HaDSoc Flashcards
Explain why quality and safety in healthcare is an important responsibility of doctors
Because there is evidence that patients are being harmed by sub-standard careVariations in healthcareDirect costs and legal billsPolicy imperatives
Explain how a systems based approach can promote patient safety and quality in healthcare
Reduces chance of adverse event1) Avoid reliance on memory2) Make things visible3) Review and simplify processes4) Standardise common processes and procedures5) Routinely use checklists6) Decrease the reliance on vigilance
Briefly describe policies and organisations for encouraging quality in the NHS
- Standard setting - define what high quality care looks like e.g. NICE2. Commissioning - Commission services for their local populations • Drive quality throughcontracts3. Financial incentives - Finance is increasingly linked toquality in the NHS - Used both to reward and to penalise. E.g. Quality and Outcomes Framework (QOF) - points generate income 4. Disclosure - Increasing emphasis on disclosing information aboutperformance to patients and the public • Organisational level and individual level • All trusts are required to annually publish “QualityAccounts” (and make them publicly available) • Focus on safety, effectiveness, and experience ofpatients5. Regulation, registration and inspection - NHS trusts (and other providers, e.g. general practices)must be registered with the Care Quality Commission • The CQC can impose “conditions” of registration if it isnot satisfied • Can make unannounced visits • Can issue warning notices, fines, prosecution, restrictionson activities • Can close particular areas or entire organisations6. Clinical audit and quality improvement – local andnational - Clinical audit: a process of identifying quality of care,trying to change it, then seeing whether it has changed
Explain what clinical governance means
“A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish”FrameworkNHS Organisations accountable to:- consistentlyimprove quality- safeguard high standards of care
Define Patient Safety
The avoidance, prevention and amerlioration of adverse outcomes or injuries stemming from the process of healthcare
Define adverse event and preventable adverse event
Adverse event: Injuries that are due to healthcare management (rather than the underlying disease) that results in prolonged hospitalisation and/or produces a disability.Preventable AE: An AE that could be prevented given the current state of medical knowledge
What is an error? Outline the two types of error and give examples for both.
An error is something realised only after the eventSlips/Lapses - Errors of action (e.g. Picking up wrong syringe) and errors of memory (forgetting the drug altogether)Mistakes - Errors of knowledge and planning
Define healthcare quality
SEPTI Safe (no needless deaths)Effective (no needless pain/suffering)Patient-centred (Focus on pt’s needs and priorities)Timely (No unwanted waiting)Efficient (No waste)Equitable (No one left out)
How do we know that quality is not optimal?
Variations in medical care E.g. Amputations, hip replacementsI.e. Care is not equitable
What is the difference between equal and equitable healthcare.
Equal - everyone treated the same. This isn’t what is done with patients as every patient may have different needs so their management will be different.Equitable - everyone with the same need gets the same care
Give an example of an unavoidable adverse event and a preventable adverse event
Unavoidable: Drug reaction (drug prescribed first time).Avoidable: WSS (Wrong site surgery), retained objects, wrong does/type of medication, failure to rescue
Explain some of the underlying reasons for an adverse event
Individuals are not fallible and make mistakes, sometimes they are at fault - be it due to incompetence, carelessness or negligenceOften there are system failures - i.e. Not enough, not right defences built in (human factors not considered)
In James Reason’s framework of error - what are active failures and latent conditions?
Active Failures: Acts that lead directly to the pt being harmed E.g. Baby -> seizures because wrong dose givenLatent conditions (or failures) - predisposing factors I.e. Context that makes active failure more likely. E.g. Poor training, too few staff, poor design of syringes
What is the swiss cheese model?
A combination of active and latent failures are all like holes in a line of Swiss cheeses 🧀 When they line up, a hazard becomes a loss
Why is evidence-based practise important?
‘Art of medicine’ was too reliant on professional opinion of the caregiver, clinical fashion, historical practise and cultureI.e. Clinicians - persisted in using ineffective interventions, failed to take up other interventions known to cause benefit and tolerated huge variations in practiseThis creates INEQUITY
