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BDS3 PMHP > quality and safety > Flashcards

quality and safety Flashcards

1
Q

quality strategy 2010

3 quality ambitions

A
  • Safe
  • Effective
  • Person centred

Realistic medicine – shared decision making – pt at centre of care plan

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2
Q

6 links for quality strategy

A
  • Effective
  • Equitably
  • Efficient
  • Person centred
  • Safe
  • timely
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3
Q

scottish government plan 2018

oral health improvement plan

A
  • Focus on prevention
    • Child to adult
  • Reducing oral health inequalities
  • Meeting the needs of an ageing population
    • How to meet their needs – dentures, managing complex existing tx
  • More services on the high street
    • Upskill dental teams so not having to refer pts to hospitals
  • Improving information for pt
    • Issue – poor communication and lack of information
    • How to invest to improve this? Social media/ written information?
    • Evidence based needs to be up to date – checked regularly for accuracy and updated
  • Quality assurance and improvement
  • Workforce
    • Implications of delayed intake 2021?
  • Finance
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4
Q

chapter 7 of oral health improvement plan

quality assurance and improvement

A
  • Director of dentistry
    • in each health broad areas – 14
    • leadership role – help communicate issues from each professional who fulfil their role
  • regulations and powers
    • no regulations over private work – COVID issue
  • NHS boards powers to prevent GDPs working where there is clear danger to pt care
    • Whistle blowers, pt complaints, fellow colleagues, dentist themselves
  • Responsible dental reference service
    • Sample pieces of work to assess quality of care, tx and if tx match pt needs
  • Practitioner with problems pathway
    • Consistent approach on how to work with the practitioners
      • Support – stress, demands of job
  • Quality indicators database
  • Quality assurance and improvement approach
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5
Q

delivering quality standards requires

A
  • Education and training
  • Clinical effectiveness – evidence-based practice
    • How to take academic knowledge into practice
  • Openness on poor performance and practice
    • E.g. airline – learning culture not blame culture
  • Processes and systems to manage poor performance
    • Need transparency
  • Risk management
  • Protected learning time
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6
Q

quality assurance means for clinical care

A

What mean for me – my career, my pt – clinics, lectures etc

What I’m working on – how I impact on it and that impacts pt care

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7
Q

formal quality improvement activity within the NHS

A
  • Clinical audit
  • Peer review
  • Significant event analysis – critical incident review
    • Not victimising
    • Whole system approach to assess
  • Research project
    • Scottish Dental Practice Research Network – Dundee??

Quality improvement projects/ Scottish patient safety initiative

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8
Q

why bother with quality improvement

A

why not focus on tx taught to do

2018 data

  • £359.7 million spent on oral health care each year
    • Does it improve oral health outcomes?
    • Hypothesis SPEND MORE = BETTER HEALTH?
  • What else can influence oral health?
  • Are we delivering quality?

How do we prove dental health improvement has happened

  • Redesign dental services to become more preventative focussed rather than focus on fee per item

Oral health influences – not just dental, diet, shopping, societal

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9
Q

health equity

A
  • Systems and processes in place in deliver
  • Accessible services
  • Reduced barriers
    • Language
    • Literacy and numeracy
  • how to measure it

Covid – reduce staff and pt footfall

How to ensure prioritise those that need care - backlog

  • messaging from clinics and practices
  • but business plan coming into play – practices need to see private pts/fee pts esp as reduced footfall but cannot neglect NHS pts
  • salaried from government to top up as only seeing 20-30% pts a day now
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10
Q

inverse care law

A

Those that need care may not be accessing

But those who don’t may be the ones accessing

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11
Q

why does inverse care law stil exist

A
  • Cost
  • Access
    • Time of work
    • Money to pay for tx, travel
  • Use of emergency dental services
    • Not able to operate at maximum capacity now due to COVID
    • So emergency dental services working extra – e.g. university students not able to register, unable to get appointments as freely
      • Increase session times – need cleaning times, fallot times
      • Bring in extra on call dentist
  • Knowledge – role for other HCP to promote visit to dental team
    • pharmacy
  • SIMD and information from payment systems

Self reported information

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12
Q

what is quality improvement

A

Combined an unceasing effort of everyone – HCP, pts and families, research, tax payers, administrators, educators

To make chances that will lead to

  • Better professional development
  • Better system performance
  • Better pt outcome
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13
Q

3 aims of quality improvement

A
  • Better professional development
  • Better system performance
  • Better pt outcome
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14
Q

is QI continuous

A

yes

“everyone in healthcare really has 2 jobs when they come to work every day: to do their work and to improve it”

  • Open ears
  • Listen to feedback
  • Need improve
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15
Q

what can quality improvement look like?

A
  • Context
  • People/relationships
  • Co-created system answer is generally in the room – communicate, teamwork
  • Systems and processes
    • Cleanliness champions
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16
Q

pt safety

A
  • Preventing pt being harmed by the care they recieve
    • pt centreed - too much/not enough care
  • If harm does occur identify and analyse it and learn from it to prevent it recurring
    • Open and transparent
      • DATIX
      • independent practice systems
        • is peer review possible to try and collaborate this individual practice data on wider scale
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17
Q

3 most common factors for issues in quality

A
  • medical complexity
    • ageing population risk
      • need most up to date prescription, up to date history to develop accurate Tx
      • shared decision making
  • system failures
  • human factors
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18
Q

2 most common solutions for issues in quality

A
  • from people in room - discussions
  • reducing adverse events
19
Q

why be concerned with pt safety in primary dental care

A
  • High volume (dentist benefit from booked in appointments)
  • Increasingly complex
    • Medical, ageing populations, technology, drugs
  • Real harm – adverse events in primary care (impact on secondary care)
    • 12% admission to hospital
    • 5.5% deaths in hospital (when GA done in primary care setting)
  • 76% of incidents in primary care are preventable

Huge volume pt – huge potential for things to go wrong

Why not celebrate when things go right

20
Q

quality improvement story

5 aspects

A
  • Issue – 1m people NHS in 36 hours
  • Measure- how to protect patients
  • Prevent- inexcusable harm
  • Safe- medicines and devices
  • Learn- from mistakes
21
Q

e.g. lessons leart from quality improvment

A
  • Communication
  • Have a plan
  • Listen to all the team players
  • Take control
22
Q

duty of candor

A

Responsibility to reach out to pt and say when things go wrong, apologise

23
Q

possible harms related to other aspects of care

A

Organisation

Environment

Individuals

Team

e.g.

  • Poor administrative systems
  • Poor communication
  • Not enough equipment
  • Stressed
  • Understaffed
  • Hierarchy
  • Poor leadership

HUMAN CLINICAL FACTORS

24
Q

overarching aim of quality improvement

A

Deliver high quality and safe healthcare to patients & the population by

  • Reducing variance
  • Increasing reliability
  • Reducing hierarchy
  • Developing the team
  • Leadership
  • Learning from failures
25
Q

5 fundamental key principles of quality imporvement

A
  • Knowing why you need to improve (aim)
  • Having a feedback mechanism to tell you if improvements are occurring
  • Developing effective changes that will result in improvement
  • Testing and adapting changes before attempting to implement
  • Knowing when and how to make changes permanent (implementing)
26
Q

model for improvemtn

A

A model for learning and change

  • Predict
  • How to make better
27
Q

improved quality together involves

A
  • Person centred care
  • Shared decision making
  • Model for improvement
  • Measurement and reliability
  • Testing changes
  • Improving quality together
28
Q

issues with hierarchy

A

complex

Easier to implement change in individual practice than public dental setting

29
Q

what gets in the way of quality improvment (5)

A
  • Performance management
  • Waiting lists
  • Surveillance
  • Staff shorting resulting in gaps in rota
  • Training rotation
30
Q

7 key ingredients for quality

A
  • Leadership
  • Culture
  • Ownership and involvement
  • Relationships
  • Learning from failure
  • Recognise and celebrate success take everyday processes for granted
  • Sustain and spread
31
Q

6 quality improvement tools

A
  • Collaborative
  • Bundles
  • Pt involvement surveys, following pt journeys
  • Trigger tools
  • Safety climate
  • Process mapping
32
Q

questions to pt should be

A

it’s all about people and relationships

  • What matters to you?
    • Instead of – What’s the matter with you?
33
Q

3 opinion questions

A

After consultation (not in dental setting anymore)

  • What was good
  • What could be improved
  • How did you feel

Actually, writing thoughts – open ended – complement 1-10 Qs

Harder to analyse but can be very rich

34
Q

care bundle

A

set of evidence-based interventions that when used together significantly improve outcomes

  • Aims to ensure pt receive optimum care at every contact
    • Right care by right HCP, right time, right place,

Structured easy of improving processes of care to deliver enhanced pt experience

35
Q

Bundle Vs Audit

A
  • Audit – identifies whether individual measures are being implemented
  • Bundle – data collection tool to sample whether optimum care is being delivered

Bundle – regular collecting data, is optimum care at every snapshot

36
Q

reason for bundle analysis

A

helps develop a checklist of what should be done for certain situations

e.g. pt on high risk medication for dental care

37
Q

fishbone diagram

A

cause and effect analysis

38
Q

what to do once id causes

A

apply model of improvement for developing actions

39
Q

e.g. causes and actions after model for improvement for wrong tooth extraction

A

Causes (some adverse events had more than one):

  • Human Error emerged as cause for 6 events.
  • Failure of supervision emerged as cause for 5 events.
  • Documentation or transcription errors emerged as cause for 3 events.
  • Complication of surgery emerged as cause for 2 events.
  • Handover process failing emerged as cause for 1 event.
  • Standard operating procedure was not followed for 2 events.

Model of improvement used to develop actions

Actions

  • Extraction protocol – confirm patient details, get patient to point at tooth etc
  • Handover sticker from all departments (pink sticker)
    • Minimise verbal errors
  • WHO checklist
  • Huddles
40
Q

safety climate survey

A

anonymous

  • Understanding the importance of a positive safety culture
  • Thinking about it
  • Measuring your safety climate
  • Discussing it and reflecting on results
  • Focussed action to improve

5 domains

fed back to develop an action plan as a team

41
Q

implementing quality improvement

A

slow process - chasm - don’t give up

42
Q

4 groups of people to consider in quality improvement plan

A
  • Population
  • Pts
  • Staff
  • yourself

their roles

ultimately PATIENT CENTERED

43
Q

key messages when developing quality improvement plan

A

What went well?

What could be the potential barriers?

  • How harms occured and understand complexity
  • Busiest/most stressful times- look after each other

What have I learnt?

  • How will this session influence my work?
  • How will it change my practice?

BDS3 PMHP (14 decks)

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