Fundamentals

Question 1

Teams in the NHS

Answer 1

Tradition in certain areas eg operating theatres
Community care and GP teams
NHS plan
Service reconfigurations

Question 2

Why are teams important

Answer 2

Efficient
Improves decision making
Reduces medical error
Essential in complex, modern healthcare

Question 3

What percentage of medical errors are due to breakdowns in teamwork

Answer 3

70%

Question 4

A good healthcare team

Answer 4

Clear roles and understanding of each team member’s role
Mutual awareness of team member’s role
Knowledge sharing
Effective communication
Shared goals
Mutual respect and trust
Positive attitude

Question 5

7 steps to patient safety

Answer 5

Build a safety culture
Lead and support staff
Integrate your risk management activity
Promote reporting
Involve and communicate with patients and public
Learn and share safety lessons
Implement solutions to prevent harm

Question 6

Problems with teams in NHS

Answer 6

Healthcare teams are not all the same
Delivered by individuals from different professions
Medics often seen as outliers
Difficult to monitor

Question 7

Obstacles to teams in the NHS

Answer 7

Environmental barriers:
Organisational- shifts/rotations
Location
Management

Other commitments of team members and professional specific goals
Complex leadership

Question 8

SBAR communication checklist

Answer 8

Situation
Background
Assessment
Recommendation

Question 9

Error

Answer 9

Any preventable event that may cause or lead patient harm

Question 10

Types of human error

Answer 10

Errors of omission
Errors of commission
Professional negligence
Skill based errors
Rule/knowledge based

Question 11

Errors of omission

Answer 11

Required action is delayed or not taken

Question 12

Errors of commission

Answer 12

Wrong action taken

Question 13

Professional negligence

Answer 13

Actions or omissions do not meet the standards of an ordinary, skilled professional who has competence

Question 14

Skill based errors

Answer 14

Mistakes during routine tasks due to poor concentration/distraction

Question 15

Rule/knowledge based errors

Answer 15

Inexperience leading to incorrect course of action, often in complex tasks

Question 16

2 outcomes of medical errors

Answer 16

Adverse event
Near miss

Question 17

Near miss

Answer 17

An event during care which has potential to cause harm but fails to develop

Question 18

Adverse event

Answer 18

Incident that results in harm to a patient , not a result of illness

Question 19

Violations

Answer 19

Deliberate deviations from practices, procedures, standards or rules

Question 20

Types of violations

Answer 20

Routine
Necessary
Optimising

Question 21

What are violations due to

Answer 21

Attitudes, motivations , contextual influences rather than cognitive limitations

Question 22

Information processing limitations

Answer 22

Automaticity
Cognitive interference
Selective attention
Cognitive biases
Transferring expectations

Question 23

Automaticity

Answer 23

Doing tasks without thinking

Question 24

Cognitive interference

Answer 24

More complex task requires higher demand

Question 25

Selective attention

Answer 25

Limited additional resources Information overload

Question 26

Cognitive biases

Answer 26

Effects of long term memory and previous exoerienes

Question 27

Transferring expectations

Answer 27

Positive or negative From familiar objects.situations to similar new ones

Question 28

Approaches to managing error

Answer 28

Person System

Question 29

Person approach to managing error

Answer 29

Focuses on the unsafe acts of professionals

Question 30

Shortcomings of person approach to managing error

Answer 30

Anticipation of blame promotes cover up No way of uncovering repeated errors Relies on trust in reporting errors

Question 31

System approach to managing error

Answer 31

adverse events are products of many causal factors Efforts are directed at removing error traps and strengthening defences

Question 32

Latent conditions

Answer 32

Lie dormant within the system before they combine with active failures and local triggers to create an accident opportunity, can be identified and remedied

Question 33

Active failure

Answer 33

Hard to foresee

Question 34

Reducing error and harm

Answer 34

Simplification and standardisation of clinical practices Checklists and aide memoire IT and softeware Team training Risk management programmes Mechanisms to improve uptake of evidence based treatment patterns

Question 35

Tips for junior doctors when reducing errors

Answer 35

Develop internal alarm bells Seek help when overwhelmed Use clinical guidelines Always document thought process, actions and plans Checking results and recorded information Speaking up if an error is suspected

Question 36

Why is safety compromised so often

Answer 36

Complex, high risk environment especially in hospitals Resource intensive Often shared responsibilities

Question 37

Ethics - Richard Norman 1998

Answer 37

Attempt to arrive at an understanding of the nature of human values How we ought to live and what constitutes right conduct

Question 38

Ethical arguments

Answer 38

Top down deductive Bottom up inductive

Question 39

Top down deductive

Answer 39

Where one specific ethical theory is consistently applied to each problem

Question 40

Bottom up inductive

Answer 40

Using past medical problems to create guides to practice

Question 41

Morality

Answer 41

Concern with distinction between good and evil, right and wrong (universal)

Question 42

Ethics

Answer 42

A system of moral principles and a branch of philosophy Defines what is good for individuals and society Differs in different cultures

Question 43

Doctrine of dual effect

Answer 43

Harmful effect is inseparable from the good effect Nature of act is good and intention is good Good effect outweighs the bad effect

Question 44

Meta-ethics

Answer 44

Nature of ethics and moral reasoning Exploring fundamental questions Right/wrong defining the good life

Question 45

Normative ethics

Answer 45

Determining the content of our moral behaviour Focus is on the act itself, the person performing it and its consequences

Question 46

Applied ethics

Answer 46

Attempting to deal with the specific realms of human action, crafting criteria for discussing issues Emergence of ethical investigation in specific areas Environmental, medical and public health