My notes Block 11 Flashcards
What are some objections to IVF?
Involves destruction of embryos
Harmful to those trying to conceive
It is unnatural
What are some arguments for IVF?
Welfare interests
Procreative autonomy
What does the human fertilisation and embryology act 1990 say? And what was updated in 2008?
A woman shall not be provided with treatment unless account has been taken of the welfare of any child that may be born of that treatment, including the need for a father.
Updated in 2008 to say need for supportive parenting rather than the need for a father
What does the abortion act 1967 state?
Abortion is legal if 2 medical practitioners are of the opinion, formed in good faith that:
pregnancy has not exceeded its 24th week and continuing with pregnancy is greater risk than ending it
Termination is necessary to prevent permanent injury to physical or mental health of women
Continuing with pregnancy risks woman life more than if terminated
That there is substantial risk that baby would be seriously handicapped
What is the harm principle?
The only purpose for which power can be rightfully exercised over any member of a civilised community against their will is to prevent harm to others
What is stated in the Fraser guidelines regarding children and sexual health?
You can provide contraception, abortion and STI advice and treatment to a child under 16 without parental consent providing that-
They understand the advice and their implications
You can’t persuade them to tell their parents
In relation to contraception you can give it of they are gonna have sex with or without it
That their physical health will suffer without treatment
That you are acting in their best interest
How can oxytocin be stimulated naturally?
Pressure on cervix Vaginal fullness Pelvic floor pressure Crowning Oxytocin positive feedback loop- more stretch get more release- Ferguson reflex
How do interventions decrease natural production of oxytocin?
Anaesethic injections inhibit Ferguson reflex
Inductions flood receptor sites so they are less sensitive to natural oxytocin
Episiotomy- reduces oxytocin as there is less stretching of the perineum
When is the highest child mortality?
Infancy- linked to congenital defects and preterm births
What is the leading cause of child death after infancy?
Injury- especially in male adolescents, suicide also a leading cause of death in adolescence
What are some next steps to reduce childhood mortality?
Reduce risk of preterm birth
Promote maternal health
Improve recognition and management of serious illnesses
Improve management of long term conditions like cystic fibrosis and asthma
Improve policies on common causes of death like accidents
Help improve poverty and education
What is the SHMI 2018- summary hospital level mortality indicator?
Compared actual mortality rates within 30 days of discharge to expected numbers given certain characteristics, then hospitals were categorised by whether they had more of less expected deaths.
What does the care quality commission do?
Regulates quality of all health and social care providers
Licenses providers of health and social care
CQC inspects different GP/ hospitals and grades it
What are some healthcare regulators?
Department of health and NHS England Health protection agency GMC Revalidation of doctors Royal Colleges
What is an adverse event?
An unintended event resulting from clinical care and causing patient harm
What is a near miss?
A situation in which events arising during clinical care fail to develop further so no injury to patient
What is a serious incident?
Event where potential for learning is so great or consequences to patient are so significant that they warrant using resources to investigate and act
What is a never event?
Serious incidents that are entirely preventable as guidelines are in place so it should never happen
How do we know a hospital is safe?
Hospital mortality data Data on other safety measures Reports of never events and serious incidents Patient safety dashboards NHS safety thermometer Care quality commission rating
Why is judging hospitals on death rates not good?
It is a mistaken concept
It is dependent on non hospital care e.g. availability of hospices
There is no relationship between numbers of deaths and quality of care
The only issue is avoidable deaths and there is no link between raw death number and number of avoidable deaths
How do adverse events occur?
An active failure or unsafe act which is then missed by follow up barriers, and has occurred on a background of latent failures and current conditions of work and background factors
What are the different types of active failures?
Errors or violations
What types of errors cause active failures?
Knowledge based errors- forming wrong plan due to inadequate knowledge
Rule based errors- apply wrong rule e.g. a small 10 year old given a dose meant for 10-15 year old and experiences an overdose
Skills based errors- attention slips/ memory lapses but was a good plan
What types of violations cause active failures?
Routine- a violation of rules that has become normal in the group
Situational- due to time pressure/ staffing etc.
Reasoned- deliberate deviation but thought to be in patient best interest
Malicious- deliberately caused harm
What have been some advances in patient safety in the NHS?
Introduction of duty of candour and protection for whistleblowers
Patient safety collaboratives
NHS resolution- national safety and learning service
System for learning from deaths
National maternity safety strategy
What are some ways to improve patient safety?
Increase staffing ratio
Create patient safety culture
Open reporting
Safety huddles
Standardise approaches to high risk patients
Provide safer prescribing and hadn’t hygiene
What to do when an AE occurs?
Report it
Assess its seriousness
Analyse why it occurred
Be open and honest with affected patient and apologise
Learn from it and put actions in place so it doesn’t happen again
