Qual And Safety Flashcards
LO2: desc ev demonstr probs of qual and safety in HC.
- var risk of amputat with T1 and 2 diab across country. RR 0 to 17.76.
- hip repl- 3.8 fold var in CCGs. 73% not foll NICE for referral. Var degrees of pain or immob or weight loss bef.
- 9% world AE rate, 44% prev, 7% lethal. Surgery AE 14%, 38% prev.
- reliability of sys 80%. Surgical eq avail as low as 63%. Outpt clinic 15% pts lack relev clinic info.
- incorr drug over 1000 incid 2005-2010.
- op defects- US nurse study show interrup ev 6 min. 10% their time working arnd op failures.
LO3: desc theories about why pt safety probs occ.
-james reaosns framew of err-
Active failures: Acts that directly= harm. Occ at sharp end of prac closest to pt. eg drug OD. Active fail is admin wrong dose.
Latent conds: predisp cond. context incr chance active failures eg poor training, poor design syring, understaff, poor supervis. Need defences that trap or mitigate err. Eg drugs look same.
-swiss cheese- start with hazards. Some holes due to active fails, some latent conds. Success lays of defs, barriers and safeguards. Holes go through them= loss. Eg route admin eg vincristine IV not intrathecal. Nottingham 2001. Diff sys in diff hosps and not chall superiors and not corr training and not check! Also drug connected to syringe. All holes align. Barriers eg protocol, practice breached simult. Latent err provoking eg time press, inexper. Latent long last eg unworkab proced, design defic.
-loss situational awareness eg cant intubate cant ventilate.
LO4: expl how a sys based appr can prom pt safety and qual in HC.
-sys factors impact safety:
Instit, hosp, dept, work env, team, indiv, task, pt.
-make safer by hum factors: av rely mem, make things visib, rev and simplif procs, stand proceds, use checklists, decr rely on vigilance.
-stand proc and impr teamw. F1 pit stop err decr 39% to 11% pt.
- cult and behav in NHS.
LO5: desc policies and orgs for encour qual in NHS.
-health and soc care act 2012- duty to impr qaul. Effectiven, safety and qual of experience. Regard to NICE qual stands.
-commissioning outcomes framework. Commiss guidance. Provider payment eg tariff, stand contract, CQUIN, QOF.
-NHS impr mechs-
stand sett by NICE For qual clinic cost effec care acroos a path or area, from best av ev and prod collab by NHS and soc care and partners and users eg screening, advice and reass.
commissioning- over 200 CCGs eng, commiss services for loc pops, drive qual through contracts.
finan incent- QOF in prim care set qual stand with indics. Clinic, org and pt exper. GP score pt and get practice payments. Published. CQUIN 1.5% provider trust income deps on ach measurab goals agreed with comiss in safety, effectiven, pt exper. Nat tariff prov consis basis for commiss services, incentivise effic, rew best practices. HRGs grps of simil tx use simil resource, dterm reimbursement. Effic trusts make profit.
disclos- org and indiv lev. Trust publish annual qual accounts. Foc saefty , effec and pt exper.
regul by registrat and inspec- NHS trusts must regist with care qual commiss, can impose conds of regist if unsatisf. Unannounced visits, warning notices,fines, prosec, restric activ, closure.
data gath and feedb.
clinic audit loc and nat- sett stands, meas curr prac, comp res with stand, change prac, re audit for impr.
-qual impr will= better pt exper and outc, better sys perf, prof dev.
-plan do study act cycles.
LO6: expl what clinic governance means.
- since 99 NHS trusts legal duty sys for monit and ensur qual of care. Clinic gov means deliv on this duty. All doctors work under duties.
- clinic gov= framew through which NHS orgs are accountab for contin impr qual of services and safeguarding high stand care by creat env where excell flourish.
LO1: recog qual and safety in HC as imp responsib of Drs.
-act if dignity or comfort comprom. Report risk. Report when anyth goes wrong for pt eg mistake, s/e. Review own practice.
-only really monit last 15yr. Qual and safety imp because: ev that pt harm or poor care, vars in HC, direct costs and legal bill, policy imperatives.
-qual= safe- no needless death. Effec- no needless pain or suff. Pt cent- foc on pt need and priorities. Timely. Effcient- no waste. Equitable- no one left out, equity=ev with same needs gets same care.
Not meet these, and var in care shows qual not optim.
-harm: AE= inj caused by medic managem not the dis that prolongs hosp, prods disabil, or both. Preventable= AE that could be prev given curr state medic knowl. Some AEs unavoidable eg 1st time drug reac. Preventable eg wrong op, retained obj, wrong dose med, fail resc, infecs. Sepsis.
- Most deaths rel to qual of clinic monit- omiss of care.
Poor sys design not acc for hum err, cult and behav.
Over reliance on indiv responsib, personal effort necess not suffic. Sys often at fault, indiv rarely. Often multip contribs.
Hum factors often predictable psych behav.
-fail gear orgs to pt safety- pushes short term fixes, encourage compensat heroic model, rushing, bodges tol, overall deg safety.
