us.
  • Learned many lessons in the process, which I am going to share with you
  1. Delegation
    - Understanding team’s strengths and weaknesses: get to know the team
    - especially important when delegating
    - understanding your juniors, seniors and yourselves limitations
  2. Clear communicator
    - Closed-loop communication is key
    - at first, was not setting specific tasks or deadlines and there was a great amount of uncertainty
    - applies to CST clarify if senior instructions are unclear. Specific to juniors
  3. Supportive
    - Actively look for burnout
    - rotate having breaks from MPH if it is becoming too much with work, the power of time off
    - Offer support to cover their tasks
    - Applies to CST

Conclusion
Many skills

25
Q

Three pillars of leadership

A

Change: Initiating and implementing change
People: developing people (and creating a positive environment)
Results: Delivering results, to make decisions that lead to results

26
Q

Capacity check

A 
Mental Capacity Act 2005
Pt has capacity if:
- understands the information 
- able to retain information 
- weigh it up 
- communicates decision
27
Q

Who to ask if not sure about capacity

A

Nursing colleagues who work with the patient
Pyschiatrist
Neurologist

28
Q

Who can take consent

A

Ideally, the person who is carrying out the procedure
But could delegate to someone else if they have:
- appropriate knowledge of the procedure
- associated risks

The task of consenting is delegated but the responsibility still is with the doctor proposing the treatment

29
Q

Age of consent

A

Anyone above 16 can give consent

Under 16 if Gillick competent (has capacity) can consent to have treatment

30
Q

Can parents override consent by a competent child

A

No cannot override

31
Q

Can children refuse consent

A

In Scotland- yes if competent

Rest of UK- no even if competent but decision made by a person with parenteral responsibility

32
Q

IMCA

A

Independent mental capacity advocate (IMCA)
If someone lacks capacity and has no one to speak for them (no friends or relatives), IMCA can be appointed to represent patients beliefs feelings nad values

IMCA cannot make decisions just to inform decision-makers (doctors) and challenge their decisions

33
Q

How to prepare patients for theatre

A
  1. NBM +/- fluids
  2. Emergency Covid swab
  3. Bloods including G+S +/- Crossmatch
  4. Mark and consent
  5. Inform theatre staff and the anaesthetist
  6. TEP form
34
Q

Probity def

A

Being honest and trustworthy

Acting with integrity

35
Q

Why is probity important in medicine

A

GMC highlights this as an important characteristic for all doctors in order to ensure that their behaviour justifies the trust the public hold in us

In order to maintain the trust of the team and patients

36
Q

Escalation for educational purposes

A

Educational supervisor
Post-graduate dean
Training Programme director
Head of school of surgery

37
Q

Welfare services to sign post to

A

I will sign post to welfare services for example GP, BMA MDU or MPS

38
Q

How to help struggling colleague

A

Sign post to welfare services such as BMA or GP
Occupational health
Encourage talking to their supervisor
Buddy system to provide peer to peer training

39
Q

ASA score

A

American society of anaesthesia

ASA 1 healthy
ASA 2 mild disease: eg smoking
ASA 3 severe disease eg poorly controlled DM, HTN
ASA 4 constant threat to life: eg IHD with Stents
ASA 5 moribund, not likely to survive without op ruptured AAA
ASA 6 declared brain dead,

40
Q

Difference between standard, guideline and protocol

A

Standard: a defined level of quality that must be achieved : seeing pt within 4 hours in ED

Guidelines: statement designed to assist clinicians in decision making. NICE guidelines on NOF management

Protocol: step-by-step approach dealing with an issue such as management of hyperkalaemia

41
Q

Limitations of the ASA grading

A

Multiple limitations

  • Age is not included in risk stratification
  • Unclear how to categorise if someone has multiple mild or severe systemic disease
  • systemic disease definition in controversial: MI is localised disease, however has systemic consequences
42
Q

Data protection act

A

Introduced with 2 aims:

  • how the data is stored
  • how the date is used

Need to ensure data is stored securely. eg encrypted USB or shred patients lists after MDT

42
Q

Data protection act

A

Introduced with 2 aims:

  • how the data is stored
  • how the date is used

Need to ensure data is stored securely. eg encrypted USB or shred patients lists after MDT

CS INT (13 decks)

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