Quality and Safety in Healthcare Flashcards
Why is quality and safety so important in healthcare?
To stop patients being harmed or receiving sub standard care
To stop variations in healthcare
For costs and legal bills
Define equity
Everyone with the same needs gets the same care
Is there equity in the NHS all across England?
No.
Many results show that there is an uneven amount of care given in England.
Care is inequitable in England
Describe some evidence that suggests an inequity in healthcare
You are twice as likely to have your foot amputated if you live in the southwest than if you live in the southeast
Most admissions to hospital with acute exacerbation of asthma are avoidable, yet 5-fold variation in admission rates across England
Define an adverse event
An injury that is cause by medical management (rather than the underlying disease) and that prolongs the hospitalisation, produces disability or both
Define preventable adverse event
An adverse event that could be prevented given the current state of medical knowledge.
Give an example of an unavoidable adverse effect
A drug reaction that occurs in a patient prescribed the drug for the first time.
Give some examples of adverse events that are avoidable
Operations performed on the wrong part of the body
Retained objects
Wrong dose/type of medication given
Failure to rescue
Some kinds of infections
Why do things go wrong in healthcare?
Poorly designed systems that do not take into account human factors
Culture and behaviour
How does an over-reliance on individual responsibility cause things to go wrong?
All human make errors - everyone of us is fallible
Most of medicine is complex and uncertain
Most errors result from the “system”
- Inadequate training
- Long hours
- Ampoules that look the same
- Lack of checks etc…
But healthcare has not traditionally tried to make itself safe - blamed individuals instead
Personal effort is necessary but not sufficient to deliver safe care
How could designs of system be better geared towards reducing human error?
Avoid reliance on memory Make things visible Review and simplify processes Standardize common processes and procedures Routinely use checklists Decrease the reliance on vigilance
Describe the Swiss cheese model
There is a route from a hazard to a loss, and to stop this you out barriers in the way, the more barriers you place the less hazards will get through and therefore reduce losses
Explain James Reason’s framework of error: active failures
Acts that lead directly to the patient being harmed
Occur at the sharp end of practise - closest to the patient
E.g. baby has seizures as a result of being given an overdose of a drug - The active failure was the administration of the wrong dose
Explain James Reason’s framework of error: latent conditions
Latent conditions are the predisposing conditions
Any aspect of context that means active failures are more likely to occur
- E.g. poor training, poor design of syringes etc…
Latent conditions can make it more likely that a baby could be given the wrong dose
So need defences that trap or mitigate the error
Give some examples of latent conditions
They can:
- be error provoking (time pressure, inexperience)
- create long lasting holes (unworkable procedures,
design deficiencies)
What happens when there is a failure to ensure organisations are geared to safety?
It pushes focus onto short term "fixes" Encourages heroic, compensatory model Makes people rush and make mistakes Mistakes get tolerated Overall effect of degrading safety
How do we make the system safer?
By looking at other professions and taking advice
E.g. By looking at F-1 pit stop and aviation models errors dropped from 39% to 11.% in some cases
Define clinical governance
A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
What are the five domains of the NHS outcomes framework that specify national outcome goals and indicators?
Preventing people from dying prematurely
Enhancing quality of life for people with long term conditions
Helping people recover from episodes of ill health/injury
Ensuring people have a positive experience of care
Treating and caring for people in a safe environment and protecting from avoidable harm
How is the NHS outcomes framework intended to work?
To provide a national level overview of how well the NHS is performing
To hold the Secretary of State for Health and the NHS Commissioning Board (NHS England) to account for £95bn of public money
And to act as a catalyst for driving up quality throughout the NHS by encouraging a change in culture and behaviour
What are the 7 NHS quality improvement mechanisms?
- Standard setting
- Commissioning
- Financial incentives
- Disclosure
- Regulation - registration and inspection
- Data gathering and feedback
- Clinical audit - local and national
Explain Standard setting.
NICE sets quality standards based on best available evidence
They aim to define what quality care should look like
What is a NICE quality standard?
A set of statements that are:
- Markers of high-quality, clinical and cost-effective
patient care across a pathway or clinical area
- Derived from the best available evidence such as
NICE guidance or other NHS Evidence accredited
sources.
- Produced collaboratively with the NHS and social
care, along with their partners and service users.
Give two examples of NICE quality standards
VTE prevention - 7 statements including:
- All patients risk-assessed using tool on admission
- Verbal and Written advice offered on discharge
Stroke - 11 statements, including:
- Brain imaging within 1 hour of arrival if indicated
- Screen for swallowing within 4 hours
- Urinary incontinence reassessed after 2 weeks
Explain Commissioning in terms of the NHS quality improvement mechanisms.
There are 211 Clinical Commissioning Groups in England
These commission services for their local populations that will drive up quality through contracts
Explain some techniques of financial incentive used by the NHS in terms of their quality improvement mechanisms
Finance is used to both reward and penalise
There are different ways of doing this, and a few examples are:
- Quality and Outcomes Framework (QOF)
- Commissioning for Quality and Innovation (CQUIN)
- Best Practice Tariffs
Explain how Quality and Outcomes Framework works
It is used in primary care
- It sets a national quality standards with indicators in
primary care
- Clinical, organisational and patient experience
- General practices score points according to how well
they perform against the indicators
- Practice payments are calculated based on points
achieved
- Results are published online
Explain how CQUIN (Commissioning for Quality and Innovation) works.
The aim of CQUIN is to reward excellence.
A practise looks at the current practice, and agrees on an achievable goal, then if the practice completes that goal, then they get a monetary reward.
Explain how Best Practise Tariffs works
It sets a standard for best practice in certain areas
And if a practice follows all of the guidelines it receives more money
Explain disclosure in terms of NHS quality improvement mechanisms.
Increasing emphasis on disclosing information about performance
Organisational level and individual level
All trusts are required to annually publish “Quality Accounts” (and make them publicly available)
Focus on safety, effectiveness and experience of patients
Explain Registration and inspection with regards to NHS quality improvement mechanisms.
NHS trusts must be registered with the Care Quality Commission since 2009
The CQC can impose “conditions” of registration if not satisfied.
They can make unannounced visits
Can issue warning notices, fines, prosecution, restrictions on activities, closure
The CQC checks Quality Accounts
Define 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.
Describe how a clinical audit works
The component parts of a clinical audit are:
- Setting standards
- Measuring current practice
- Comparing results with standards (criteria)
- Changing practice
- Re-auditing to make sure practice has improved
Explain professional regulation in terms of NHS quality improvement mechanisms.
The idea that each professional has a duty to uphold their standards and report any body who is not
It involves doctors having to demonstrate they are fit to practice in order to remain registered
