Final Flashcards
(31 cards)
What to do about someone who always has sleeves down?
Monitor situation
Tell Infection control
Tell nurse in charge of ward
Tell Reg
Nurse > Reg > Monitor > Tell infection control
Patient doesn’t speak ANY english. Do you continue trying to communicate as best possible or telephone next of kin to ask about symptoms
Telephone next of kin to ask about symptoms
Simply continuing without taking any alternative action would not be good clinical care (B).
Consultant requests scan that reg says is not needed, is it better to
Request Scan
Discuss with consultant radiologist
Request Scan
The consultant retains overall responsibility for the patient and so if it is not possible to discuss the reasons for different viewpoints, it is appropriate to follow the consultant’s advice (A).
Discussing the case with the radiologist is likely to be beneficial for patient management and your learning but it would be better to understand the reasons for the difference in opinion by discussing with your own team rather than involving another consultant (B)
Rank these options if you are concerned a patient may be allergic to what has been prescribed?
A.Speak with the on-call pharmacist about whether you should prescribe the drug
B.Explain to the locum doctor that you are concerned about prescribing the drug
C.Ask another senior doctor whether it is appropriate to prescribe the drug to
D.Prescribe the drug as requested by the locum doctor
E.Speak about your concerns with the nurse who would administer the drug
BAECD
The nurse also has a responsibility, as they will be giving the drug to Mr Singh and needs to know about your concerns(E).You may find that experienced nurses will bring concerns regarding prescribing to your attention. Talking to another senior doctor about this would also be a reasonable course of action but not as good as speaking to the doctor concerned and introduces another opinion (C).
When may you not have to tell a patient there has been an error as a priority?
They are confused
Option(B) is not immediately necessary and the patient would probably not be able to retain or understand the information as they are confused.
Disruptive relatives when you are trying to take blood. Do you:
Ask a nurse to take the blood sample whilst you talk to the relatives elsewhere
Ask the relatives to be quiet whilst you take the blood sample
Ask the nurse
(C)will also deliver patient care but involves other staff and may take more time. (A)delivers safe patient care but doesn’t defuse a stressful situation. Further, it doesn’t maintain patient privacy and puts added pressure on the procedure.
You are taking urgent blood samples and a nurse asks you to examine a patient immediately. There is no need to urgently examine the patient but she is the relative of a surgical consultant in the hospital.
A.Tell the nurse that, at the moment, you must prioritise taking the blood samples
B.Ask a senior whether you should continue taking blood samples or examine the patient
C.Tell the nurse that you will examine the patient once you have taken all the blood samples
D.Ask your consultant to examine the patient next, explaining that she is a relative of the surgical consultant
E.Examine the patient, as requested
CABDE
It is clear that the blood samples have been identified as urgent, they would therefore take priority over the non-urgent task. (C)conveys this and reassures Reuben that it will be dealt with when you are available; it is therefore the most appropriate response. (A)conveys the urgency and need to take blood samples but is less appropriate as it does not address Reuben’s query specifically. Seeking clarification from the FY2 (B)is reasonable if you are unsure what to do -however, in this case the prioritisation of the blood samples has already been made clear. Asking Dr Patrick to examine the patient (D)is less appropriate as it has been established that the ward is busy and that examining the patient is a non-urgent task. Finally, simply examining the patient (E)means that you have moved from completing a specific urgent task to a non-urgent task without informing your colleagues.
When may it be more appropriate to ask a nurse to contact your F1 colleague who has disappeared from the ward instead of doing it yourself?
If you are in the process of completing a critical action
E.g. Completing a drug chart
You don’t understand why you need to make a gastro referral. Do you:
Contact the gastroenterology consultant to explain that you need to make the referral, and ask what information they need to proceed
Ask a more experienced colleague what information the Gastroenterology department will require to make the referral
Ask a more experienced colleague what information the Gastroenterology department will require to make the referral
You don’t understand why you need to make a gastro referral. Do you:
Contact the gastroenterology consultant to explain that you need to make the referral, and ask what information they need to proceed
Conduct research on the Internet into why the referral could be required
Conduct research on the Internet into why the referral could be required
Rate the appropriateness of:
“I’m here to help you, please don’t speak to me that way”
3 - Somewhat inappropriate
You are stressed and ask to leave your shift early. How important is the amount of time you have left on your shift?
3 - Of minor importance
Rate the appropriateness of:
Advise your F2 colleague that you have observed a change in behaviour that is having a negative impact on their work?
2 - Somewhat appropriate
It is the F2s responsibility to be aware of their behaviour, but you should raise concerns
Rate the appropriateness of:
Suggest taking on some of your F2 colleague’s workload to allow her more time to study
4 - Inappropriate
It is out of your scope of practice
Rate the appropriateness of:
Inform your colleague that some of the nurses have noticed a change in her behaviour
2 - Somewhat appropriate
It is your responsibility to raise concern about your colleague’s behaviour and be honest about its impact on the rest of the team
Rate the appropriateness of:
Inform your colleague that some of the nurses have noticed a change in her behaviour
2 - Somewhat appropriate
It is your responsibility to raise concern about your colleague’s behaviour and be honest about its impact on the rest of the team
Rate the importance of:
The ward nurse in charge must have a reason for wanting you to stay
2 - Important
They may have a different but equally relevant perspective about clinical priorities which needs to be considered.
Rate the importance of:
Your relationship with the ward nurse might be negatively affected if you leave the ward
3 - Of Minor importance
Patient care and safety comes first
You forgot to take blood:
Send a text to your colleague to do it
Return to the ward
Send a text
Your colleague calls in sick. They have posted pictures of a night out last night:
A. Make other colleagues on the rota aware of the photos from the party
B. Suggest to your FY1 colleague that she remove the photos from the social networking site
C. Seek advice from another FY1 colleague
D. Ask your colleague for an explanation of why she called in sick the day after a party
E. Alert a senior colleague to the photos on the social networking site
DCBEA
Informing a senior colleague would only be the correct action if there was no adequate explanation forthcoming, the doctor did not show genuine remorse and learning or there were on-going concerns regarding patient safety (E)
Nurse consistently rude to you and undermines you in front of patients and staff
Inform consultant
Inform Nurse in charge
Consultant
Informing the nurse in charge (B) is best left to your consultant.
Colleague has social media post about a patient which can be identified.
C. When you next see Neal, suggest that he removes the social media post
D. Inform your on-call consultant of Neal’s social media post
E. Advise Neal to change his social media settings to ‘private’ so that only his contacts are able to read his posts
CDE
Although the advice to change media settings to private (E) is sensible that could be interpreted as condoning the original post which is inappropriate irrespective of settings.
You see a handover list at your colleagues house:
A. Inform Susanna that this is a breach of patient confidentiality
B. Advise Susanna to destroy the handover list
D. Destroy the handover list
E. Advise Susanna to discuss the breach of patient confidentiality with her educational supervisor*
ABED
Discussion and reflection with her supervisor (C) are important but represent an action that will become more appropriate later once the immediate issue with the handover sheet has been dealt with. Destroying the list (D) may mean that Suzanna is unaware of what has happened to the document which may cause problems when reporting the breach of confidentiality at work.
You are in the Acute Admissions Unit* (AAU) and are writing up a patient’s drug chart. The nurse tells you that one of the patients has been waiting 10 minutes for a cannula to be inserted. You know that the patient was seen by your FY1 colleague, Alex, five minutes ago. Alex has now left the AAU but you do not know the reason why. The nurse informs you that Alex did not insert the cannula when he was with the patient. There is no clinical urgency to insert the cannula.
A. Ask the staff if they know why Alex has left the ward
B. Contact Alex and ask him to return to the ward and insert the cannula
C. Ask the nurse to contact Alex to request that he returns to AAU to insert the cannula
D. Tell the nurse you will insert the cannula as soon as you have finished writing up the patient’s drug chart
ADCB
The most appropriate response is to establish why Alex left the ward (A) as this may have been to attend an emergency or obtain equipment for the procedure. Doing the cannula when you are able can ensure the ongoing care of the patient (D), but it does not address why a member of the team (Alex) has left. Contacting Alex is reasonable but it is more important to establish why he left the ward first from the staff as he may be busy with an important task. As you are in the process of dealing with a patient critical action i.e. completing a drug chart, this should take priority so asking the nurse to find where Alex is would be more appropriate (C) than leaving the task to contact him on your own (B).
