Quality Flashcards

1
Q

Why is quality and safety important?

A

Evidence that patients were being harmed
Variations in healthcare
Direct costs and legal bills

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2
Q

What is clinical governance?

A

Delivering on the legal duty that NHS trusts have to put in place systems for monitoring and ensuring quality of care provided

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3
Q

Which aspects of the health service are monitored when trying to improve standards?

A

Effectiveness of the service
Safety of the services
Quality of the patients’ experiences

All done in regard to the quality standards prepared by NICE

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4
Q

What evidence is there that there are problems with quality and safety with healthcare?

A

Variations in health care - suggests not everyone is getting the best
Harm

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5
Q

What is equity?

A

Everyone with the same need gets the same care

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6
Q

What is inequitable care?

A

Patients across England vary in the extent to which they receive high quality care and in access to care

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7
Q

What is an adverse event?

A

An injury caused by medical management (rather than underlying disease) that prolongs the hospitalisation, produces disability or both

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8
Q

Give an example of an unavoidable adverse event

A

Drug reaction in a patient when it was their first time having it

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9
Q

What is a preventable adverse event?

A

An adverse event that could be prevented given the current state of medical knowledge

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10
Q

Name the types of errors

A

Slips and lapses
Mistake
Violation

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11
Q

What is a slip/lapse?

A

Error of action - person has the knowledge, but action goes wrong eg give wrong dose when they meant to give the right

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12
Q

What is a mistake?

A

Error of knowledge/planning

Action goes as planned but fails to achieve intended outcome because the wrong action was taken.

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13
Q

Violation

A

Intentional deviations from protocols, standards, safe operating procedures or other rules

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14
Q

What is the swiss cheese model of accident causation?

A

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

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15
Q

Difference between active failures and latent failures/conditions?

A

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

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16
Q

What is the NHS Outcomes Framework?

A

Set specific national outcome goals in 5 domains. Give financial incentives

17
Q

What are the goals of the NHS Outcomes Framework?

A

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

18
Q

What are the NICE quality standards?

A

A set of statements which are markers of high quality, clinical and cost effective patient care across a pathway or clinical area

19
Q

What are clinical commission groups?

A

Around 200
They commission services for their local population
Drive quality through contracts

20
Q

What is the Quality and Outcomes Framework? (QOF)

A

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

21
Q

What are some NHS quality improvement mechanisms?

A
Standard setting
Financial incentives
Regulation - registration and inspection
Data gathering and feedback
Clinical audits
Commissioning
Disclosure
22
Q

What is the Care Quality Commission (CQC)?

A

All NHS trusts need to be registered with them. Considers NICE quality standards and checks quality accounts

23
Q

How does the CQC do its job?

A

Can visit practices unannounced
Impose registration conditions if not satisfied
Issue warning notices, fines, prosecution, restrict activities, closure

24
Q

What is a clinical audit?

A

A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against criteria and the implementation of change

25
Q

What are the components of a clinical audit?

A

Setting standards
Measuring current practice
Comparing results with standards (criteria)
Changing practice
Re-auditing to make sure practice has improved

26
Q

How can a systems-based approach improve quality of care?

A

Removes human factors to give a safer design

27
Q

Give examples of systems-based approach to improve quality of care ie to remove human factors

A
Avoid reliance on memory
Make things visible
Review and simplify processes
Standardise common processes and procedures
Routinely use checklists
Decrease the reliance on vigilance