SJT Themes & Notes Flashcards
Themes from GMC GMP - Knowledge, skills
Make care of patient first concern
Provide good standard of practice and care
Keep professional knowledge and skills up to date
Recognised and work within limits of competence
Themes from GMC GMP - Safety and Quality
Take prompt action if you think patient safety, dignity or comfort is being compromised
Protect and promote health of patients and public
Themes from GMC GMP - Communication and teamwork
Treat patients as individuals and respect their dignity
Treat patients politely and considerately
Respect patients’ right to confidentiality
Work in partnership with patients
Listen to, and respond to, their concerns and preferences
Give patients information they want or need in a way they can understand
Respect patients’ right to reach decisions with you about their treatment and
care
Support patients in caring for themselves to improve and maintain their health
Themes from GMC GMP - Maintaining Trust
Be honest and open and act with integrity
Never discriminate unfairly against patients/colleagues
Never abuse patients’ trust in you or the publics’ trust in profession
Notes - Domain 1 Knowledge, Skills and Performance
Develop and maintain professional performance
Be competent in all aspects of work
Keep professional knowledge and skills up to date
Regularly take part in activities to maintain and develop competence
Be familiar with guidelines and developments
Keep up to date, with law, guidance
Take steps to monitor and improve the quality of your work
You should:
Be willing to find and take part in support opportunities offered by your
employer (mentoring)
Apply knowledge and experience
Recognise and work within limits of competence
Assess patient’s condition, provide advice, investigations or treatment and refer
if needed
Prescribe drugs or treatment, only when adequate knowledge of patient’s
health
Provide effective treatments based on best available evidence
Take all steps to alleviate pain and distress when cure not possible
Respect patient’s right to seek second opinion
Avoid providing medical care to yourself or anyone with a close relationship
with
Have consent before examination or investigation
o Record your work clearly, accurately and legibly
Document clear, accurate and legible records, at same time as events or ASAP
Clinical records should include:
o Relevant findings
o Decisions made and actions agreed
o Information given to patient
o Drugs prescribed or investigation/treatment
o Who is making record
Notes Domain 2 - Safety and Quality
Contribute to and comply with systems to protect patients
Take part in reviews and audits of work, take steps to address any problems
and carrying out further training
Regularly reflect on standards
Report adverse incidents that put or have potential to put safety of patient, or
another at risk
Report suspected ADRs
Take prompt actions if patient safety, dignity or comfort compromised:
If not receiving basic care, you must immediately tell someone who is in
position to act straight away
If patient at risk because of inadequate premises, equipment or resources you
should put matter right if possible, raise concern and record steps
If colleagues not fit to practice, ask advice from colleagues, report and record
steps taken
Notes Domain 3 - Communication, Partnership and Teamwork
Communicate effectively
Listen to patients, take account of views and respond honestly
Give patient information they want or need to know in way they can understand
Teaching, training
Staff managed have appropriate supervision
Patients
Be polite and considerate, treat with respect and dignity
Explain your conscientious objection to procedures, tell them of rights to see another
doctor and make sure enough information available to exercise that right. If not practical
to see another doctor, make sure arrangements are made for suitably qualified
colleague to take over your role
Notes Domain 4 - Maintaining Trust
Not use professional position to pursue a sexual or improper emotional relationship with patient
or someone close to them
Not express personal beliefs to patients which may exploit or distress patient
Must be open and honest with patients if things go wrong, if patient under your care has suffered
harm or distress, you should:
Put matter right (if possible)
Offer an apology
Explain fully and promptly what has happened and likely short-term and long-term
effects
Do not deny treatment to patients because their medical condition may put you at risk, if it does,
take all available steps to minimise the risk before providing treatments or making other suitable
alternative arrangements
Respond promptly, fully and honestly to complaints and apologise when appropriate
End professional relationship with patient only when the breakdown of trust between you and
patient means you cannot provide good care
Honest and trustworthy when writing reports and signing forms/documents:
Take reasonable steps to check information is correct
Not deliberately leave out relevant information
When must you tell the GMC regarding issues?
Must tell GMC without delay if anywhere in world:
Accepted caution from police or criticised by official inquiry
Charged with or found guilty of criminal offence
Another professional body has made a finding against your registration as a result of
fitness to practice procedure
What is the rulings on financial dealing?
Be honest in dealings with patients, employers
Not allow interests you have to affect the way you treat, refer patients
If faced with conflict of interest, be open about conflict, declaring interest formally and
exclude yourself in decision making
Not ask for or accept – from patients, colleagues or other – any gift, inducement that
may affect or be seen to affect the way you treat patietns
When can confidentiality be broken?
Patient consent
Disclosure is overall benefit to a patient who lacks the capacity to consent
Assume patient has consent – assess capacity to particular decision at time it needs to
be met (understand, retain, weight up and communicate)
Make patient first concern, respect dignity, encourage patient to be involved
If temporary – could you wait until they regain capacity, any previously expressed
preferences, views of legal guardians
Required by law
Ordered by judge
Justified in public interests
Protect individuals or society from risks of serious harm/death, crime/communicable
diseases
Try to seek consent, should tell patient about intention to disclose personal information
Key points when breaking confidentiality?
When disclosing information:
o Anonymise information if practical
o Get patients explicit consent
o Keep disclosure to minimum
- If patient cannot be informed of personal information disclosed:
o Inform when regains capacity
Key points when sharing information with close ones?
Establish what patient wants – document patient’s wishes
If patient has capacity and refuses permission:
May be appropriate to reconsider
Abide by patients’ wishes unless disclosure justified by public interests
If lacks capacity:
Assume patient wants closest to be kept informed
If close family wants to discuss concerns about patient’s health without involving patient, do not
refuse to listen on grounds of confidentiality however you might need to tell patient about
information received and do not disclose personal information
Key points for disclosing to protect adults without capacity?
Disclose if required by law, or you believe patient is experiencing or at risk of neglect,
physical/sexual/emotional abuse or other kind of serious harm
What are the rights of adults with capacity?
Rights of adults with capacity to make their own decisions:
o Ask consent before disclosing
o If patient refuses – explore reasons and may be appropriate to encourage patient to consent and
warm of risks of not consenting
o If patient refuses – abide by wishes, even if it leaves them at risk of death or serious harm
What are the factors with disclosing information to protect others?
Legal requirements
Notification of infectious diseases and prevention of terrorism
In public interest
Crimes, patient not fit to drive, communicable disease, not fit for work
Consider:
Potential harm to patient arising from disclosure
Potential harm to trust in doctors
Potential harm to others
Potential benefits to individual or society
Nature of information to be disclosed
Whether harms can be avoided or benefits gained without breaching patient’s
privacy
Key points with consent to sharing information and when people does not want to know results?
Sharing information and treatment options, consider:
o Needs, wishes and priorities
o Level of knowledge
o Nature of condition
o Complexity of treatment
o Nature and level of risk associated with investigation or treatment
If patient does not want to know detail about condition/treatment:
o Find out why they don’t
o Respect their wishes
When is a person assumed to have capacity?
Presume capacity in all adults > 16 years old
Children < 16 may have capacity if mature enough and able to demonstrate capacity
Assessment capacity
o Understand, retain, weigh up and communicate
o If unsure, ask nursing staff or other involved in patients care, or those close to patient
Making decisions about treatment if lack capacity:
o Care of your patient your first concern
o Treat patients with respect
o Encourage patients to be involved
o Consider:
Whether capacity is temporary or permanent
Least restrictive option
Evidence of previously expressed preferences (advanced statements or decision)
View of legal authority to make decision
Best interests
When to report critical incidents?
Unexpected or avoidable death
Serious harm to patients, staff, visitors (outcome requires life-saving interventions, major
interventions, permanent harm or shorten life-expectancy or prolonged pain)
Allegations of abuse
Never event
Common types of never events?
Wrong surgical site
Wrong implant
Retained foreign object post-operation
Wrongly prepared high-risk injectable medication
Maladministration of potassium-containing sodium
Wrong route of chemotherapy
Wrong route of oral/enteral treatment
IV administration of epidural medication
Maladministration of insulin
Overdose of midazolam during sedation
Opioid overdose in naïve patient
Inappropriate administration of daily oral methotrexate
Suicide using non-collapsible rails
Escape of transferred prisoner
Falls from windows
Entrapment in bedrails
Transfusion of ABO-incompatible blood
Transplant of ABO incompatible organs
Misplaced naso-gastric tube
Wrong gas administrated
Air embolism
Misidentified patients
Scalding patient
Maternal death due to PPH after elective C-section
Order of action when raising concerns?
Raise concerns promptly
o With senior (SHO, registrar, consultant)
Key points from gifts/donations
- Not encourage gifts
- May accept gifts from patients if:
o Does not affect, way you treat patient
o Not used your influence to pressurise or persuade patients or their relative to offer gifts - Refuse gifts that may be seen as an abuse of trust
Ending a relationship with a patient - before and when you decide?
Before you end professional relationship:
o Warn patient you are considering ending relationship
o Do what you can to restore relationship
o Explore alternatives to ending
o Discuss situation with experienced colleague
If you decide to end professional relationship:
o Patient is told
o Record decision
o Ensure continuing care for patient
Maintaining professional boundaries with patient - key points on current and former patients?
Patients are not a potential sexual partner
Current patients
o Not pursue sexual or improper emotional relationship with current patient
o If patient pursues this, treat them politely and try to re-establish professional boundary, if broken
down then end relationship
o Not pursue someone close to patient
o Not end professional relationship to pursue personal relationship with them
Former patients
o Consider:
Length of time since professional relationship
Nature of previous relationship
Whether patient was vulnerable
Whether you will be caring for family members
Key point on sexual behaviour
Sexual Behaviour and duty to report colleagues
Never make sexual advance towards patients
Key points on DVLA advice and concerns?
Driver legally responsible for telling DVLA – remind them of this
If patient is unfit to drive but continues:
o Tell them you may be obliged to disclose this to DVLA if continue to drive
o Inform DVLA – tell patient in writing and spoken word
Key points in confidentiality - gunshot and wounds?
Police informed whenever person presents with gunshot wound (even accidental) and wound from knife
attack with knife, blade
Police not informed:
o If knife/blade injury appears to be an accident or self-harm
Key points on openness when apologising to patient?
When to apologise to patient:
o If something has gone wrong, and after doing what you can to put matters right
Speak as soon as possible when you realise something has gone wrong
If a near miss, discuss with patient
Points on conscientious objection
o Explain you have an objection
o Explain patient right to see another doctor
o Ensure patient has access to relevant healthcare professional
Points on relationship with patients online?
o Decline friend request
o Not responding online
o Tell someone at practice
o Don’t necessarily have to terminate doctor-patient relationship
Clinical Incident Form- what to report?
Any adverse incident what the potential to produce unwanted effects, or any incident
which has a learning point
Any incident which causes loss, injury or near miss to patient/staff or others
Examples
Clinical – medication, poor transfers of care, infection issues, medical device
failure, delay in treatment, unexpected outcomes, pressure sores
Environmental – accidents, violence/aggression
Professional – records, breaches in confidentiality, standards
Service – loss of service, loss of data
Process of incident reporting - steps to take?
Incident occurs
Take immediate actions to prevent harm
Inform person in charge
Take further immediate action
Complete incident form
Incident review, inclusion in system
Key Points on Illness in Job?
Follow hospital policies
D&V – sick leave until 48 hours after symptoms resolved
Inform one of your team
Inform medical staffing
Key Points on Child Protection
If you have concerns that a child or young person is being abused or neglected, inform Child
Protection services
Can remain anonymous but your details can be useful and never disclosed to suspected
When to use Yellow Card Reporting System?
ADRs to medications, vaccines, blood factors, herbal/homeopathic medications
Medical devices
Defective medicines
Key points of Foundation Doctors - members of support?
Clinical supervisors (consultant looking after you) – responsible for clinical issues
Educational supervisor – personal issues, follow through FY1 year
FY1 cannot do FP10 prescriptions
FY not allowed to discharge
o Unless senior review and part of plan
o If patient requesting discharge
Assess capacity
Discuss risks and benefits
Advise GP and follow up blood tests
Key Themes to communication and conflicts
- Avoid arguments
- Address problem directly
- Solve the problem yourself if possible
- Patient safety is first and foremostK
Key Themes to Gifts
o Honest, don’t let it affect management or treatment or patient interaction
o If significant amount, must accept and register as organisation
Key Point to Consent to procedures
Must know procedure, benefits + risks in depth OR be able to do procedure
Key Themes to Errors
Ensure patient safety
If no harm done – stop harm
If adverse effect – minimise harm
If near miss – address and inform patient, inform direct superior
Apologise to patient
Avoid excuses
Key Themes - Best Interests
Always assume capacity in > 16
Must prove no capacity – best interests’ decision
If life-threatening – act in BI, least restrictive option to save life
Key Themes to Handover
o Should be in person
o Failing that, to another doctor involved in direct care (SHO)
o Avoid members not involved
o If not, leave entry in patient notes
Key Themes to leaving late
o If finite time and not regular – stay and help
o If not specific time and regularly late – not appropriate to stay
Key points to escalation
o Up your escalation ladder (your team)
o If personal – clinical and educational supervisor
o External – only if tried escalating up your team
What is Gillick Competence?
A child under the age of 16 can consent to treatment/investigations if they have sufficient understanding and intelligence to fully understand what is involved in proposed treatment (including purpose, nature, effects, risks and chance of success and other options)
If a child passes Gillick Test - considered Gillick competent to consent
Only valid if given voluntarily and not under undue influence or pressure
Decision specific
If a child does not pass Gillick test then consent of a person with parental responsibility (sometimes court) is needed to proceed with treatment
What are the Fraser Guidelines? What do they relate to? What criteria?
Relate to contraception and sexual health in under 16’s without parental consent
Advice can be given as long as:
- Sufficient maturity and intelligence. to understand the nature and implications of proposed treatment
- Cannot be persuaded to tell her parents or allow doctor to tell them
- Very likely to begin or continue having sexual intercourse with or without contraceptive treatment
- Physical or mental health is likely to suffer unless they receive the advice or treatment
- Advice or treatment is in the young person’s best interests
Should still encourage young person to inform parents and get permission
If the conditions are not all met, however, or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality
