PTSR BDS5 Flashcards
A patient with difficulty hearing presents to your clinic.
The patient needed new dentures but didn’t want them.
What are your THREE duties of care to this patient?
- To protect patients’ life and health to an acceptable professional standard
- To respect autonomy
- To act justly and fairly
How to judge capacity
2 stage test
* Stage 1:
o Are there any disturbances in the functioning of the patients mind or brain?
o Are the disturbances significant to affect the decision making of the patient?
- Treat every patient politely and considerately and have respect for the patient’s dignity and privacy
- Listen to patients and respect their views and give patients information in a way in which they can understand
- Respect the rights of the pt to be involved fully in decisions about their care
4 Make sure personal beliefs do not prejudice my patients care - Act quickly to protect pts from risks, if I have a good reason to believe that I or a colleague may not nor fit to practise
- Keep my professional knowledge and skills up to date and recognise the limits of m professional competence
- Be honest and trustworthy and respect and protect confidential information
- Never discriminate unfairly against my patents or colleagues and be prepared always to justify my actions to them
- Avoid abusing my position as a member of the dental profession and work with colleagues in ways which best serve the patient”
What non-verbal communication techniques would you use to aid understanding with a patient with hearing difficulties?
Body language
o Facial expression
o Height to patient
*Writing
*Diagrams and drawings
*Sign language
*Act out or use video
*Modelling- use a volunteer and model on them what you are going to do
How will you obtain informed consent?
Valid consent needs to be…
VOLUNTARY (decision only made by pt)
INFORMED (pt needs to be told the following in layman’s terms:
○ Tx involved
○ Risks & benefits
○ Reasonable alternative tx options
○ No tx & consequences
○ Cost & time of tx
○ Give pt TIME to digest all this info (esp for high risk procedures))
pt has to have CAPASITY = ability to understand the info & make an informed decision
Must respect decision made by adult w capacity
For elderly w/out capacity: valid consent can b obtained by Lasting Power of Attorney (LPA) or Court Appointed Deputy (CAD)
For elderly w/out capacity & w/out LPA or CAD: seek opinion of another healthcare professional to confirm pt best interest
Consent not necessary when… (3 marks)
- During emergency
- During operation
- Severe medical health condition (e.g. schizophrenia)
Mental Capacity Act 2005 summary
Presume every adult has capacity until there is clear evidence otherwise
How can you judge the patient’s competency?
- Patient is able to communicate a choice-preferred treatment option
- Able to understand information given to them- repeat back in their own words what they understood
- Appreciate the situation and its consequences- patient acknowledge their illness and what would happen if not treated
- Able to reason about treatment options- able to explain reasons why they have come to that particular choice
Down’s syndrome patient attends with their mother - they are experiencing pain in the mouth and are uncooperative.
What is the aetiology of Down’s syndrome? (1 mark)
- Trisomy 21
- Translocation 21
- Mosaicism
A patient contacts your surgery and complains about it a few months later, what do you do?
NOTE GDC Standard 5
Every patient has the right to make a complaint and we must respect this right, and give patients a prompt and constructive response. We must make sure that there is an effective complaints procedure readily available for patients to use, and follow that procedure at all times
- Complaints procedure must be displayed where patients can clearly see”
- Complaints can be made up to 12 months after date of which the cause of complaint occurred or from when they noticed the cause
If a VERBAL complaint
* Try to resolve this within 24 hours & as a result will not have to go through the formal complaints procedure, but the complaints lead/manager should keep a note of the complaint and the outcome.
- If not resolved after 24 hours, the complaint must be acknowledged in writing and a copy forwarded to the patient
If a WRITTEN complaint
* Complaint must be acknowledged within 3 working days either verbally or in writing
- The complaint should be resolved within 10 working days, if longer then inform patient on the progress
There must be written explanation of:
* How complaint was considered
* Conclusions reached on basis of the facts
* Explanation of what action if any the practice intends to take as a consequence and to prevent in future
* If we are unable to resolve this complaint locally we can advise the patient they can try the NHS
Define empathy
The ability to understand and share the feelings of another
Mrs Jackson is rather deaf. Describe five communication skills that you could use to overcome the communication challenges raised by Mrs Jackson’s deafness
- Move closer to the person to increase loudness of sound addressing them directly and not the not interpreter
- Talk face to face, speak at eye level, do not cover your mouth with a mask when you’re asking the patient questions or giving instructions
*Write down explanations to treatments as visual aids may help patients understanding
- Speak slowly and clearly (there is no need to raise your voice – never shout at a person who is hard of hearing)
- Ask the patient about their hearing impairment, as one ear may be worse than the other, and speak into the better ear if so
- Make sure the person fully understands what you said as they may be embarrassed by their hearing loss, simply ask the person to repeat what you said
- The use of hearing loupes in practice may also help assist the patient
What ways might you communicate with someone with poor eyesight?
- Don’t stand behind them and sit in front of the patient, speaking directly to the person who is visually impaired and not through an intermediately such as guide
- Offer the patient leaflets in braille for visual impairment e.g. about their dental condition to take home
- Give visually impaired persons verbal cues to let them know that you are actively listening, as they cannot necessarily see the look of interest on your face
- Tell the patient when you are leaving the room and where you are going e.g. I am going to develop the x-rays that we just took
- Be thorough and precise when you describe people, places, or things to someone who is blind
- Indicate the end of a conversation with a person who is blind or severely visually impaired to avoid the embarrassment of leaving the person speaking when no one is actually there
- Orient person to sounds of environment e.g. demonstrate the sound of the ultrasonic instrument before using it in patient’s mouth
What is Duty of Candour? (6 marks)
Duty of Candour - Professional and Legal duty
Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.
This means that healthcare professionals must:
TELL THE PATIENT (or, where appropriate, the patient’s advocate, carer or family) WHEN SOMETHING HAS GONE WRONG;
APOLOGISE TO THE PATIENT (or, where appropriate, the patient’s advocate, carer or family);
OFFER AN APPROPRIATE REMEDY OR SUPPORT TO PUT MATTERS RIGHT (if possible);
and
EXPLAIN FULLY TO THE PATINET (or, where appropriate, the patient’s advocate, carer or family) THE SHORT & LONG TERM EFFECTS OF WHAT HAS HAPPENED.
What are the conditions for informed consent?
Voluntary - consent must be freely given & person must not be manipulated or coerced in any way to have any particular treatment against their will.
Informed - patient must be given enough information, explanation of treatment, reasonable alternative treatment options, risks and benefits, cost & time of treatment & consequences of no treatment. Pt needs to be given TIME to digest the info.
Competence - patient must be deemed to have adequate mental capacity to understand and reason about their treatment.
Understanding - information must be presented in a way which is easily understood by the patient
What needs to be said for consent?
- Introduction
- What patient understands is problem
- Explain what the problem is
- Treatment options and explain procedures- to include no treatment, and cost and time of each treatment.
- Risks and benefits of treatment options
- Check that the patient understands
- Invite and answer any questions
- Confirm the preferred treatment option
- Gain consent explicitly, verbal or written and make a note of it in the medical notes.
9 principles of GDC
1) Put patients’ interests first
2) Communicate effectively with patients
3) Obtain valid consent
4) Maintain and protect patients’ information
5) Have a clear and effective complaints procedure
6) Work with colleagues in a way that is in patients’ best interests
7) Maintain, develop and work within our professional knowledge and skills
8) Raise concerns if patients are at risk
9) Make sure our personal behaviour maintains confidence in us and the dental profession
What is an audit and how would you carry one out?
“NICE define audit as:
a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.
Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria.
Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery
What is Duty of Candour? (6 marks)
Duty of Candour - Professional and Legal duty
Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.
This means that healthcare professionals must:
TELL THE PATIENT (or, where appropriate, the patient’s advocate, carer or family) WHEN SOMETHING HAS GONE WRONG;
APOLOGISE TO THE PATIENT (or, where appropriate, the patient’s advocate, carer or family);
OFFER AN APPROPRIATE REMEDY OR SUPPORT TO PUT MATTERS RIGHT (if possible);
and
EXPLAIN FULLY TO THE PATINET (or, where appropriate, the patient’s advocate, carer or family) THE SHORT & LONG TERM EFFECTS OF WHAT HAS HAPPENED.
What is Duty of Candour? (6 marks)
Duty of Candour - Professional and Legal duty
Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.
This means that healthcare professionals must:
TELL THE PATIENT (or, where appropriate, the patient’s advocate, carer or family) WHEN SOMETHING HAS GONE WRONG;
APOLOGISE TO THE PATIENT (or, where appropriate, the patient’s advocate, carer or family);
OFFER AN APPROPRIATE REMEDY OR SUPPORT TO PUT MATTERS RIGHT (if possible);
and
EXPLAIN FULLY TO THE PATINET (or, where appropriate, the patient’s advocate, carer or family) THE SHORT & LONG TERM EFFECTS OF WHAT HAS HAPPENED.
What is Duty of Candour? (6 marks)
Duty of Candour - Professional and Legal duty
Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.
This means that healthcare professionals must:
TELL THE PATIENT (or, where appropriate, the patient’s advocate, carer or family) WHEN SOMETHING HAS GONE WRONG;
APOLOGISE TO THE PATIENT (or, where appropriate, the patient’s advocate, carer or family);
OFFER AN APPROPRIATE REMEDY OR SUPPORT TO PUT MATTERS RIGHT (if possible);
and
EXPLAIN FULLY TO THE PATINET (or, where appropriate, the patient’s advocate, carer or family) THE SHORT & LONG TERM EFFECTS OF WHAT HAS HAPPENED.
