Quality Flashcards
Why is quality and safety important?
Evidence that patients were being harmed
Variations in healthcare
Direct costs and legal bills
What is clinical governance?
Delivering on the legal duty that NHS trusts have to put in place systems for monitoring and ensuring quality of care provided
Which aspects of the health service are monitored when trying to improve standards?
Effectiveness of the service
Safety of the services
Quality of the patients’ experiences
All done in regard to the quality standards prepared by NICE
What evidence is there that there are problems with quality and safety with healthcare?
Variations in health care - suggests not everyone is getting the best
Harm
What is equity?
Everyone with the same need gets the same care
What is inequitable care?
Patients across England vary in the extent to which they receive high quality care and in access to care
What is an adverse event?
An injury caused by medical management (rather than underlying disease) that prolongs the hospitalisation, produces disability or both
Give an example of an unavoidable adverse event
Drug reaction in a patient when it was their first time having it
What is a preventable adverse event?
An adverse event that could be prevented given the current state of medical knowledge
Name the types of errors
Slips and lapses
Mistake
Violation
What is a slip/lapse?
Error of action - person has the knowledge, but action goes wrong eg give wrong dose when they meant to give the right
What is a mistake?
Error of knowledge/planning
Action goes as planned but fails to achieve intended outcome because the wrong action was taken.
Violation
Intentional deviations from protocols, standards, safe operating procedures or other rules
What is the swiss cheese model of accident causation?
There are successive layers of defences, barriers and safeguards
Hazards are able to penetrate the barriers leading to losses
Holes caused by active failures and latent conditions
Difference between active failures and latent failures/conditions?
Active failures at the sharp end of practice, closest to the patient eg giving wrong dose
Latent conditions are predisposing conditions which make active failures more likely eg poor training, design, too few staff
What is the NHS Outcomes Framework?
Set specific national outcome goals in 5 domains. Give financial incentives
What are the goals of the NHS Outcomes Framework?
Prevent dying prematurely
Enhance quality of life for people with LTC
Help people to recover from ill health or injury
Positive experience of care for patients
Treat people in a safe environment and protect them from avoidable harm
What are the NICE quality standards?
A set of statements which are markers of high quality, clinical and cost effective patient care across a pathway or clinical area
What are clinical commission groups?
Around 200
They commission services for their local population
Drive quality through contracts
What is the Quality and Outcomes Framework? (QOF)
Used in primary care - sets national quality standards with indicators in primary care
GPs score points according to how well they perform against indicators and then get payments based on points achieved
Results published online
What are some NHS quality improvement mechanisms?
Standard setting Financial incentives Regulation - registration and inspection Data gathering and feedback Clinical audits Commissioning Disclosure
What is the Care Quality Commission (CQC)?
All NHS trusts need to be registered with them. Considers NICE quality standards and checks quality accounts
How does the CQC do its job?
Can visit practices unannounced
Impose registration conditions if not satisfied
Issue warning notices, fines, prosecution, restrict activities, closure
What is a clinical audit?
A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against criteria and the implementation of change
