Clinical Governance Flashcards
What is Clinical Governance?
Defined by Scally and Donaldson.
Framework** through which NHS organisations are **accountable** for **continually improving the quality of services.
Aims to create an environment which excellence in clinical care will flourish.
What are the components of clinical governance?
CORE
- Clinical audit
- Clinical effectiveness (QI)
- Openness
- Risk management
- Research and development
- Education and training
ACE RIPS
1 audit
2 clinical research
3 education and training
4 risk management
5 IT and using information e.g. accurate and confidential patient data
6 PPI (patient and public involvement) E.G. local patient feedback questionnaires
7 staff management
What are the framework/connections of clinical governance?
- NICE (National Institute for Health and Clinical Excellence)
- CHI (Commission for Health Improvement)
- CPD (Continuous Professional Development)
- National Audits
- Lab accreditation
How can a pathologist contribute to clinical governance?
- All of the CORE
- Audit
- QI
- Risk management
- Research
- Continuous medical education
- Revalidation
What is clinical governance data used for?
- Risk assessment
- Research
- Clinical audit
- Information management
- Education for patients and public
- Education and training for doctors
- Staffing and workload
What is an audit?
A quality improvement process** that seeks to improve patient care and **outcomes** through **systematic review** of care against **explicit criteria** and the **implementation of change.
It is to ensure that what should be done is being done.
What are the phases/How do you design an audit?
- Find the problem
- Define the criteria and standards
- Data collection (prospective vs retrospective)
- Compare performance with criteria and standards
- Implement change
- Close the loop with re-audit
- Dissemination
What sources of help could you draw upon for audits?
- RCPath for templates and scheme for certification
- NICE for current standards
- Departmental audit lead/Audit department
- Colleagues/Medical students
- Evaluators/Clinical Effectiveness Department post-submission
What is the difference between audit and research?
Clinical audit** is a way of finding out whether you are **doing what you should be doing by asking if you are following guidelines and applying best practice.
Research** evaluates practice or compares alternative practices, with the purpose of **contributing to a body of knowledge by asking what you should be doing.
How would you collect/record audit data?
- Pre-agreed period of clinical practice
- RCPath proformas/Audit department proformas
- Amass interest from colleagues/medical students
- Gather notes/forms
- Database/Excel
What would you do if you found a particular clinical team was not providing enough information?
- Present data/Education
- Avoid overt criticism/demotivation
- Achievable changes - avoid resistance
- Joint audit with team in question
What would you do if education didn’t work?
- Identify causes for resistance
- More team involvement
- More team accountability - avoid accusing
- More senior involvement
- IT approaches - online form/Altering system
What would you do to check audit outcomes are improving?
- Close loop in reasonable timeframe.
- Dissemination of results
What types of errors are there in clinical practice?
Diagnostic
- error or delay in diagnosis
- failure to employ appropriate tests or using outmoded tests
- failure to act on results
Treatment
- error in performance
- error in doses or methods
- avoidable delays
Preventative
- failure to provide prophylactic treatment
- inadequate monitoring/follow up
Other
- failure of equipment
- failure of communication
What do you understand by the phrase ‘significant error’
An error that has impacted patient care and jeopardises patient health, safety and best outcomes
- Errors of omission occur as a result of actions not taken. Examples are not strapping a patient into a wheelchair or not stabilizing a gurney prior to patient transfer.
- Errors of the commission occur as a result of the wrong action taken. Examples include administering a medication to which a patient has a known allergy or not labeling a laboratory specimen that is subsequently ascribed to the wrong patient.
