Admin questions Flashcards

Question

information that you would include in patient's ED management e.g. frequent presenter, drug seeking behaviour

Answer 1

Presenting complaint pattern : description of typical back pain, frequency of presentations, chronic vs medically unexplained Summary of previous workup and findings, state if no ongoing organic cause found History of opioid use and request : past prescriptions, sources, medication-seeking behaviour Past history, D+A and forensic history, medication allergies and intolerances Behavioural concerns or ED interactions : include incidents of aggression, manipulation or refusal of care, security involvement, resolution External providers or services involved : GP and practice (if known), addiction medicine/pain clinic Plan for medical assessment : early review by senior doctor Plan for pain relief : offer multimodal non-opioid analgesia in the first instance emphasising return to function, not elimination of pain

Answer 2

- Wrong medication dose - Procedure on wrong patient/part - Patient suicide in hospital - Retained instruments post op - Maternal death a/w labour - Suicide in custodyE

Answer 3

1. Providing constructive feedback 2. Clear expectations of mentoring program 3. Building mutual relationship that benefits both mentor and mentee 4. Addressing/Focus on needs of the mentee 5. Empowers mentee 6. Develops mentee problem solving 7. Regular meetings/relationship 8. Separate from formal assessment 9. confidential benefits - exploration of future career goals - individualised professional development - discuss issues in a non threatening environment - inc confidence and leadership skills benefits to organisation 1. reduces sick leave 2. more supportive for trainees 3. mentees fulfilment 4. job satisfaction 5. better workplace culture/communication

Answer 4

Single tier - Full activation based on abnormal physiological parameters or mechanism of injury - Activation on mechanism of injury alone often unnecessary - Leads to inadequate utilisation of resources and increased workload Two tier system - Activation of full trauma team only with abnormal physiological variables or certain physical signs - Activation of subset of trauma team for other criteria o Based on mechanism of injury o Activation may occur at time of ED assessment or pre-hospital o E.g. Gen surg and radiographer alerted, no anaesthetics required - Effects o Reduces unnecessary full team call outs hence better use of resources e.g. anaesthetics not always required o Increases risk of failure to activate when necessary - potential delays in diagnosis and/or tx of potentially life threatening injuries

Answer 5

- Frequent repeated orientation - Give usual meds - Avoid sedatives/hallucinating drugs - Keep fed/watered - Meals at set times - Early IDC - Seek and treat cause e.g. infection, pain etc - Engage family as much as possible - Window access – maintains day/night orientation, sleep pattern - Provide glasses/hearing aids - Consistent staffing presence - Low background noise environment - Early operative repair of fractures - Early rehab after surgery - TV, radio for stimulation - Familiar objects

Answer 6

Contributing factors - Access block - Inadequate analgesia - Clinical mistakes - Poor communication - Patient needs not addressed - Demographics – socioeconomic; increases with wealtlh - Communication barriers – NESB - Individual performance of staff Steps to investigate incidents - Review patient notes and med chart - Interview staff involved - Check levels of supervision, what issues led to complaint/misdiagnoses - Speak to person supervision JMO – did they review pt - Inform JMO supervisor to put into perspective with JMO’s overall performance - Inform director

Answer 7

Patient - Gains understanding of what happened and why and opportunity to ask questions and have concerns addressed - Restores trust in healthcare - Ameliorates anger, guilt, grief, helpelessness - Encourages person and/or supports to participate in healthcare quality improvement process Healthcare providers - Enables discussion on ways to prevent future complications or ongoing consequences/harmful incidents - Accountability for mistakes - Manages stress after harmful incident - Facilitates investigations to improve safety and quality - Fulfils professional ethical and moral obligations Organisation - Facilitates safer health system - Strengthens public trust in healthcare organisations - Reduced medicolegal risk - Improves staff moral and retention - Embeds transparency and openness into health care services

Answer 8

Role of assessor - Provide accurate non biased feedback of performance - Observe directly - Invite trainee to self reflect - Identify any further education needs - Provide strategies for improvement - Non judgemental feedback - Ensure up ot standard expected at level of training Trainee - Identify issues/key components of WBA - Formulate plan for improvement - Identify further education needs - Consideration of patient safety issues - Complete and submit WBA - Act on plan to improve future performance

Answer 9

a. Distribute elective admissions evenly throughout the week b. Having a 24 hour hospital coordinator to facilitate hospital patient flow c. Having short stay units for patients who are likely to be discharged within 24 hours to free up inpatient beds d. Having hospital bed occupancy 85% to allow for emergency admissions and surge capacity e. Ensuring early morning discharge of inpatients in anticipation of more admissions in the afternoon f. Early senior decision making of inpatients to facilitate discharges g. Early identification of patients that can be transferred to private hospitals h. Weekend/out of hours discharges i. Transient lounges for discharges

Answer 10

1. Confirmation bias – data interpreted in a way that confirms researcher’s hypothesis 2. Selection bias – selection method is biased, not randomised and doesn’t represent population 3. Recall bias – pt does not remember events accurately = incorrect results 4. Sampling bias – individuals not chosen randomly, don’t represent population 5. Observer bias – researcher’s expectations/beliefs influences the experiment, distorting the data

Answer 11

1. Awareness of bias 2. Challenging assumptions 3. Obtain other perspectives/multiple perspectives 4. Having cognitive flexibility Tolerating uncertainty Aware of prevalence of diseases Time out for discussion with colleagues Allowing time for disease to declare itself if able consider other diagnoses Utilise decision support tools Documenting decision process

Answer 12

Process to analyse the cause of a system failure during a sentinel event, solve problems & provide recommendations for change. When should it be taken? - As soon as possible after an incident or during audit proess - For high risk, high impact incident with potential harm for patients What are the 4 principles of a RCA investigation? - Focuses on systems and processes rather than individual performance - Fair, thorough, efficient - Focuses on problem solving - Uses recognised analytical methods - Uses scale of effectiveness to develop recommendations 5 major steps of RCA 1. Define incident/problem 2. Map a timeline of event 3. Analyse the critical event 4. Identify root causes and support with evidence 5. Identity ways t address the problem and provide recommendation

Answer 13

- Early psych clinician reviews on presentation for mental health assessment to address deterioration - Code grey/black responses - Planned code greys to mitigate risk when administering meds - Security alarms installed in cubicles - Physical presence of security in ED - Staff training on violence prevention e.g. verbal de-escalation - Reporting systems for incidents of violence - Use of alerts on patient’s records ED design measures to reduce violence - Behavioural assessment rooms - High visibility areas for assessment - Separate waiting/treatment areas for patients at risk of behavioural disturbances - Measures to prevent unauthorised access e.g. locks, barriers - Providing basic amenities e.g. food, tv - Waiting time signage - Duress alarms installed

Admin questions Flashcards

(38 cards)