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SPIES Flashcards

1
Q

What’s ASERNIPs

A

Australian Safety and efficacy register of new interventional procedures, surgical.

Formal evaluation process.
Considers
-safety, efficacy, risk-benefit, cost-benefit, ethics, conflicts of interest, training, informed consent, follow-up and auditing.

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2
Q

What is involved in audit?

A

Identification of a clinical question
Identifying a guideline or research data for comparison
Data collection
Presentation of results + comparison to pre-identified standard
Implementation of changes to improve outcomes
Re-auditing

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3
Q

What is audit?

A

Audit is a continuous process that assesses performance against an established guideline or standard

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4
Q

What does breaking bad news involve?

A

Breaking bad news involves communicating an unpleasant medical outcome appropriately, clearly and with empathy

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5
Q

What is bullying?

A

Bulling is a pattern of repeated behaviour that is inappropriate, unreasonable and creates a risk to health and safety

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6
Q

How can someone bully another?

A

Bulling can be through:
Intimidation, Threatening, Excluding, Degrading, Insulting, Humiliating or Offending.

Can be verbal, physical, sexual or through social media.

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7
Q

What is Discrimination?

A

Discrimination is treating someone less favourably on the basis of legally protected attributes and characteristics.

These include: Age, Sex, Gender, Race, Culture, Religious or Political beliefs, Pregnancy, Breastfeeding, Family responsibilities, Marital status. Sexual orientation, Disability or Impairment.

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8
Q

What is clinical governance?

A

Clinical governance encompasses a range of quality improvement and risk management mechanisms to facilitate systematic care optimisation and risk reduction

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9
Q

What are the components of clinical governance?

A

Clinical governance includes:

  • Clinical audit
  • Risk managment, root cause analysis, sentinel events and near-miss events management
  • Professional development, performance review and complaints management
  • Quality assurance project implementation
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10
Q

What are sentinel events?

A

These are serious, specific and wholly preventable events that require mandatory reporting

These include:

  • Wrong side, site, patient surgery
  • Retained instruments
  • Medication errors causing death
  • Haemolytic transfusion reaction from ABO incompatibility
  • Suicide in inpatients
  • Intravascular gas emobilism causing death or neurological damage
  • Maternal death
  • Infant discharged to wrong family
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11
Q

What’s the Pendleton model of feedback?

A
  • Meet the person in a private setting
  • Discuss what the session will involve
  • Ask what they think they’re doing well
  • Provide feedback of their strengths
  • Ask what they think they can improve on and why
  • Provide feedback on areas for improvement, using specific examples
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12
Q

What does APHRA reporting require?

A

APHRA reporting requires that you have a reasonable belief that a practitioner is placing the public at risk of substantial harm

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13
Q

What is informed consent?
What does it require?
What’s my responsibility?

A

Informed consent is a process in which a fully informed patient actively participates in choices about their healthcare.

Informed consent requires:
Receiving information
Informed decision making
Giving consent for a specific healthcare provision.

I have a responsibility to educate and empower the patient to make and informed decision whilst respecting their autonomy

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14
Q

What issues do you need to consider with interpersonal conflict?

A

Patient safety
Professional, respectful and clear communication
Conflict resolution and ongoing collaboration

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15
Q

Who can you gain best proxy consent from?

A 
MTDM
Appointed guardian -VCAT
NOK- spouse/partner, primary carer, adult child, parent, sibling
OPA
Hospital medical executive
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16
Q

What is Gillick competence?

A

When a child under 16 years is able to weigh risks and benefits to make an communicate an informed decision.

17
Q

What is open disclosure?

A

Open disclosure is a timely discussion that should occur after adverse events, where patients have been harmed, or have had unexpected outcomes.

It should use compassion, transparency and clear communication.

18
Q

What are the elements of open disclosure?

A
  • Timely, compassionate, clear conversation
  • Apology, acknowledgement of harm
  • A factual explanation of what happened- using plain language
  • Opportunity for pt/family to ask questions & relay their experience
  • Discussion of the consequences of the adverse event and plan for the patient moving forward
  • Explanation if steps being taken to manage the event and prevent recurrence
19
Q

What are the steps of graded assertiveness?

A

Clarify concerns/Check/Curious

  • I’m hoping to clarify
  • I’d like to check
  • For my learning I’m wondering

Options- we could proceed by? do you want xyz? Do you think this is the duct? Would you like another consultant?

Demands-I’m very worried, please pause/ stop, if this was my family member I would be very concerned

Escalates - stop now, we need another pair of hands, this situation requires a specialist, notify anaesthetist call another surgeon, a code/security

20
Q

What is graded assertiveness?

A

Graded assertiveness is a communication approach used to overcome authority gradients in order counteract risks to patient safety.

It involves respectfully clarifying and escalating concerns in a stepwise progression, aiming to prevent or minimise harm.

21
Q

What are SET safe working hours

A

Surgical training is optimised between 50-60 hours
- Maximum 65 hours of clinical training per week /4 week period

Minimum of 2x sequential full days off in a 14 day cycle

22
Q

Why might someone be underperforming?

A

Hungry/thirsty/tired/under-caffeinated/stressed/time-poor

Personal/family issues
Health/mental health/substance use 
Knowledge/skill deficit
Poor progression/career or personal setbacks
Bullying/Harrasment/Discrimination 
Fatigue or Burn out
23
Q

What’s the WHO Safety checklist?

What does it do?

A

The world health organisation safety checklist is a process and a physical checklist that has 3 phases, sign in, time out and sign out.

  • Focuses the operative team, and create a shared mental model within the team for the patient and procedure
  • Improves communication and teamwork
  • Improved safety by reducing the risk of adverse and sentinel events
24
Q

What’s involved in WHO sign in?

A

Patient identification, consent, procedure, site and side confirmed with patient & patient marked.
- Allergies/alerts reviewed

Anaesthetic machines/medicines pre-checked, anaesthetic monitoring, airway, lines, equipment checked

Est blood loss considered with valid group and hold checked pre-op investigations checked

Special equipment and prosthesis requested/checked

Reg: Pathology forms written, imaging requested, radiographers notified, pathologist aware of frozen specimen to be taken.

25
Q

What’s involved in WHO time out?

A

Team introduced with roles with these clearly displayed on whiteboard and screen

Patient details, operation & site confirmed with consent rechecked.

  • Allergies and alerts checked
  • Antibiotics discussed
  • Key imaging confirmed and checked
  • Specific anaesthetic, surgical, nursing concerns discussed x3
  • Anaesthetics give ASA score, Anaesthetic type in qand discuss specific patient risks /plans
  • Surgeons operative length, est blood loss, any anticipated critical steps discussed and alternative equipment or contingency plans discussed.
  • Nursing confirm sterility and discuss key equipment
26
Q

What does WHO sign out involve?

A
  • Name of procedure is recorded
  • Confirm if instrument count is correct, with pack count to be confirmed prior to skin closure
  • Specimens labelled correctly, pathology forms written
  • Record and send off any equipment that needs repair
  • Est blood loss recorded and DVT prophylaxis plan discussed
  • Key anaesthetic /nursing/ surgical concerns discussed
  • Post op management plan discussed
  • Op note detailing:
  • Ongoing specific monitoring and Management plan, drain tube plan
  • Abx/VTE prophylaxis plan
  • Diet/Mobilisation
  • Details of who to call if issues arise and threshold to call
  • Patient disposition discussed- ward/HDU
27
Q

What’s the ideal set up for pt communication

A

Private, quiet area, with no time constraints, on call phone handed off. Everyone sitting.

Support person, interpreter, cultural liaison officer, patient liaison officer or specialist nurse present.

Clear concise communication, plain language, avoiding jargon.

Good eye contact open body language. Give oppertunity for pt to relay experience, actively listening and answering Qs.

Providing visual and written information, clear plan and follow up.

28
Q

What’s the ideal setting for discussion with colleague?

A

A private, quiet, neutral location, no time constraints, on call phone handed off. Sitting, using professional, respectful and clear communication, actively listening.

Facilitating an exchange of ideas.

29
Q

What is self care?

A

Taking action to improve ones own health and well-being.

Going outside: to a park or the beach, Walking my dog, creative outlets: painting, playing guitar, exercise: going to the gym, swimming, catching up with friends and family. Getting enough sleep, eating well.

Debriefing with colleagues or a mentor. Seeing the GP, or mental health services, seeking counseling if needed. Engaging VDHS, peer to peer support, RACs helpline, beyond blue.

30
Q

What is feedback?

A

A process where learners recieve information about their work that appreciates similarities and differences compared with appropriate standards.

+ information about the quality of their work aimed to facilitate improvement

31
Q

What is capacity?

What compromises capacity?

A

The ability to understand information and use it to make and communicate a decision

Capacity should be assumed for adults patients unless there is contrary evidence of:

  • Drug or alcohol intoxication
  • Reduced GCS
  • Situational crisis/mental health crisis
  • Mental impairment, delerium or dementia, significant intellectual disability or brain injury
32
Q

What is equity?

A

WHO defines equity as the absence of avoidable or remediable differences amoungst groups of people, with ethnic, social, economic or demographic disparities.

Interview (5 decks)

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