PPS

Question 1

How can clinical negligence occur? (6 things)

Answer 1

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

Question 2

What is neglect? (3 things)

Answer 2

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

Question 3

What is poor performance? (3 things)

Answer 3

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

Question 4

What is misconduct? (4 things)

Answer 4

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

Question 5

Define clinical negligence

Answer 5

A legal entity - a civil claim for damages

Question 6

If you are found liable for clinical negligence who pays?

Answer 6

NHS litigation authority

Question 7

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

Answer 7

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?

Question 8

What is the Bolam test?

Answer 8

Would a group of reasonable doctors do the same?

Question 9

What is the Bolitho test?

Answer 9

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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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

Question 12

What is the Swiss cheese model?

Answer 12

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

Question 13

Give 5 types of error

Answer 13

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

Question 14

Give 3 examples of sloth

Answer 14

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

Question 15

Give 3 examples of fixation and loss of perspective

Answer 15

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

Question 16

Give an examples of playing the odds

Answer 16

Choosing the common and dismissing the rare event

Question 17

Give 2 examples communication breakdown

Answer 17

Unclear instructions or plans.

Not listening to or considering others opinions.

Question 18

Give an example of bravado

Answer 18

Working beyond your competence or without adequate supervision

Question 19

Give 2 examples of ingnorance

Answer 19

Lack of knowledge.

Unconscious incompetence.

Question 20

Give an example of mis triage

Answer 20

Over/underestimating the seriousness of a situation.

Question 21

Give an example of lack of skill

Answer 21

Lack of approrpriate skills, teaching or practice.

Question 22

Give an example of system error

Answer 22

Inadequate built in safeguards.

Question 23

Give 5 examples of never events

Answer 23

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

Question 24

Give 3 examples of poor team working

Answer 24

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

Question 25

Give 3 reasons why rationing needs have increased

Answer 25

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

Question 26

What are the 3 allocation theories?

Answer 26

1. Egalitarian principle 2. Maximising principles 3. Libertarian principles

Question 27

Which allocation theory was the NHS founded on?

Answer 27

Egalitarian

Question 28

Outline the egalitarian principle of resource allocation

Answer 28

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

Question 29

Outline the maximising principle of resource allocation

Answer 29

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

Question 30

Outline the libertarian principle of resource allocation

Answer 30

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.

Question 31

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

Answer 31

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

Question 32

What are the 5 criticisms of the German health incentive

Answer 32

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

Question 33

What is the rule of rescue

Answer 33

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.