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CiP 7 Flashcards

1
Q

Steps of Needs Assessment

A

1) Identify Health priorities
2) Health priority for action
3) Plan for change
4) Review

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2
Q

Needs Assessment

A

Systematic method
reviewing health issues facing a population
-agree priorities
-resource allocation
to improve health and reduce inequalities

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3
Q

Health functioning

A

Individual/population’s experience as to whether something affects:
- social roles
-physical ability
-pain
-mental illness
-vitality/energy levels

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4
Q

Health triangle

A

identify health issues, review associations, collection/presentation of data
1) health functioning (rank 1 to 5)
2) determinant factors
3) health conditions

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5
Q

What is a stakeholder?

A

partner/sector that should be involved in decision making

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6
Q

Health Impact Assessment

A

policy/project
predict impact on population

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7
Q

Integrated Impact Assessment

A

policy/project
impact on- economic, social, environmental

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8
Q

Health Equity Audit

A

review enquiries into cause of ill health and access to service of population

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9
Q

Wilson and Jungner principles of screening

A

1) Condition is an important health problem
2) Accepted treatment
3) Diagnosis/treatment is available
4) Recognised latent/early symptomatic phase
5) Suitable test/examination
6) Natural history well understood
8) Agreed policy on whom to treat
9) Balanced cost of case finding
10) Case finding is a continuous process and not once and for all

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10
Q

Cervical Screening statistics

A

Screening prevents death
80% reduction in mortality
reduced incidence of cancer and death
reduced benefit and increased harm if over 25
reduced benefit if >65 and 2 negatives in last 10 years

> 50= 5 year interval
25-49 = 3 year

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11
Q

What is commissioning?

A

planning, purchasing and monitoring of services
-health needs assessment
-service specification
-design pathways
-contract negotiation/procurement
-continuous assessment

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12
Q

Health and Social Care Act 2012

A

1) Competition enshrined by law
2) Payment by results (tariff system)
3) Clinical Commissioning System (CCGs to commission secondary care/specialists)

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13
Q

Women’s Health Strategy 2022

A

Women spend significantly longer in ill health/disability
disparities across country

10 years:
boost outcomes for women and girls
improve how system engages/listens to

-lifecourse approach
-improve access
-improve info/education
-improve research
-listen to voices
-address disparities
-increase understanding in the workplace

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14
Q

Women’s health strategy aspects

A

Menstrual health
Gynaecology
Fertility and pregnancy
mental health
violence
menopause
cancer
ageing and long term health

-Women’s Health Ambassador
-Women’s Health Lead in NHSE
-Women’s Health Hub
-Investments in research
-pregnancy loss certificates

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15
Q

Hatfield Vision

A

Reduced reproductive health inequalities by 2030
1) Increase supply in SRH workforce
2) increase supply in primary care workforce
3) service specifications should include training requirements
4) Collaborative commissioning
5) Accountability in SRH/ICS
6) digital service platform
7) London measure of unplanned pregnancy
8) Teachers
9) improve resources

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16
Q

16 Goals of Hatfield Vision

A

reduce unplanned pregnancies to <30%
reduce disparity in unplanned pregnancies
offer full range of contraception at chosen location
patient-centre consultations
increase access to contraception/ hardly reached groups
equitable LARC access
free oral EC in all pharmacies
PNC
preconception care
menstrual health
menstrual products in schools
abortion
80% cervical screening target by 2025
menopause access
reduce disparities in black women
make information easily accessible

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17
Q

What is Clinical Governance

A

a system through which NHS organisations are accountable for:
continuously improving quality of services
safeguarding high standards of care
creating an environment in which excellence will flourish
monitoring systems and processes (patient safety/quality of care)

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18
Q

What is a care pathway?

A

process for treating patient with a specific condition/needs
based on expert opinion/evidence
-improve satisfaction
-ensure feels understood
-improve engagement
-reduce need for unplanned/unnecessary care
-encourage pt to take active role in healthcare

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19
Q

Patient Safety Strategy 2019

A

Patient safety incident response 2022
-no obligation to investigate every event
-explore themes
-how can we make it easier to do the right thing?
-include those with lived experience

What went wrong? What can we learn?

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20
Q

After action review

A

discussion with external team

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21
Q

Swarm huddle

A

immediate conversation with team

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22
Q

MDT/M&M

A

themes/systems

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23
Q

Pt safety incident investigation
MUST investigate

A

Never event
death caused by incident
maternity
suicide

24
Q

Datix

A

Feed into national system ‘learning from patient safety events’
-72 hours to review
-30 days to close

25
Duty of Candour- moderate harm
If threshold of moderate harm met: -tell patient/NoK and apologise -agree next steps with above -apologise in writing -keep record/datix
26
Never Event
Wholly preventable due to strong systemic barriers (eg wrong IUD) trigger patient safety incident investigation (currently out for consultation) 100-200 a year
27
Patient Safety Incident
Something unexpected or unintended has happened, or failed to happen that could have or did lead to patient harm for one or more person(s) receiving healthcare.
28
Low physical harm
When all of the following apply: minimal harm occurred – only extra observation or minor treatment did not or is unlikely to need further healthcare beyond a single GP, community healthcare professional, emergency department or clinic visit did not or is unlikely to need further treatment beyond dressing changes or short courses of oral medication did not or is unlikely to affect that patient’s independence did not or is unlikely to affect the success of treatment for existing health conditions.
29
Moderate harm
at least one of the following apply: has needed or is likely to need healthcare beyond a single GP, community healthcare professional, emergency department or clinic visit, and beyond dressing changes or short courses of medication, but less than 2 weeks additional inpatient care and/or less than 6 months of further treatment, and did not need immediate life-saving intervention has limited or is likely to limit the patient’s independence, but for less than 6 months has affected or is likely to affect the success of treatment, but without meeting the criteria for reduced life expectancy or accelerated disability described under severe harm.
30
Serious harm
at least one of the following apply: permanent harm/permanent alteration of the physiology needed immediate life-saving clinical intervention is likely to have reduced the patient’s life expectancy needed or is likely to need additional inpatient care of more than 2 weeks and/or more than 6 months of further treatment has, or is likely to have, exacerbated or hastened permanent or long term (greater than 6 months) disability, of their existing health conditions has limited or is likely to limit the patient’s independence for 6 months or more
31
Business case
proposal requesting a resource 1) Case for change 2) Priorities and funding 3) Demonstrate financial impact (cost/effectiveness/saving) 4) Impact on workforce/patients 5) Understand governance/decision making process
32
CEU Guidelines development
1) Identify guidelines (correspondence, surveys, evidence requests-annual review) 2)submit to CEC 3) approval by CEC= development Updated 5 yearly, start looking 12/12 before or if significant new evidence
33
Guideline development process
1) Set up- GDG, PPI, timescale/proposal, at least 2 laypeople 2) Scope drafts/consultations with stakeholders 3) Guideline drafts and consultations with a) GDG b) external review c) public consultation 4) Sign off by CEU/CEC leads 5) Publish and disseminate
34
Guideline components
auditable outcomes case based digest 10 SBAs 80% consensus by GDG
35
Severe Harm in SRH
Life threatening sepsis post IUD fit Hysterectomy (unforeseen) post IUD fit
36
Never event in SRH
wrong IUD retained object post procedure (ie swab after coil fit)
37
Moderate harm in SRH
perforation with IUD in pelvic cavity late perforations diagnosed at service ectopic with IUD PID>sepsis>hospitalisation vasovagal at time of fit with admission >24hrs
38
DoC response- low harm (UHB policy)
Apologise hold discussion with patient/NoK by medical/nursing/ops lead document in records and ensure reported (Radar)
39
DoC response- Moderate or worse (UHB policy)
1) Report 2) Identify DoC lead. Hold discussion between DoC lead, patient/NoK within 10 working days 3) Appendix C proforma in records, provide copy to clinical governance team and upload to Radar 4) Clinical Governance and Safety review stage 1- ensure DoC filled -Never events: Notification of investigation letter maintain contact -Other investigations: maintain contact of case by case basis
40
Duty of Candour- GMC
something goes wrong or potential of harm/dustress -tell the person (must record if does not want to know, must explain consequences) -apologise -offer a remedy or support -explain short and long term effects of what has happened
41
3 components of an apology
What happened what we can do to deal with harm what will be done to prevent others from being harmed does not mean admitting liability may evidence insight in a fitness to practise panel
42
Do I need to tell patients about a near miss?
adverse incident with potential for harm but nil harm use professional judgement about whether to tell patient
43
Guideline
suggested course of action that provides advice as to when and how activity should be performed
44
Policy
way of ensuring goals of service and applied uniformly rules/framework within which everyone should work
45
Procedure
established local sequence/uniform method for performing activity- specific information for that activity
46
Marmot Review
highlights discrepancies in life expectancy between individuals and communities
47
ICS
local partnerships (42) bring health and care organisations together to develop shared plans and joined-up services NHS organisations and upper-tier local councils, as well as: voluntary sector social care others Established July 2022
48
ICP
integrated care partnership ran by ICS Broad alliance of partners who all have a role in improving local health, care and wellbeing Plan/strategise
49
ICB
NHS organisations responsible for planning health services for their local population One in each ICS area Make a five year plan to achieve ICS strategy Commission/allocate budget
50
What does Local Authority Commission for SRH?
Contraception/unplanned pregnancy in SRH LARCs in primary care STI testing and treatment HIV testing Specialist SRH teenage parents chlamydia screening psychosexual services
51
What do ICPs commission for SRH?
Abortion Contraception for gynae reasons sterilisation Non-sexual health psychosex HIV testing in non SRH setting
52
What does NHSE commission for SRH?
Contraception at GP Smears Fetal Med HIV treatment STI testing/treatment by GP HPV vaccination SARC SRH for detained Infectious diseases in preg screening
53
Wales SRH
7 local health board commission 3 year plans
54
Scotland SRH
14 Health Boards 31 Health and social care partnerships
55
NI
5 boards, aiming for a CCG like structure GU clinic at each trust with some abortion services, limited

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