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Public health > PPS > Flashcards

PPS Flashcards

1
Q

How can clinical negligence occur? (6 things)

A
  1. System error
  2. Human error
  3. Judgment failure
  4. Neglect
  5. Poor performance
  6. Misconduct
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2
Q

What is neglect? (3 things)

A
  1. Culture of no showing sufficient care
  2. Repeated minor mistakes
  3. Falling below expected standards
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3
Q

What is poor performance? (3 things)

A

A problem of attitude
Not learning from mistakes
Often rudeness, scruffiness and laziness

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4
Q

What is misconduct? (4 things)

A
  1. Causing deliberate harm
  2. Covering errors
  3. Fraud/ theft/ abuse - faslely claiming sickness, drug/alcohol abuse
  4. Improper relationships
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5
Q

Define clinical negligence

A

A legal entity - a civil claim for damages

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6
Q

If you are found liable for clinical negligence who pays?

A

NHS litigation authority

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7
Q

What are the 4 questions asked when trying to demonstrated clinical negligence?

A
  1. Was there a duty of care?
  2. Was the duty of care breached?
  3. Did the patient come to harm?
  4. Did the breach in duty of care cause the harm?
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8
Q

What is the Bolam test?

A

Would a group of reasonable doctors do the same?

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9
Q

What is the Bolitho test?

A

Court has to be satisfied that it would it be reasonable of the panel of medics to do so

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10
Q

Give 4 strategies to reduce error and harm in a clinical setting

A
  1. Simplify & standardise clinical processes
  2. Checklists: surgical checklist
  3. Training
  4. Risk management programmes
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11
Q

Name 4 tools used to identify risk in the clinical work place?

A
  1. Incident reporting
  2. Audits
  3. Complaints and claims
  4. Service evaluation
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12
Q

What is the Swiss cheese model?

A
  1. Slices of cheese represent barriers but in place by an organisation to defend against failure
  2. Holes are weaknesses in individual parts of the system that vary in size and portion
  3. When holes in each barrier align leads to trajectory of accident opportunity
  4. When hazard passes through all holes leads to failure
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13
Q

Give 5 types of error

A 
Sloth
Fixation & loss of perspective 
Communication breakdown
Playing the odds
Bravado
Ignorance
Miss-triage
Lack of skill
System error
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14
Q

Give 3 examples of sloth

A

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

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15
Q

Give 3 examples of fixation and loss of perspective

A

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

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16
Q

Give an examples of playing the odds

A

Choosing the common and dismissing the rare event

17
Q

Give 2 examples communication breakdown

A

Unclear instructions or plans.

Not listening to or considering others opinions.

18
Q

Give an example of bravado

A

Working beyond your competence or without adequate supervision

19
Q

Give 2 examples of ingnorance

A

Lack of knowledge.

Unconscious incompetence.

20
Q

Give an example of mis triage

A

Over/underestimating the seriousness of a situation.

21
Q

Give an example of lack of skill

A

Lack of approrpriate skills, teaching or practice.

22
Q

Give an example of system error

A

Inadequate built in safeguards.

23
Q

Give 5 examples of never events

A 
Wrong site surgery
Wrong implant or prothesis 
Retained foreign object post procedure
Overdose on methotrexate for non cancer treatment
Scalding of patients
24
Q

Give 3 examples of poor team working

A

Staff working independently
Poor instructions
Some out of dept, others under-utilised

25
Q

Give 3 reasons why rationing needs have increased

A
  1. Shift from acute illness to chronic long term
  2. Normal physiological events medicalised i.e. pregnancy
  3. Increase in choice and increase in expensive drugs
26
Q

What are the 3 allocation theories?

A
  1. Egalitarian principle
  2. Maximising principles
  3. Libertarian principles
27
Q

Which allocation theory was the NHS founded on?

A

Egalitarian

28
Q

Outline the egalitarian principle of resource allocation

A

Provide care that is necessary and ensuring that everyone has equal access to services

29
Q

Outline the maximising principle of resource allocation

A

The best action is the one that maximizes public utility - which produces the greatest well-being of the greatest number of people

30
Q

Outline the libertarian principle of resource allocation

A

Everyone is responsible for their own health, wellbeing and fulfilment of life plan. People must be willing to invest and pay the cost of their own healthcare needs directly or indirectly through private health care insurance.

31
Q

What are the 3 key features of the German health incentive scheme and which principle of resource allocation is it an example of?

A

Libertarian.

  1. Everyone contributes towards health care (% of income earned)
  2. People get incentives to change individual behaviour (i.e. cash, sports reduction in insurance contributions) for participating in routine screening, health promotion and check ups, compliance to treatment
  3. Pay outs are made for savings through better health behaviour
32
Q

What are the 5 criticisms of the German health incentive

A
  1. Question of equity: private programmes attract and retain higher income groups
  2. People from higher socio-economic groups are less likely to benefit from incentives
  3. To what extent does bonuses result in change of behaviour
  4. Should drs police health behaviour?
  5. Most contribution comes from the rich but mostly benefits the poor
33
Q

What is the rule of rescue

A

The ethical imperative to save individuals lives, regardless of expense, even when money might be more efficiently spent to prevent deaths in the larger population.

Public health (5 decks)

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