W5 Ethical considerations, Ethics in practice, IPE workshop

Question 1

What is ‘Capacity’?

Answer 1

Being able to make decisions, communicate them and understand them.

Question 2

What act is “Capacity” under?
When does a person “Lack capacity”

Answer 2

The England and Wales “Mental Capacity Act 2005”
Under this act^ someone acts capacity if:
At the time the decision needs to be made, they are unable to make or communicate the
decision because of an impairment or disturbance that affects the way their mind or brain works.

Question 3

What is the Capacity Act in Scotland?
What does it state?

Answer 3

• In Scotland, under the Adults with Incapacity (Scotland) Act 2000, a person lacks capacity if they cannot act, make decisions or communicate them, or understand or remember their decisions because of a mental disorder or physical inability to communicate in any form.

Question 4

What are the types of consent?

Answer 4

Verbal, Non-verbal, Written

Question 5

What is Explicit consent?

Answer 5

Explicit consent: When a person gives a pharmacy professional, written or spoken consent to do it.

Question 6

What is implied consent?

Answer 6

When a person gives their consent indirectly (body language)

Question 7

For consent to be valid, the person must: (5)

Answer 7

• Have the capacity to give consent
• Be acting voluntarily
• Have sufficient, balanced information to allow them to make an informed decision.
• Be capable of using and weighing up the information provided.
• Understand the consequences of not giving consent

Question 8

What is the definition of consent?

Answer 8

To express willingness, give permission, agree

Question 9

What does confidential information include?

Answer 9

• Electronic and hard copy data
• Personal details
• Information about a person’s medication (prescribed and non-prescribed)
• Other information about a person’s medical history, treatment or care that could identify
  them
• Information that people share that is not strictly medical in nature, but that the person
  disclosing it would expect to be kept confidential

Question 10

What does confidential information not include?

Answer 10

• Anonymous information
• Pseudonymised information
• Information that is already legitimately in the public domain

Question 11

What is the one exception where a professional can give a patient a medicine without their consent.

Answer 11

Under the Mental Capacity Act, a professional can give a patient an anti-psychotic drug if they are in a state where they could pose as a risk to themselves or other patients

Question 12

How do you assess for “capacity”

Answer 12

Ask questions to see if patients can answer
Explain information to the patient about medication
Ask patient to relay information

Question 13

How can a patient prepare before they “lose capacity”

Answer 13

Arrange to write up an Advanced Care Agreement which will give details of how they would like their treatment to continue after they lose capacity.

Question 14

What are controlled drugs?

Answer 14

Risk of abuse and addiction

Question 15

Can doctors self-prescribe?

Answer 15

Yes it is legal, but not ethical

Question 16

What is explicit consent?

Answer 16

Explicit consent: When a person gives a pharmacy professional, written or spoken consent to do it.

Question 17

Pre reg exam (for info)

Answer 17

2 cycles- June and September
Important to have background training in a pharmacy setting prior- it improves your chance of passing the exam

Question 18

What is a ‘right culture’ vs a ‘just culture’

Answer 18

The ‘right culture’ is a culture based upon the principles of fairness, quality, transparency, reporting, learning and safety.

Whereas A just culture promotes an open culture (transparency and discussion), a reporting culture (raising concerns), and a learning culture (learning from mistakes).

Question 19

What are the importances of raising concerns? (3)

Answer 19

• Duty of care
• Protecting people receiving care
• Public safety

Question 20

What can you raise concerns about?

Answer 20

Anything that can affect the patients safety
Work environment
Competency, Behaviour
Confidentiality
Bullying and Harrassment

Question 21

Examples of reporting concerns on site or off site (e.g. placement)

Answer 21

• Bullying and harassment
• Unprofessional practice in clinical staff - a professional whose health or fitness to practise may be impaired
• Poor patient care – abuse of a person receiving care, patient harm
• Breach of patient confidentiality
• Lack of professionalism online
• Irresponsible or illegal prescribing
• A crime, or a civil offence (e.g. illegal diversion of medicines)
• A miscarriage of justice

Question 22

What are the mechanisms for raising concerns?

Answer 22

• Find out the organisation’s policy
• Report without delay
• Report to the immediate supervisor
• Report to another suitable person in authority or an outside body
• Keep a record
• Maintain confidentiality

Question 23

What risk do Immobile patients have?
What medications should be used?

Answer 23

High risk of blood clots
Anticoagulants (blood thinners) not anti platelets should be given

Question 24

What do anti platelets do?
Examples?

Answer 24

Prevent platelets from aggregating and forming a clot
Clopidogrel

Question 25

What is the PIDA?

Answer 25

*PIDA= Public Interest Disclosure Act 1998

The PIDA sets out a step-by-step approach to raising and escalating concerns.
* Aims to protect employees from unfair treatment or victimisation from their employer if they have made certain disclosures of information in the public interest.
* Under the PIDA pharmacy professionals should raise a concern about issues which have happened, or which they reasonably believe are likely to happen.

Question 26

Why do complaints of concerns arise?

Answer 26

• Human error
• System failure
• How a complaint or concern is handled in the pharmacy.

Question 27

What to do in the event of a dispensing error?
(memorise-7 steps)

Answer 27

1- Establish if the patient has taken any of the incorrect medicine- If they have immediately send them to A&E (any medication) but still investigate 2-8

2- Inspect the incorrect medicine
3- Apologise
4- Never try to minimise the seriousness of the incident
5- Make a supply of the correct medicine ordered on the prescription, if appropriate
6- Establish their expectations
7- Provide details of how to complain to an ‘official body’ if requested
8- Try and establish what happened and what went wrong

9- Follow company procedures/ SOPs for reporting errors or complaints
10- Record, review and learn from errors made
11- Notify the pharmacist who was on duty at the time, if it was not you
12- Inform your professional indemnity insurance provider

Question 28

What are SOPs?

Answer 28

Standards of Operating Procedures

Question 29

Why is it important to maintain clear sexual boundaries?

Answer 29

Crossing them can damage public trust and confidence in the pharmacy profession

If pharmacy professionals are sexually, or inappropriately involved with a person under their care their professional judgement can be affected. This involvement may affect the decisions that they make about a person’s healthcare.

Question 30

What is Power imbalance?

Answer 30

• People receiving care are in a vulnerable position.
  *Power imbalance may be because personal information is shared with the pharmacy professional.
• Pharmacy professionals should always be clear with the person receiving care about the reason for an examination or why they want them to come into the consultation room.
• The person receiving care should be given all the information they need and the opportunity to ask questions, and they should give their consent before the pharmacy professional goes with them into a consultation room.

Question 31

What is Sexualised behaviour?
What is it not limited to?
What are examples of breaches of sexual boundaries?

Answer 31

Sexualised behaviour is defined as ‘acts, words or behaviour designed to arouse or gratify sexual impulses or desires’.

• A breach of sexual boundaries is not limited to criminal acts, such as rape or sexual assault. For example, carrying out an unnecessary physical examination or asking for details of sexual orientation when it is not necessary or relevant, would both be a breach.

Examples include:
* revealing intimate personal details about themselves to a person under their care during a consultation
* giving or accepting social invitations
* visiting a home of a person under their care without an appointment
* asking questions unrelated to a person’s health

Question 32

How can you avoid breaches of sexual boundaries?(5)

Answer 32

1. Discuss this with an impartial colleague, a pharmacy organisation that represents them,
   a professional leadership body or their professional indemnity insurance provider.
2. Find other care for the person e.g. another pharmacy professional
3. If a person receiving care shows sexualised behaviour towards a pharmacy professional,
   the pharmacy professional should address the matter in a constructive way and try to re-establish a professional relationship, or transfer the person’s care to another pharmacy professional.
4. Have a chaperone
5. REMEMBER Cultural differences can affect a person’s view of their personal boundaries and what is appropriate.

Question 33

What is the definition of Professionalism?(MEP)
What are some examples?

Answer 33

Pharmacy professionalism can be defined as a set of values, behaviours and relationships that underpin the trust the public has in pharmacists.

Examples of these are:
1. Altruism
2. Appropriate accountability
3. Compassion
4. Duty
5. Excellence and continuous improvement
6. Honour and integrity
7. Professional judgement
8. Th for other patients, colleagues and other healthcare professionals (including listening to and acting on feedback when needed)
9. Working in partnership with patients, doctors and the wider healthcare team in the patient’s/ public’s best interest
10. Work within competence
11. Ensure patient is placed at the centre of all
decision making
12. Being honest about scope of practice
13. Knowing when to seek support.

Question 34

What act is “Capacity” under?

Answer 34

Mental Capacity Act 2005

Question 35

What is the Capacity Act in Scotland?

Answer 35

Adults with Incapacity Act 2000

Question 36

What is GpHC standard 2? (partnership)

Answer 36

Pharmacy professionals must work in partnership with others

Question 37

What are the benefits of professionalism? (5)

Answer 37

Protects patients
Strict adherence to a code of behaviour and
performance
Act honestly and with integrity
Preserves public confidence
Values, skills and behaviour

Question 38

What is The right to determine? (for info)

Answer 38

• “The principle of self determination requires
  that respect must be given to the wishes of the
  patient,
• An adult patient of sound mind refuses,
  however unreasonably, to consent to treatment or
  care by which his life would or might be prolonged, the doctors responsible for his care must give effect to his wishes, even though they do not consider it to be in his best interests to do so. …

Question 39

Propriety of Treatment: (for info)

Answer 39

Consent goes to the very heart of the rightness – propriety of treatment
Bodily invasions in the course of proper
treatment stand completely outside the
criminal law.
If consent is absent, and is not dispensed
with in special circumstances by operation
of law, the acts lose their immunity

Question 40

What are the Elements of a real consent?

Answer 40

This consent must be, full, free from duress and reasonably informed

Question 41

Ill treatment or wilful neglect:
What act protects patients who lack capacity?
What acts protect all patient groups?

Answer 41

= S.44 Mental Capacity Act 2005

=Criminal Justice and Courts Act 2015
=Section 20 - Ill-treatment or wilful neglect:
care worker offence
=Section 21 - Ill-treatment or wilful neglect:
care provider offence

Question 42

What are The Guilding Principles about?

Give an example of one:

Answer 42

• A person must be assumed to have capacity unless it is established that he lacks capacity.
• A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
• A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
• An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
• Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

Question 43

What is Covert administration?

Answer 43

Administering medicines through a disguised format e.g. hidden in food/drink

• Court of Protection holds that the use of covert administration of medicines with adults who lack decision making capacity is a serious interference with a person’s right to liberty and a private life under articles 5 and 8 of the European Convention of Human Rights

The Nursing and Midwifery Council (NMC) considers covert administration to be measure of last resort.
* By disguising medication, the patient is being led to believe they are not receiving medication, when in fact they are. The NMC would not consider this to be good practice.

Question 44

What is GPhC Standard 8? (Reporting poor practice)

Answer 44

Pharmacy professionals must speak up when they have concerns or when things go wrong

Question 45

What does PIDA stand for?
What is it?

Answer 45

Public Interest Disclosure Act 1998
* Protects workers from reprisals, dismissal and victimisation that might follow after the disclosure of concerns that are made in the public interest.
* Protected against dismissal and detriment if their disclosure alleges criminal offence, failure to comply with a legal obligation, miscarriage of justice, risk to health and safety or environmental damage.
* The Act forms part of UK employment legislation.
* Employees and agency workers (including some locum pharmacists) are covered if they are dismissed or victimised after raising a concern to an appropriate organisation.

Question 46

What is the Duty of candour?

Answer 46

Be open and candid with all patients about all aspects of care and treatment, including when any mistakes or harm have taken place

Question 47

Duty of candour -dispensing error steps

Answer 47

1. Establish if patient has taken any of the incorrect medicine
2. Inspect incorrect medicine
3. Apologise
4. Don’t minimise seriousness of incident
5. Make a supply of correct medicine if appropriate
6. Establish their expectations
7. Provide details of how to complain to an ‘official body’ if requested.
8. Try and establish what happened and what went wrong

Question 48

Why is it important to maintain confidentiality?

Answer 48

-A person may be reluctant to ask for advice if they believe the pharmacy may not keep the information confidential.
-Can damage public trust and confidence

Question 49

Does the Duty of Confidentiality apply after death?

Answer 49

Yes.

Question 50

When would you disclose confidential information?

Answer 50

• Have the consent of the person under your care
• Have to disclose the information by law
• It is in the public interest
• Or in the vital interests of a person receiving treatment or care, for example
• if a patient needs immediate urgent medical attention

Question 51

What would you do if a person with capacity refuses to give consent for information
to be shared with others e.g. healthcare professionals?

Answer 51

• Limited care, consequences
• Use pseudonymised information

Question 52

For consent to be valid the person must:

Answer 52

• Have the capacity to give consent
• Be acting voluntarily
• Have sufficient, balanced information to allow them to make an informed decision.
• Be capable of using and weighing up the information provided.
• Understand the consequences of not giving consent

Question 53

What are examples of cases where a pharmacy professional’s religion, personal values or beliefs may influence their day-to-day practice? (6)

Answer 53

Services related to:
* contraception (routine or emergency)
* fertility medicines
* hormonal therapies
* mental health and wellbeing
* substance misuse
* sexual health

Question 54

Is Diazepam 5mg a P medicine?

Answer 54

No. Diazepam 5mg is a POM Schedule IV Part I

Question 55

Can a doctor self-prescribe 3 months of benzodiazepine

Answer 55

Yes although it may not be ethical. So should be discussed with Dr