Session 1 - Whatever it is

Question 1

What changed quality and safety standards in the NHS?

Answer 1

The emergence of research evidence about quality and safety

Question 2

Define clinical governance

Answer 2

A framework through which NHS organisations are accountable for continuously improving the quality and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish

Question 3

What did the 2012 health and social care act make the secretary of state responsible for?

Answer 3

o Effectiveness of the services
o Safety of the services
o Quality of the experience undergone by patients
o In regard to the quality standards prepared by NICE

Question 4

Give three quality problems in NHS

Answer 4

Evidence that patients are being harmed or receiving sub-standard care
Variation in healthcare suggest that not everyone is getting the best care
NHS inefficiency

Question 5

What is equity?

Answer 5

Everyone with the same need gets the same care.

Question 6

What is inequitable care?

Answer 6

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

Question 7

What is an adverse event

Answer 7

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

Question 8

What is a preventable adverse event?

Answer 8

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

Question 9

Give five preventable adverse events

Answer 9

Operations - Foreign objects, etc
Transfusion of blood of the wrong grouo
Wrong dose of medication give
Wrong type of medication given
Incorrectly adminstered medication

Question 10

Give three reasons medical errors occur

Answer 10

o Everyone is fallible
o Most medicine is complex and uncertain
o Most errors result from “the system” – e.g. inadequate training, long hours, ampoules that look the same, lack of checks etc.

Question 11

What role does personal effort play in avoiding mistakesd?

Answer 11

Necessary but not sufficient to provide safe care

Question 12

Give three types of error

Answer 12

Slips and lapses
Mistake
Violation

Question 13

What is a slip and lapse?

Answer 13

 Error of action
 Person knows what they want to do but action does not turn out as intended
 E.g. wanted to give a baby 0.05mg of a drug but gave 0.5mg instead

Question 14

What is a mistake?

Answer 14

 Error of knowledge or planning
 Action goes as planned but fails to achieve intended outcome because the wrong action was taken
 E.g. perfect administration of migraine treatment, but problem was a brain tumour

Question 15

What is a violation?

Answer 15

 Intentional deviations from protocols, standards, safe operating procedures or other rules
 E.g. not using aseptic technique when inserting a catheter

Question 16

Outline the swiss cheese model of accident causation

Answer 16

o Successive layers of defences, barriers and safeguards
 Layers of cheese
o Hazards are able to penetrate the barriers leading to losses
 Holes in the cheese

Question 17

What are active failures?

Answer 17

 Happen at the sharp end of practice, closest to the patient
 E.g. administration of the wrong dose

Question 18

What are latent conditions?

Answer 18

 Predisposing conditions that make active failures more likely to occur
 E.g. poor training, poor design of syringes, too few staff

Question 19

What is NHS outcomes framework?

Answer 19

Specific national outcome goals and indicators in 5 domains, linked to payments and financial incentives

Question 20

Give five areas of NHS outcomes framework

Answer 20

o Preventing people from dying prematurely
o Enhancing quality of life for people with long term conditions
o Helping people recover from episodes of ill health/injury
o Ensuring people have a positive experience of care
o Treating and caring for people in a safe environment and protecting from avoidable harm.

Question 21

Who is accountable for NHS outcomes?

Answer 21

Health Secretary and NHS comminsing body

Question 22

What are nice quality standardS?

Answer 22

o Markers of high quality, clinical and cost effective patient care across a pathway or clinical area that are:
 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

Question 23

What i a clinical commisioning group? Give two things they do

Answer 23

There are around 200 Clinical Commissioning Groups
o Commission services for their local populations
o Drive quality through contracts

Question 24

What holds CCGs accountable for their outcomes?

Answer 24

Commissioning Outcomes Framework (COF) used by NHS commisioning boards

Question 25

What is the quality and outcomes framework?

Answer 25

o Sets national quality standards with indicators in Primary Care.
o Clinical, organisational and patient experience
o General practices score points according to how well they perform against indicators

Question 26

How valuable are QOF to GP practices?

Answer 26

25% of income

Question 27

What is a quality account?

Answer 27

All trusts are now required to publish quality accounts, increasing the disclosure of information about performance, both at organisational level and individual level.
o Published annually
o Publically available
o Focus on safety, effectiveness and patient experience

Question 28

What is the care quality commission? Give three powers it has

Answer 28

All NHS trusts must be registered with the Care Quality Commission since 2009. The CQC considers NICE quality standards, checks quality accounts and can:
o Impose registration ‘conditions’ if not satisfied
o Make unannounced visits
o Issue warning notices, fines, prosecution, restrictions on activities, closure

Question 29

What is a clinical audit?

Answer 29

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

Question 30

Outline the process of an audit?

Answer 30

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

Question 31

Explain how a systems-based approach can promote quality in health care

Answer 31

o Avoid reliance on memory
o Make things visible
o Review and simplify processes
o Standardise common processes and procedures
 Errors dropped from 39% of patients to 11.5%
o Routinely use checklists
o Decrease the reliance on vigilance