Things I don't know Flashcards
What are the stages of an audit?
identify current standards measure current performance compare performance to standards make improvements re-evaluate
Why do audits?
improve patient care
encourage teamwork
financial benefits
assess progress against national standards
Limitations of audits?
only compares service to best current practice
may not always help
costs time, money and resources
if no changes made, then money wasted
What are guidelines?
Consensus of best practice based on available evidence, implemented to ensure consistencies in healthcare
How to create a guideline?
collect a wide range of clinical and user perspectives
incorporate external reviews
use a time limit
How to implement guidelines?
computer messages audio-visual aids electronic publications educational outreach areas local opinion leaders computer decision support systems
How might liver disease priorities vary internationally?
available resources
different financial and healthcare priorities
cultural/ societal interpretation
extent of alcohol related disease burden
How to deal with outbreak of food poisoning?
identify and isolate source
identify and treat infected individuals
advise on further treatment and prevention e.g. staying off work until 48 hours clear
How to handle diarrhoea outbreak in hospital?
rapid isolation of patients with diarrhoea
rapid identification and notification of outbreak
close monitoring of management protocol e.g, cleaning, sanitising, antibiotic regimes etc.
Ensure good communication with staff and patients etc.
Common causes of hospital diarrhoea?
c diff norovirus rotavirus ecoli klebsiella staph aureus
Factors leading to higher transplant rates?
use of opt out policy
large numbers of transplant centres
high percentage university educated
high percentage Roman Catholics
Factors affecting organ donation rate?
proactive donor detection programme
economic reimbursement for hospitals
high number of road traffic accidents
What is the Calman Hine framework?
1995
highlighted need to develop strategic cancer networks incorporating primary care, cancer units and cancer centres
What are the aims of strategic cancer networks?
reduce cancer incidence
maximise cancer patient survival
enhance quality of life for patients and families
improve patient experience of cancer services
provide high quality service focused on needs of patients and families
What do strategic cancer networks do?
develop strategic plans for delivering better care
implement national policies
deliver the improvements in care
provide resources for audits and research
provide a channel for communication between groups across the network
What do cancer units do?
diagnose and treat common cancers
diagnose intermediate cancers
refer to specialists
provide drug therapy and other treatments
What do cancer centres do and pros and cons?
provide cancer unit services
provide cancer services for large areas
specialist diagnosis and treatment
Good- better and more specialist management
Bad- patients may have to travel long way, increased geographical inequalities
What are partnership groups?
combine users of cancer services- professionals and patients
act to improve cancer services by giving opinions and advice on what could be better in future
What do cancer registries do?
responsible for collection, analysis and dissemination of cancer data for whole region
collect information of all new diagnoses
submit data to office of national statistics
essential to implemementation of cancer plan through reliable data of incidence, prevalence and survival rates
What does national cancer research network do?
supports recruitment of patients for trials and improves speed, quality and integration of research into care services
integrates and supports work from charities
What does national cancer research institute do?
promote cooperation between government, charities and industry for benefit of patients, public and scientific community
helps avoid unnecessary effort
maintains a research database that analyses the research being done and informs about decisions for new research
How to stop smoking?
one to one counselling
support groups
nicotine replacement therapy
bupropion (zyban)- reduce cravings and reduce withdrawal symptoms
Vareniciline (champix)- blocks nicotine receptors
What are palliative care aims?
affirm life and regard dying as normal process
provide relief from pain/ distressing symptoms
integrate spiritual/ psychological aspects
ensure patients live as actively as possible until death
offer support system for families bereavement
What is used to calculate Qrisk?
age sex ethnicity BMI BP Cholesterol Family history RA Smoking Deprivation CKD AF
What does NSF- mental health do?
Helps drive up equality and remove the unacceptable variations in provision of healthcare
Set national standards and define service models for promoting and treating mental illness
Put in place programmes to support local delivery of services
Establish milestones and performance indicators which progress can be measure against
What are the standards of NSF-MH?
mental health promotion primary care and access to services caring about carers preventing suicide round the clock care and crisis for those with severe mental illness
What are the every child matters key outcomes?
healthy- physical/ mental/ lifestyle safe- from harm and neglect enjoy and achieve most out of life contribute to society and community economic wellbeing and reach full potential
What is the purpose of MDT’s for child safety?
children to get help when they need it
professionals take timely action to protect children
professionals ensure children are listened to and respected
agencies and professionals work together to assess needs and risk and develop effective plans
agencies and professionals share information
professionals are confident and competent
agencies work with members of the community
What are the effects of falls?
Head injury neck of femur fracture wrist fracture back injury long lie- pressure sores, hypothermia, rhabdomyolysis, AKI Psychological- loss of confidence, immobility, isolation effect of ADL's death
What are the risk factors for falls?
Medical- Parkinson’s, stroke, arthritis etc
Pharmaceutical- poly pharmacy, sedatives, antihypertensives
Environmental- poor lighting, rugs, poorly fitting footwear
How to decrease falls risk?
strength and balance training cleaning glasses staff monitoring in nursing homes home safety assessment and modifications podiatry services and walking aids
What are the benefits of registering as blind with local authority?
blue badge parking permit leisure centre concessions bus and rail ticket concessions tv licence concession career and employment advice disability living allowance, incapacity benefit etc.
Why do only 1/3rd of blind people register as blind?
not in contact with specialist eye services
unaware of registration and benefits
professionals may not recommend as worried about emotional impact
do not want to be labelled as blind due to stigma
What are the principles of NSF for older people?
make sure older people not unfairly discriminated against
person centred care of elderly patient
intermediate care and integrate services for faster recovery
make sure older people get specialist care if needed and maximum benefit from hospital stay
reduce incidence of stroke
reduce incidence of falls and better treatment and rehab
promote good mental health
health promotion to extend healthy life expectancy
What are technology appraisals?
NICE assesses clinical evidence and cost effectiveness to decide to provide new healthcare technology or not
What is the process of technology appraisals?
topic selection
trial data submission
review data for clinical and cost effectiveness
call for contributions from interested parties
fund- if issued as mandatory then ccg’s must fund service if required
How is cost effectiveness calculated?
cost difference between old and new treatment / QALY difference
What are the quality standards for long term conditions?
person centred early recognition/ diagnosis/ treatment emergency/ acute treatment early specialist rehab vocational rehab personal care/ support palliative care family/ carer support care during admission
What are the quality standards for dementia?
People should receive:
care from specialist dementia staff
memory assessment and dementia diagnosing service
written information about diagnosis and treatment
personalised care plan with named coordinator to discuss individual needs
opportunity to discuss advance care plans and LPA while still have capacity
assessment and management of non cognitive symptoms
access to special dementia liaison services when accessing inpatient care
assessment of palliative care in later stages
carers receive assessment of emotional and social needs and receive support
carers have access to respite
What are the quality standards for stroke?
Patients with suspected stroke should be:
screened with validated tool and sent to acute stroke unit
receive brain imaging within 1 hour
admitted directly to stroke unit and assessed for thrombolysis
have swallowing assessed within 4 hours
are assessed by specialist rehab team within 24 hours
receive ongoing rehab in specialist rehab unit
offered minimum of 45 minutes of therapy thats required
assessed for cause and receive treatment plan if still incontinent after 2 weeks
screened within 6 weeks for mood disturbance or cognitive impairment
carers given training
Advantages and disadvantages of releasing performance data?
Good- focuses attention on improving patient care, public reassurance about effectiveness and safety, competition will boost performance
Bad- unmeasured performance will suffer, opportunity for data manipulation by only choosing healthier patients, case mix- some areas or centres only receive patients with poor prognosis
What are 4 pillars of medical ethics?
beneficience
non-maleficence
justice
autonomy
What is needed for valid consent?
valid
informed
patient has capacity
What does a patient need to know to be informed?
overview of condition
likely outcome of condition
treatment options including second opinion
When is consent not required?
additional procedures mental health act emergency situation risk to public health severely ill and living in unhygienic conditions
What does the Nuremberg code about medical ethics state?
voluntary consent is required from all participants
should yield results beneficial to society that can’t be got from other means
based on animal experimentation and a knowledge of natural history of disease
avoid all unnecessary mental and physical suffering
should not be performed if prior reason to believe intervention harmful
should be conducted by scientifically qualified people
risk should not exceed humanitarian importance of the problem solved by experiment
subjects should be able to leave whenever they wish
Scientist in charge should be prepared to end the experiment if harm to subjects becomes likely
When can you break confidentiality?
Protect children Protect the public Required by the courts Provide care in life threatening situation e.g. suicide/ self harm protect service provider DVLA for TIA/ stroke/ epilepsy Gun and knife wounds reported to police communicable diseases
What are the most common causes of food poisoning and onset times?
rapid- staph aureus, bacillus cereus
intermediate (12hrs)- clostridium perfringens, clostridium botulism
Several days- campylobacter, coli, shigella, salmonella, hep a, parvovirus
Most common overall- campylobacter
What is the aim of diabetes prevention programme?
identify those with impaired glucose tolerance
prevent or delay diabetes onset
reduce cardiovascular risk factors
reduce cardiac risk factors
reduce atherosclerosis
lifestyle reduces onset by 58%, metformin. by 31%
What are the causes of obesity?
genes and tendency to gain weight
not adopting healthy habits
environment that encourages fatty food and immobility
low income, bad food is cheaper
modernisation and abundance of food
urbanisation and not having to walk far for food
How to tackle obesity?
easy access to exercise schemes reduce dietary fat education about balanced diet healthy school dinners clear food labelling
What are the national obesity forum aims?
create recognition of obesity as serious medical problem
provide education of obesity management
provide guidelines for obesity management in primary care
provide a network for support and information resources
convince government to give obesity high priority
highlight health inequalities of obesity
What is euthanasia?
act of deliberately ending a person’s life to relieve suffering
What are the types of euthanasia?
active- actively ends another’s life
passive- withhold life prolonging treatment
voluntary- where person who wants to die asks for help
Non-voluntary- where person can’t ask for help now but previously expressed their wishes
Involuntary- murder
What are the arguments for euthanasia?
ethical- should have autonomy to choose
relieves suffering
Pragmatic argument that end of life care such as withdrawing food is the same thing
Arguments against euthanasia?
religious- only god should end life
slippery slope- could lead to people feeling they should die to avoid being a burden, misdiagnoses
ethics- violates non maleficence
alternative- advances in palliative care mean no one should be suffering anyway so euthanasia not needed
What are the barriers to healthcare?
personal- negative past experience, stigma
geographical- transport, postcode lottery
cultural- beliefs, language barrier
Socio economic- can’t get time off work, education, finances, prescription costs
Organisational- disabled access, long waiting times, few out of hours appointments
What are some common complaints?
safety of clinical practice poor/ insufficient information ineffective clinical practice poor handling of complaints lack of dignity and respect poor attitudes of staff
What are the reasons complaints are handled badly?
failure to acknowledge validity of complaint
failure to apologise
response to complaint does not say what has been done to prevent recurrence
response to complaint contains medical jargon
failure to involve the staff directly involved in complaint in investigation
What is the complaints process?
local resolution first with hospital and GP and raising matter with practitioner, or local CCG, then escalation with parliament and health service ombudsman
What is PALS?
patient advice and liaison service
give impartial advice on complaints procedure
offers confidential advice and support on healthcare related matters
provide point of contact for patients and families
give information on health related questions, complaints procedure and external support groups
What are adverse events?
Unintended event resulting from clinical care and causing physical or psychological patient harm
Give some GP and hospital examples of adverse events?
prescribing errors documentation error diagnosis delays consent, communication, confidentiality errors procedure errors patient accident
What is a near miss?
events or omissions arising during clinical care but not developing far enough to cause harm to patient
What is a never event?
serious patient safety incidents that should never occur if available preventative measures have been implemented.
e.g. wrong site surgery
Who are adverse events reported to?
NPSA- national patient safety agency which collects information from staff, patients and carers and ensures solutions produced to prevent harm where risks identified
NRLS- national reporting and learning system, an anonymous system run by NPSA
Yellow card system run by MHRA for drug reactions
Why do we monitor adverse events?
they are common- 1 in 10 hospital admissions they occur
they are preventable
to learn from them
opportunity to introduce preventative measures
What are the barriers to learning from adverse events?
lack of communication
lack of responsibility and scape goat culture
focus on immediate event not root cause
pride and rigid attitudes of staff
What are the 2 types of post mortem?
hospital- where cause of death unknown/ interesting and doctor wants to do one or when family unsure of cause and request one. Need family consent
Coroner- when death is sudden or suspicious- mandatory
Why are deaths referred to the coroner?
sudden death unknown cause of death unnatural death- suicide, murder death from industrial disease death during surgery death within 24 hours of admission patient in custody patient detained under MHA not seen by doctor in 28 days
What happens after deaths referred to coroner?
if cause if obvious e.g. has cancer but saw gp 5 weeks ago then they sign death certificate
or if death sudden or suspicious then do post mortem and then may go to inquest if still not sure of cause and if suspicious or not
What are the benefits of post mortem?
gain deeper insight into pathological processes
learn how to prevent future patient death
help with teaching or medical research
further understand long term effects of drug therapy
study and monitor levels of chemicals absorbed from environment
What is the childhood vaccine schedule?
8 weeks- 6 in 1 (hib, hep b, diphtheria, tetanus, pertussis, polio), rotavirus, men b
12 weeks- 6 in 1, rotavirus, pneumococcal
16 weeks- 6 in 1, men b,
1 year- hib/ men c, MMR, men b, pneumococcal
preschool- 4 in 1 (pertussis, diphtheria, tetanus, polio), MMR
13- hpv
14- 3 in 1 (polio, tetanus, diphtheria), menACWY
What are Wilson’s screening criteria?
condition is an important health problem
natural history of the disease is well understood
should be a recognised symptomatic or latent period
test should be easy to perform and interpret and acceptable to patients
should be an accepted treatment
treatment should be more effective id started early
should be a policy on who should be treated
diagnosis and treatment should be cost effective
case finding should be a continuous process
What does an argument need to be?
Logical
Valid
Sound
What makes an argument valid?
conclusion must follow on logically from the premises
What makes an argument sound?
must be valid- conclusion follow on from premises and all premises must be true
What is opportunity cost?
benefits foregone by particular use of resources
What is cost minimisation analysis?
not a full form of economic evaluation, assume equal health effects and choose least cost option
What is cost effectiveness analysis?
efforts measured in terms of single most appropriate unidimensional natural unit e.g. cost per baby with down’s syndrome detected in downs screening but cost per life saved in kidney transplant. So difficult to compare different things as measuring different outcomes.
What is cost utility analysis?
multidimensional effects, compares quality of life years gained. Uses QALY’s for effectiveness.
Able to compare different interventions
