Social science Flashcards
What is autonomy
The right of a competent adult to make informed decisions about their own medical care. The individual must have capacity to make the relevant decision, have sufficient information to make the decision and do so voluntarily.
Define patient centred care
- A way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs.
- This means putting people and their families at the centre of decisions and seeing them as experts, working alongside professionals to get the best outcome.
When is autonomy outweighed by other considerations
- Compulsory treatment is provided under mental health legislation e.g. providing food for an anorexic patient that has refused it
- If the conditions for autonomous decision making are not met
How is patient centred care personalised
It takes into considerations people’s desires, values, family situations, social circumstances and lifestyles to come to an agreement with the patient, rather than carrying out generic treatment to them
How should we proceed when the conditions of autonomous decision making are not met
- If someone is being coerced (or suspected to be coerced) then good practice will involve spending time alone with the patient and exploring their views to confirm that the decision is genuinely theirs
- If patient lacks capacity, the decision must be made on their behalf (parents of children, healthcare professionals or IMCA if adult lacks capacity)
How can patient centred care improve quality of care
- Improving the experience people have of care and helping them to feel more satisfied
- Encouraging people to lead a more healthy lifestyle
- Encouraging people to be more involved in decisions about their care so they get services and support that are appropriate for their needs
- Reduce how often people use services
- Improving how confident and satisfied professionals themselves feel about the care provided
What are the guidelines surrounding autonomy in children
- Young person of any age can give valid consent to treatment or examination provided they are considered competent to make the decision. Gillick competence
- At 16, there is a presumption that the patient is competent to give valid consent
- Where the child or young person lacks capacity, a person, or a local authority, with parental responsibility can give consent on the patient’s behalf.
- A decision by a person under 18 to refuse treatment can in some circumstances be overridden - particularly if the young person’s life is at risk.
- Doctors may still be able to provide treatment that is in his or her best interests but legal advice should be sought.
What do doctors have a duty to raise concerns about?
Where they believe that patient safety or care is being compromised by the practise of colleagues or the systems, policies and procedures in the organisation in which they work
Describe how to raise an etghical or clinical concern relating to a patient
- Wherever possible, you should first raise your concern with you manager or an appropriate officer of the organisation that employs you e.g. consultant or medical director/practice partner
- If your concern is about a partner, it may be appropriate to raise it outside the practice e.g. the clinical governance lead responsible for you organisation
- DATIX is an online database used to report unsafe acts, near misses and minor injuries
- Lost time injuries and fatalities are reported via serious incident requiring investigations/serious untoward incident reports
What does a datix report involve
A first person account of what had happened that should then be reflected upon and discussed with an educational supervisor
What does a serious incident requiring investigation/serious untoward incident report involve?
- Completing an incident form
- Ensuring notes are completed accurately, be clear about when you are writing and when the events took place
- Taking part in the debrief with the team involved
- Discussing the event with your educational supervisor
- If requested, writing a formal statement that should be reflective
What are never events
An event that happens that should never happen i.e. operating on the wrong patient, DKA during admission, wring organ/limb etc
What is the duty of candour
- Duty to be open, transparent and have candour.
- Openness - enabling concerns and complaints to be raised freely without fear and questions asked to be answered
- Transparency - allowing information about the truth about performance and outcomes to be shared with staff, patients, the public and regulators
- Candour - any patient harmed by a provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked.
Ways to reduce errors
- Standardise common processes and procedures
- Routinely use checklists
- Avoid reliance on memory
- Review and simplify processes
Surgical checklist: questions to ask before the induction of anaesthesia
- Has the patient confirmed his/her identity, site procedure and consent
- Is the site marked
- Is the anaesthesia machine and medication check complete
- Is the pulse oximeter on the patient and functioning
- Does the patient have a known allergy
- Does the patient have a difficult airway or aspiration risk
- Risk of >500ml blood loss (7ml/kg in children)
Surgical checklist: questions to ask before skin incision
- Confirm all team members have introduced themselves by name and role
- Confirm the patients name, procedure and where the incision will be made
- Has antibiotic prophylaxis been given with the last 60 minutes
- To surgeon: what are the critical or non-routine steps? How long will the case take? What is the anticipated blood loss?
- To anaesthetist: are there any patient specific concerns?
- To nursing team: has sterility (including indicator results) been confirmed? Are there equipment issues or any concerns?
Surgical checklist: before the patient leaves the operating theatre- the nurse verbally confirms
- The name of the procedure
- Completion of instrument, sponge and needle count
- Specimen labelling (read specimen labels aloud, including patient name)
- Whether there are any equipment problems to be addressed
What drugs are given as part of the alcohol withdrawal pathway (CIWA)
Chlordiazepoxide - relieves anxiety & agitation
Haloperidol - treat hallucinations
Pabrinex - vit B and C replacement, mainly B1
Thiamine - B1 replacement
What score is used to rate the severity of alcohol withdrawal
CIWA-AR
takes into account BP, N/V, tremor, sweats, anxiety, agitated, tactile distortion, auditory distortion, visual distortion, and clouding sensation
Main issues in refeeding syndrome
Hypophosphatemia
Hypokalaemia
Hypomagnasaemia
Also abnormal sodium and fluid balance, changes in glucose, protein, and fat metabolism, and thiamine deficiency
Mg needs to be replaced first in patients at risk of refeeding
