week 3 Flashcards
clinical governance
a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish
example of clinical governance
an audit
differences between an audit and research
a clinical audit involves an intervention or investigation in use only, does not require NHSREC, is designed to determine whether the service reaches a predetermined standard, conducted to produce info to inform delivery of best care
research addresses clearly defined questions, aims and objectives, usually involves collecting data that are additional to those for routine care but may include data collected routinely, may involve treatments, samples or investigation, requires NHSREC
differences between service evaluation and clinical audit
a clinical audit involves an intervention or investigation in use only, does not require NHSREC, is designed to determine whether the service reaches a predetermined standard, conducted to produce info to inform delivery of best care
a service evaluation is conducted to define or judge current care, determines what standard the service achieves, usually involved analysis of existing data but ay include administration of simple interview or questionnaire
what is a clinical audit
a quality process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implentation of change
aspects of the structure, processes and outcomes of care selected and evaluated
where indicated, changes are implemented at an indivdual, team or service level and further monitoring is used to confirm improvement in healthcare delivery
why undertake clinical audit
to ensure the best possible care for patients is available
ensures clinical practice is evidence based
it is an integral part of clinical governance
assist with the implentation of national initiatives
to improve working between multi-disciplinary groups
GMC makes us do it
essential elements of a clinical audit
should be patient focused
should have a direct impact on patient care
assists to improve patients’ experience of NHS
can highlight an area of concern
should be based on evidence based practice
helps to ensure an efficient use of resources
what can be audited
structure - resources and personnel available eg skill mix of staff, patient access to see GP
process - amount and type of activities of clinical care eg annual review for diabetes
outcome - result of an intervention eg pain relief, patient satisfaction
clinical audit cycle
select topic agree standards of best practice define methology pilot and data collection analysis and reporting make recommendations implement change re-audit
placebo effect
originally considered as placebos or inert substances
improvements in patients symptoms that are attributed to their participation in the therapeutic encounter with its rituals, symbols and interactions
extrinsic circumstances the placebo effect relies on
emotional and cognitive engagement with clinicials especially trust
social and physical value of interaction/intervention
setting specific
anticipation and expectation of clinical improvement
conditioned response
type of placebo eg larger pills, red pills
complex neurobiological mechanisms the placebo effect involves
neurotransmitters eg endorphins, dopamine
activation of specific, quantifiable and relevant areas of the brain
placebo effects
symptomatic relief
rarely treats disease
primarily address subjective and self-appraised symptoms
can have negative effects - nocebo
work even when the patient knows they have the placebo
ethical issues with a placebo
FDA and NICE not approved
deceiving patients unethical
safety and regulation concerns
not always successful in helping a patient’s symptoms
placebos in randomised control trials
used to prove a new treatment effective above and beyond the psychological results of a simple belief in the ability of the drug to cure
compares the results of the experimental treatment for an illness with those obtained from the placebo
unethical to participant v protect society from harm
