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Phase 3a > PPD > Flashcards

PPD Flashcards

1
Q

what is error?

A

an unintended outcome

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2
Q

why is safety in health care so often compromised?

A

healthcare is a complex, high risk environment
resource intensive
system, patient and practitioners interactions
responsibilities are often shared
practitioners often take risk unknowingly

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3
Q

what are the common issues in accidents and safety in healthcare?

A 
wrong diagnosis = wrong plan
medication reconciliation 
high conc medication solutions 
patient identification 
patient care handovers
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4
Q

how can errors be classified?

A

based on intention
based on action
based on outcome
based on context

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5
Q

how is error classified based on intention?

A

failure of planned actions to achieve desired outcome
skill based errors - actions made is not what was intended
rule-based mistakes - incorrect application of a rule/inadequacy of the plan
knowledge-based mistakes

automaticity makes us prone to action not as planned
limited attentional resources
memory containing mini-theories rather than facts

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6
Q

how is error classified based on action?

A

generic factors - e.g. omission, intrusion, wrong order, mistiming
task specific factors - wrong blood vessel/verve/organ/side, bad knots

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7
Q

how is error classified based on outcome?

A 
near miss 
successful detection and recovery 
death/injury/loss of function 
prolonged intubation/stay in ICU 
cost of litigation 
unplanned transfer
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8
Q

how is error classified based on context?

A 
anticipations and perseverations 
interruptions and distractions 
nature of procedure 
team factors 
organised factors 
equipment and staffing issues 
accumulation of stressors
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9
Q

what are the different perspectives on error?

A
  • the person approach (focus on the individual) error are the product of wayward mental health processes, focus on the unsafe acts of people on the frontline, short comings - anticipation of blame promotes cover up - need detailed analysis to prevent recurrence

the system approach - focus on the working conditions - errors are commonplace - adverse events are the product of many causal factors, remedial efforts directed at removing error traps and strengthening defences, interaction between active failures and latent conditions - proactive risk management: remedy latent factors

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10
Q

what strategies are there to reduce error and harm?

A
  1. Simplification and standardisation of clinical processes
  2. Checklists and aide memoires - SBAR
  3. Information technology
  4. Team training
  5. Risk management programmes
  6. Mechanisms to improve uptake of evidence based Tx patterns
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11
Q

what tools are there for risk identification?

A
  • incident reporting
  • complaints and claims
  • audit, service evaluation and benchmarking
  • external accreditation
  • active measurement/complaint
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12
Q

what are never events?

A

Never events - serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented

surgery - wrong site/implant, retained item
medication - wrong preparation/route
mental health - suicide

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13
Q

what are the different leadership styles?

A

inspirational
transactional
laissez-faire
transformational - inclusive leadership is distributed throughout all levels of an organisation

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14
Q

what is a sloth error?

what skill/behaviour or attribute could solve this error?

A

not bothering to check results/information for accuracy. Incomplete evaluation. Inadequate documentation

conscientiousness - Attention to detail. Completeness. Not assuming that information presented to you is correct. Full documentation.

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15
Q

what is a fixation and loss of perspective error?

what skill/behaviour or attribute could solve this error?

A

Early unshakeable focus on a diagnosis. Inability to see the bigger picture. Overlooking warning signs.

Open mindedness. Situational awareness.
Recognition of the clinical patterns but considering facts that don’t fit. Re- evaluation if deviation from the expected.

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16
Q

what is a communication breakdown error?

what skill/behaviour or attribute could solve this error?

A

Unclear instructions or plans. Not listening to or considering others opinions.

effective communication - being approachable and open, listening, clear explanations with appropriate terminology and reinforcement

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17
Q

what can lead to poor team work error and what skill/behaviour can be done to solve this?

A

team members working independently, poor direction, some individuals out of depth, others underutilised

good team working 0 clear team structure and roles with sharing of views concerns and management plans.
clear logical leadership

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18
Q

how do errors occur by playing the odds and what can be done to solve this?

A

choosing the common and dismissing the rare event

probability assessment - evaluation based on scenario features as well and likelihood

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19
Q

what is a bravado (timidity) error and what skills/behaviours could avoid this?

A

working beyond your competence or without adequate supervision. A show of confidence to hide underlying deficiencies

humility - accurate self-evaluation, open communication of mistakes

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20
Q

what is a ignorance error and what skills/behaviours could avoid this?

A

Lack of knowledge. Unconscious incompetence. Not knowing what you don’t know.

self awareness - aware of your own abilities and limitations. consideration of factors which may affect your judgement (e.g. stress, fatigue)

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21
Q

what is a mis-triage error? and what skills/behaviours could solve it

A

Over/underestimating the seriousness of a situation

prioritisation - appreciate the relative importance or urgency of each situation

22
Q

what is an example of lack of skill error and how could it be prevented?

A

lack of appropriate skills, teaching or practice

effective technical skills - being properly trained in your role

23
Q

what is a system error and how can they be prevented?

A

environmental, technology, equipment or organisational features, inadequate built in safeguards

system design - a system designed to be easy to use, complete and with design features that identify potential risks

24
Q

what is the swiss cheese model?

A

In the Swiss Cheese model, an organization’s defenses against failure are modeled as a series of barriers, represented as slices of cheese. The holes in the slices represent weaknesses in individual parts of the system and are continually varying in size and position across the slices. The system produces failures when a hole in each slice momentarily aligns, permitting “a trajectory of accident opportunity”, so that a hazard passes through holes in all of the slices, leading to a failure

25
Q

what things can lead to negligence?

A
  • system failure
  • human factors (personal factors, teamwork problems, working environment, decision density)
  • judgement failure - defective decision making (analytical or intuitive, wrong amount or type of info, wrong decision making strategy, bias)
  • neglect - not showing sufficient care, falling below the expected standard, often chain of minor failures, MDT - communication and assumptions, may or may not lead to harm)
  • poor performance - repeated minor mistakes, not learning from mistakes
  • misconduct - deliberate harm, covering up errors, fraud, theft, abuse, improper relationships
26
Q

how is negligence decided?

A
  • was there a duty of care
  • was there a breach in that duty (are the actions supported by others, would a group of reasonable doctors do the same (bolam test), would it be reasonable of them to do so? (Bolitho test)
  • did the patient come to any harm
  • did the breach cause the harm (patient must demonstrate that it was your action/inaction that caused the harm)
27
Q

if a negligence claim is successful how much will they get?

A

loss of income
cost of extra care
pain and suffering

28
Q

what are the different types of learner?

A

theorist - complex situation, can question ideas, offers challenges
Activist - new experiences, extrovert, likes deep end, leads
Pragmatist - wants feedback, purpose, may like to copy
Reflector - watches others, reviews work, analyses, collects data

29
Q

what is the tripartite model for approach to learning

A

. Surface: Fear of failure, desire to complete a course. Learning by rote and focus on particular tasks.
. Strategic: desire to be successful, leads to patchy and variable understanding (well organised form of surface learning)
. Deep approach (Intrinsic, vocational interest, personal understanding): making links across materials, search for deeper understanding of material, look for general principles

30
Q

what is Kolb’s learning cycle?

A

Experience (activist)  review, reflect on experience (reflector)  conclusions from experience (theortist)  what can I do differently next time? (pragmatist)

31
Q

what are the key responsibilities of small group tutors?

A

Managing the group; the activities; and the learning
Facilitator of learning: leading discussions, asking open-ended questions, guiding process and task, and enabling active participation of learners and engagement with ideas.

32
Q

what are the fundamental questions to think about when teaching?

A

• Who am I teaching? Numbers, level
What am I teaching? The topic or subject, the type of expected learning (knowledge, skills, behaviours).
How will I teach it?
How will I know if the students understand/understood?

33
Q

what are the different question strategies when teaching?

A

Evidence - How do you know that? What evidence is there to support this?
Clarification – Can you give me an example? Can you explain that term?
Explanation – Why is that the case? How would we know that?
Linking and extending - How does this idea support/challenge what we explored earlier in the session?
Hypothetical – What might happen if…? What would be the potential benefits of X?
Cause and effect – How is this response related to management? Why is/isn’t drug X suitable in this condition? What would happen if we increased/decreased X?
Summary and synthesis – What remains unsolved/uncertain? What else do we need to know or do to understand this better/be better prepared?

34
Q

what model can be used to describe cultural factors?

A

Iceberg model of culture
above sea level - gender, age, ethnicity, nationality

below sea level - socio-economic status, occupation, health, religion, education, social groupings, sexual orientation, political orientation, cultural beliefs, expectations and behaviours

35
Q

why do we need to learn about diversity ?

A
  • better health outcomes for patients (doctors identify their patients problems more accurately, patients are more likely to adhere to treatment, fewer diagnostic tests and referrals, patients symptom burned reduced)
  • more satisfying doctor-patient encounters (doctor is more time efficient, doctors own wellbeing is improved, patients are more satisfied with their care, better able to understand their problems, investigations and treatment options, fewer complaint s
36
Q

what is culture?

A

Culture is a socially transmitted pattern of shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life. An individual’s cultural identity may be based on heritage as well as individual circumstances and personal choice and is a dynamic entity

37
Q

what is ethnocentrism?

A

Ethnocentrism - The tendency to evaluate other groups according to the values and standards of one’s own cultural group, especially with the conviction that one’s own cultural group is superior to the other groups

38
Q

what is a stereotype?

A

involves generalisation about the typical characteristics of members of a group

39
Q

what is prejudice ?

A

attitude towards another person based solely on their membership of a group

40
Q

what is discrimination ?

A

Actual positive or negative actions towards the objects of prejudice

41
Q

what is Kleinman’s explanatory model of illness?

A

What do you call your illness? What name does it have?
What do you think has caused the illness?
Why and when did it start?
What do you think the illness does? How does it work?
How severe is it? Will it have a short or long course?
What kind of treatment do you think you should receive? What are the most important results you hope to achieve from treatment?
What are the chief problems the illness has caused?
What do you fear most about the illness?

42
Q

why have rationing needs increased?

A
  • shift from acute illness to chronic long term
  • normal physiological events becoming medicalised
  • increase in choice and increase in expensive drugs
43
Q

what is rationing?

A

resource is refused because of lack of affordability rather than clinical ineffectiveness

44
Q

what are the allocation theories?

A
  • egalitarian principles - provide all care that is necessary and appropriate to everyone (challenge - tension between egalitarian aspirations and finite recourses)

Maximising principles - criteria that maximise public utility

Libertarian principles - each is responsible for their own health, well being and fulfilment of life plan

45
Q

what rights are frequently engaged in healthcare?

A

Art 2 – the right to life (limited)
Art 3– the right to be free from inhuman and degrading treatment (absolute)
Art 8– the right to respect for privacy and family life. (qualified)
Article 12 – right to marry and found a family

46
Q

what are the benefits of social media?

A

establishing wider and more diverse social and professional networks
engaging with the public and colleagues in debates
facilitating public access to accurate health information
improving patient access to services

47
Q

what are the risk of social media?

A

loss of personal privacy
potential breaches of confidentiality
online behaviour that might be perceived as unprofessional, offensive or inappropriate by others
risks of posts being reported by the media or sent to employers

48
Q

what are GMC duties of a doctor?

A
  • make the care of you patient your first concern
  • protect and promote the health of patients and the public
  • provide a good standard of care (up to date knowledge and skills, work within limits, work well with colleagues)
  • treat patients as individuals and respect their dignity
  • work in partnership with patients (listen and respond to their concerns and preferences, give all info in a way they can understand, respect their right to reach a decisions with you about their treatment
  • be honest and open and act with integrity
49
Q

features of a communicable disease to make it a public health concern

A 
High mortality
High morbidity
Highly contagious
Expensive to treat
Effective interventions
50
Q 
phe notification - 
who 
when 
what 
how
A

Who?
Registered medical practitioners
Labs
When?
Any case of a notifiable disease – on clinical suspicion! Not lab confirmation.
Any other infection/contamination that could risk human health
What?
Case details e.g. NHS no., DOB, contact details
Details of the disease/contamination
How?
Contact local health protection authority / PHE
Written notification or telephone if urgent

51
Q 
define
cluster 
suspected outbreak
confirmed outbreak
epidemic
pandemic
endemic
hyper-endemic
A

Cluster = An aggregation of cases which may or may not be linked

Suspected outbreak = Occurrence of more cases than normally expected within a specific place/ group over a given period of time. 2+ cases linked through common exposure/ characteristic/ time/ location . SINGLE case of rare/ serious disease

Confirmed outbreak = Link confirmed through epidemiological/ microbiological investigation

Epidemic = Occurrence within an area in excess of what is expected for a given time period

Pandemic = Epidemic widespread over several countries

Endemic = Persistent level of disease occurrence

Hyper-endemic = Persistently high level of disease occurrence

Phase 3a (41 decks)

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