Clinical Skills - Pharmacology and Prescribing

Question 1

Patient safety

Answer 1

Prevention of available harm, whether by an a error or an omission

Question 2

Never events

Answer 2

Existing national guidance or safety recommendations if followed would’ve prevented this event e.g. retained foreign body
Easily identified, defined and measured
Results in permanent harm or death

Question 3

Examples of never events

Answer 3

Surgical errors e.g. wrong site surgery
Placement of wrong implant
Administration of med by the wrong route
Mis-selection of solution e.g. strong K is lethal

Question 4

First check on WHO checklist

Answer 4

The team brief

Meeting w/ all staff and all cases discussed and problems highlighted

Question 5

Second check on WHO checklist

Answer 5

Pt checked on Ward by TSW
Details on name tag
Consent form checked
Pregnancy status recorded

Question 6

Third check on WHO checklist

Answer 6

Sign in

Time out

Question 7

Wtonmg site surgery

Answer 7

Wrong knee, hip, limb, organ, pt

Incl biopsy, radiological procedure and drain insertion

Question 8

What is excluded when classifying wrong site surgery

Answer 8

Excludes wrong site because of abnormal patient anatomy, documented in note

Question 9

Why do we mark digits

Answer 9

Naming digits helps avoid error

Question 10

Drug errors

Answer 10

IV administration of epidural med
Wrong route administration of oral/enteral treatment
Maladministration of insulin
Opioid overdose in an opioid naive patient
Inappropriate administration of oral Methotrexate

Question 11

Misplaced naso- or orogastric tubes

Answer 11

Measure pH of aspirate, not just litmus paper turning red as many factors influence acidity e.g. foods, drugs.
X-ray abdomen most accurate
Check before feeding
Medical administration
Flush

Question 12

Patient safety during COVID-19

Answer 12

Mortality of GA whilst COVID+ is v. high

Therefore postpone surgery if safe to do so

Question 13

Patient streams during COVID-19

Answer 13

Green (elective) – confirmed -ve COVID test
Yellow – no symptoms; test awaited
Red – confirmed test/ +ve symptoms awaiting test

Question 14

Non-pharmalogical pain management

Answer 14

Physical and occupational therapy 
Self-help
Wt loss
Surgery 
CBT

Question 15

Hydrotherapy

Answer 15

Relaxes muscles; can help to build strength in a warm, pain-relieving environment without pressure induced by gravity + weight-bearing

Question 16

Splints/ orthoses

Answer 16

Temporary rest and support; shouldn’t be used for long so as to avoid muscle wasting
Can prevent further damage whilst sleeping
Useful for people who are severely disabled but can’t have surgery
Often custom-made

Question 17

Aids and appliances

Answer 17

Provide dignity + independence for daily tasks, e.g. raised toilet seats

Question 18

Self-help

Answer 18

For patients with incurable chronic pain- aims to help patients manage the controllable aspects of their disease, esp the emotional aspect i.e. coming to terms with how their life has been affected

Question 19

Wt loss as pain management

Answer 19

Obesity often makes pain much worse as it causes more pressure on the joints and is a risk factor for many diseases

Question 20

Surgery as pain management

Answer 20

Provide pain relief and increase function
Depends on cause of pain
May include soft tissue release (e.g. in carpal tunnel syndrome), synovectomy, arthroplasty, arthrodesis, tendon repairs, etc

Question 21

CBT as pain management

Answer 21

Not successful or suitable for everyone with chronic pain
Helps treat the psychological aspects of pain
Believed to reduce stress, depression, and anxiety by challenging unhelpful/negative thoughts

Question 22

Types of errors causing harm to patients

Answer 22

Medication errors 
Surgical/ procedural errors 
Diagnstic errors 
Transition of care errors 
Teamwork/ communication errors 
Healthcare-associated infections 
Device-related errors

Question 23

Diagnostic errors

Answer 23

The failure to establish an accurate and timely explanation of the patient’s health problem(s) or communicate that explanation to the patient.”

Question 24

Dealing with transition of care issues

Answer 24

Use a checklist for handover such as I-PASS

Provides clear expectation for both the provider and recipient of patient information

Question 25

Key never events

Answer 25

Wrong site surgery
Wrong implant prosthesis
Retained foreign object post procedure
Administration of medication by wrong route
Overdose of methotrexate for non-cancer treatment