SJT paper rationale Flashcards
Contacting colleague about their mistake
- most appropriate action
Preferable for you to contact the person directly, rather than asking someone else to do so
Patient to be discharged but feels they should stay in hospital
- most appropriate action
Most appropriate: ask their concerns
Least appropriate: coerce them into leaving by saying they are taking another patient’s bed
Note: do NOT discharge patients until you are sure they are MFFD (if there are any doubts or the patient/family are concerned - ask for senior help)
- any patient concerns must be taken seriously; speaking to relative probably does not directly affect the patient concerns
Finishing late again and missing a social event
- most important considerations
Most important: patient safety
Then: your own wellbeing (which impacts on patient safety)
Least important: disappointing your friends/ missing the social event
- note: don’t send a text message for handover of important details as it may not be received and acted upon (better to ask someone else to pass the message onto them)
Prescription errors
Most urgent: prevent any immediate prescription errors as can directly impact on patient safety
Who to tell:
- PATIENT (duty of candour)* and PRESCRIBER (they may have made a mistake, or may know something you don’t)
- Then… senior colleague
- Then… ward pharmacist
*If patient is confused, this may not be essential as they won’t retain it anyway
Clarifying drug choice for a patient
Most: contact person who prescribed the drug (if it has already been prescribed)
Next: contact senior member of own team (knowledge of the patient and the specific indication, e.g. pre-splenectomy antibiotic choice)
Next: ward pharmacist
Then: on-call microbiologist (don’t have knowledge of the patient)
Then guidelines: BNF > local guidelines > national guidelines
Breaking bad news
Most appropriate: Advise that senior will talk to them
Then: you can discuss any patient’s concerns
Note: ensure you know ALL necessary information before disclosing information to patients
Raising concerns about another FY1 colleague
Most appropriate: speak directly to the FY1*
(possibly advise she talks to her supervisor)
Then: talk to a senior (nurse in charge - sets standards on ward; medic)
Finally: snitch on her
*if another colleague was the one to make the observation, they should speak to the person in question first of all (not you)
When there is uncertainty whether the patient’s situation has changed and the family is involved
- who to involve?
Most: senior colleague (ideally consultant*)
- note: generally, you should go to a consultant rather than asking them to come to you
Concerns about colleagues treating you unfairly
a) who to speak to?
b) should you request to move teams?
c) what if a nurse is treating you unfairly?
d) when may it not be suitable for you to speak to the person in question directly?
a) Most: speak to the colleagues directly
- Then: ask for senior advice (note - this is not the most appropriate, as it doesn’t address the issue)
- Should also ask colleagues if they have been experiencing similar things
b) Requesting to switch teams does not solve the problem of team-working - this should be a last resort once other options to resolve the issue have been tried
c) If a nurse, you should first try to speak to them. If this fails, speak to your line manager (consultant supervisor) who will then inform their line manager (nurse supervisor)
d) If you have previously tried and failed (or they were abusive, dismissive, etc.) - it should state this in the stem if this is the case
You feel you are not receiving sufficient learning opportunities on the wards
- who to speak to?
Most: consultant - offer to involve in OP/theatre, etc.
Then: Foundation programme director
What about supervisors?
You hand a routine job (eg. blood) over to the FY1 taking over from your shift and they refuse it due to being too busy
- action?
Most: be assertive with them and clarify to them their responsibilities
Then: find someone else to do it* (or do it yourself, providing this is practicable - not if it needs taking in 2 hours time)
*Do not delegate to someone else to find a suitable person, find them yourself
Patient speaks Urdu, no English - how should you deal with this?
Most: find a Doctor who speaks Urdu to see them
Then: get a translator
If delay and concerns about patient welfare: contact senior for advice
Last resort: phone relative to act as translator
Patient needs urgent discharge for work-related meeting but senior doctor is running 45 minutes late.
- What to do?
Most: find another senior doctor who can discharge them
Then: phone the doctor running late to clarify if this is ok, then review with them when they arrive
Then: advise patient on right to self-discharge
NEVER discharge patients as FY1
Patient/family are complaining or angry about something
- what should you do?
- when is it appropriate to ask a nurse to speak to them?
Most: Apologise, ask/address any concerns they have
Then: explain the reasons for issues
Finally: tell them the formal complaints procedure
Only appropriate to ask nurses to speak to the patients when there is an issue with the NURSING care, rather than the MEDICAL care
- Note: never contradict a concern/complaint (eg. they complain about a nurse being rude and you say you have always found them to be nice - this is showing you aren’t taking the complaint seriously)
You have an excessive workload - solutions
a) If your FY1 colleague is in theatre
b) If your FY1 colleague has no work to do
c) In general
a) Most: Ask them to return to ward to help you out, address any concerns you have with them directly (then, involve senior colleagues if necessary)*
b) Always speak to them first directly (note - do not speak to their educational supervisor without speaking t to them)
c) - If a senior is delegating jobs disproportionately to you, speak to them directly about your concerns first
- Ask colleagues to help out (short-term solution): ask fellow FY1 or seniors
- Notify consultant/ supervisors about workload (long-term solution)
Where there are concerns for patient safety, team-working or workplace bullying, is it ever OK to do nothing?
No.
It is always your place to act in some way
Prescribing treatments without assessing the patient
Potentially dangerous (e.g. laxative in the constipated patient - could be dangerous if they have bowel obstruction)
Handovers (best to worst)
- Face-to-face verbal (even if it means finishing late)
- Written down and handed directly to person who is taking over
- Handover to another doctor to pass the messages on
- Write in the patient notes (may not be seen for a while)
- Leave a message in the handover room (may not be seen at all)
*Note: Where possible, you should be leaving work on time and handing over important, outstanding tasks is vital in this
Aggressive patients
a) threatening violence
b) currently violent (just punched a nurse)
c) when is explaining to patients that their behaviour is unacceptable not important?
a) call security, explain to patient their behaviour is unacceptable, ensure other patients aren’t distressed
b) call security, attempt to talk to the patient to calm him down, check that the nurse who was punched is OK
c) when they don’t have capacity or insight into their actions (confusion, dementia)
