Patient Safety

Question 1

what is HCAI

Answer 1

health care associated infection

Question 2

when does HCAI occur

Answer 2

direct contact with health care setting or due to health care intervention eg medical or surgical treatment

Question 3

what are some examples where HCAI can spread

Answer 3

catheter 
hospital acquired pneumonia 
cannulation sites 
C difficile 
MSSA
MRSA
norovirus

Question 4

how many people are affected by HCAI and why is this a problem

Answer 4

300,000 a year which cost about 1bil per year

Question 5

what are the 5 preventing steps to HCAI

Answer 5

hospital environmental hygiene 
hand hygiene 
use of PPE
safe use and disposal of sharps 
principles of asepsis

Question 6

what is Clostridum Difficile and why is it a problem

Answer 6

gram positive anaerobic bacterium
resist heat, light, and disinfectant
spread through contact or spores
found in gut flora and can survive long periods without host
can be asymptomatic, diarrhoea, toxic megacolon and death

Question 7

what handling patients with suspected infectious diarrhoea what protocol is used

Answer 7

SIGHT
Suspect may be infective as no one reason for diarrhoea
Isolate patient to determine cause of diarrhoea
Gloves and aprons for contact
Hand washing before and after
Test stool for toxin

Question 8

what is the most effective way to protect from HCAI

Answer 8

hand hygiene

Question 9

where is most germs found on the hand and what’s the difference between men and women for hand washing

Answer 9

90% found under nails

20% women
40% men don’t wash hands after toilet

Question 10

what is the yellow sign for isolation

Answer 10

patient is isolating due to infection
keep door closed
wash hands on entry and exit

Question 11

what is route cause analysis

Answer 11

the systematic analysis of all factors which predisposed to or had potential to prevent harm or error

Question 12

what are the 3 basic principles of RCA

Answer 12

react
record
respond

Question 13

what are the 3 investigative tools for RCA

Answer 13

5 why’s - 5 why’s of what cause error
tabular timeline - all the events leading up to error in timeline form
fishbone analysis tool - listing all the factors such as task, communication, team, social, working condition to combine into why error occurred

Question 14

when we are challenging poor infection control what is development of culture of healthy challenge

Answer 14

don’t be afraid to to challenge hygiene of people regardless of rank or stature

Question 15

what does PACE mean in graded assertiveness

Answer 15

Probe - do you know that
Alert - can we reassess the situation
Challenge - please stop what you are doing
Emergency - STOP what you are doing

Question 16

how do you measure professionalism

Answer 16

360 form or ramsey scale
peer rating model for evaluating performance of practicing physicians
need 11 responses of this from to provide reliability

Question 17

what are the 4 types of error event in healthcare

Answer 17

adverse event - injury resulting in hospitalisation or death due to HC management

significant event - anyone in the team which causes significance in the care of patients

near miss - an error which had the potential to cause harm

serious incident - a never event, unexpected or avoidable death threatens to prevent further HC service

Question 18

what is the professionalisms duty of candour

Answer 18

all clinicians must report errors at early stage so lessons can be learnt and patients protected from potential harm in the future

Question 19

what are the 5 types of incidence

Answer 19

clinical incidence - relating to HC procedure
patient incident - slip/fall
security incident - theft
staff incident - verbal abuse or exposure to hazard
information governance incidents

Question 20

what is clinical risk management

Answer 20

specifically concerns with improving the quality and safety of HCS’s that identify events that could put patients at risk

Question 21

how does a risk matrix work

Answer 21

consequence score - 1 to 5 no sig harm to catastrophic
likelihood score - 1 to 5 - chance of happening rare to almost certain

these two score are multiplied together

Question 22

what is a hazard

Answer 22

the ability of things to do harm

Question 23

what is a risk

Answer 23

the likelihood that an incident would occur

Question 24

define a serious incident such as never events

Answer 24

adverse effect such as wrong surgery site, chemo via wrong route which results in 1 of: death or staff patients or visitors, serious harm requiring life saving intervention, an event which threatens to prevent an organisation continuing HC

Question 25

give examples of never events

Answer 25

wrong site surgery 
retained foreign object after procedure 
wrong implant 
misplaced gastric feeding tube 
scalding patients 
wrong drug route administration

Question 26

if a serious event does occur what is the process of next steps

Answer 26

identify and reposed 
communicate to patient 
report 
do RCA in timely manner 
CCG review and respond 
action plan 
disseminate learning 
monitor

Question 27

what is an active failure

Answer 27

cause immediate negative results such as caused by an individual

Question 28

what is a latent failure

Answer 28

scheduling problems ie lack of resources or training

Question 29

for a serious adverse event to be labelled as such what must happen

Answer 29

2 directors need to agree upon severity of the incident

Question 30

What is NEWS and what is it used for

Answer 30

National early warning score

measures physiological parameters to identify how urgent medical attention is needed

Question 31

what do the scores mean in the NEWS score

Answer 31

0 = stable, minimum observations

0-4 = low, observe every 4 hours and monitor urine

5 overal or score of 3 in 1 section - nurse check every 2 hours, glucose, fluid balance

7+ immediate assessment
hourly checks, fluids, critical care

Question 32

what parameters are in the NEWS score

Answer 32

rating 1-3 for each 0 = normal

RR (12-20)
O2 sat (greater than 96)
Supplemental O2 (no)
temp (36.1-38)
systolic BP (111-219)
HR (51-90)
Level of consciousness