Health Care Policy

Question 1

Describe the 4 overall functions of the clinical record

Answer 1

1. support patient care
2. improve future care
3. social purposes at the request of the patient
4. medico-legal document

Question 2

1. Name 6 medical functions of the clinical record
2. name non-clinical purposes of the clinical record
3. Name emerging purposes of the clinical record

Answer 2

1. support method of, and structure to history and examination
   ensure clarity of diagnosis
   record treatment plans
   ensure comprehensive monitoring
   maintain a consistent explanation for the patient
   ensure continuity of care

2. providing medico-legal evidence
providing legal evidence in respect of claims by a patient against a third party
support claims for benefits
record patient preferences
provide evidence of workload
assist service planning
support clinical research

3. management of cost effective prescribing
   read-only shared record

Question 3

Name 7 things that need to be recorded on a clinical record

Answer 3

1. presenting symptoms, and reasons for seeking health care
2. relevant clinical findings
3. diagnosis and important differentials
4. options for care and treatment
5. discussion about risk and benefits of treatment
6. decisions made
7. action taken and outcome

Question 4

1. Name 4 advantages of handwritten records
2. name 3 disadvantages of handwritten records
3. name advantages of computerised records

Answer 4

1. continuous
   writer is identified
   contemporaneous
   portable
2. legibility issues
   structural issues
   must be dated and signed

3. problem orientated
audit trail
searchable
patient safety focus
clinical decision support

Question 5

Name 6 potential causes for poor UK performance in the Eurocare report

Answer 5

1. differences in data collection
2. age differences (but rates were age standardised)
3. differences in stage of presentation
4. differences in social class
5. differences in access to treatment
6. more delay in pathway to diagnosis

Question 6

What were the 7 propositions of the Calman Hine Report to improve cancer care

Answer 6

1. all patients have access to uniformly high quality of care
2. education to aid early recognition
3. clear information about treatment options and outcomes
4. development of patient centred cancer services
5. emphasis on primary care
6. recognise psychosocial needs of cancer suffers
7. MDTs would be key to managing patients

Question 7

1. What were the 4 aims of the NHS cancer plan 2000?
2. What did this plan broadly cover?
3. What are cancer networks?

Answer 7

1. save more lives
   ensure people with cancer get the right professional support, care and best treatments
   tackle health inequalities
   invest in cancer workforce
2. prevention, screening, diagnosis and treatment
3. health service commissioners, providers, voluntary sector and local authorities

Question 8

What were the 6 key areas for action outlined by the cancer reform strategy 2007?

Answer 8

1. prevention
2. earlier diagnosis
3. ensuring better treatment
4. living with and beyond cancer
5. reducing cancer inequalities
6. delivering care in most appropriate setting

Question 9

Name contributing factors to delayed diagnosis

1. patient factors
2. system factors
3. disease factors

Answer 9

1. demographic, co-morbidities, psychosocial, social, cultural, previous experiences
2. access, policy, delivery
3. site, size, growth rate, symptoms

Question 10

What are the diagnostic intervals of cancer care

1. referral
2. between referral and start of treatment
3. from treatment plan to start of treatment

Answer 10

1. 2 week wait
2. 62 days
3. 31 days

Question 11

What were the four aims of the “Improving outcomes: a strategy for cancer” report?

Answer 11

1. prevention and early diagnosis
2. quality of life and patient experience
3. better treatments
4. reducing inequalities

Question 12

1. What were the findings of the Mid Staffordshire Scandal?
2. What was the Bristol Royal Infirmary Scandal?
3. What were the findings of an enquiry into this?

Answer 12

1. large number of patient deaths as a result of poor care between 2005 and 2009
2. high death rates in paediatric cardiac surgery
3. staff shortages, lack pf leadershop, old boys culture and lax approach to safety

Question 13

1. When is a patient’s death judged as avoidable

Define the following:

2. Acts of omission
3. Acts of commission

Answer 13

1. when a problem in care contributed to death
2. failure to treat according to best evidence
3. incorrect treatment or management

Question 14

Why are high error rates not necessarily a bad thing?

Answer 14

means that errors are being reported

Question 15

What is the Summary Hospital Level Mortality Indicator?

Answer 15

actual mortality rates within 30 days of discharge, compared to expected mortality, given the hospital’s characteristics

Question 16

1. What are hospital episode statistics?

2. What are patient recorded outcome measurement?

Answer 16

1. dataset including diagnoses, consultant responsible, referring GP, procedures give, duration of stay and discharge/death
2. assess the quality of care delivered to NHS patients from the patient perspective. Currently covering Knee and Hip replacements, PROMs calculate the health gains after surgical treatment using pre- and post-operative surveys

Question 17

What is the role of the CQC

Answer 17

Regulates quality of all health and social care providers, public and private
Licensing all providers of health and social care
Policing - unannounced visits and use of hospital episode statistics

Question 18

Name 6 other agencies (apart from CQC) involved in consumer protection

Answer 18

1. NHS improvement
2. NICE
3. Department of Health
4. Heath Protection Agency
5. GMC
6. Royal Colleges

Question 19

Define the following:

1. Adverse Event
2. Near Miss
3. Serious Incident
4. Never Event

Answer 19

1. an unintended event, resulting from clinical care, that cause patient harm
2. a situation in which events or omissions, arising during clinical care, fail to develop further, thus preventing harm
3. events where the potential for learning is so great, or the consequences to patients, families and carers, staff or organisations are so significant that they warrant using resources to investigate and act
4. serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at national level, and should have been implemented by all healthcare providers

Question 20

Why is the Hospital Standardised Mortality Ratio a poor measure of hospital care (4)

Answer 20

1. higher proportion of deaths in hospital
2. hospital may be in area where there is good or poor hospice care, which influences death rate
3. choice of case mix adjustment model
4. relationship with quality of care has not been demonstrated

Question 21

Describe the swiss cheese model

Answer 21

hazards are prevented from causing human losses by a series of barriers.
Each barrier has unintended weaknesses, or holes
When by chance all holes are aligned, the hazard reaches the patient and causes harm

Question 22

1. What are active failures?

2. Name the two types of active failures

Answer 22

1. unsafe acts committed by people in direct contact with the patient
2. errors and violations

Question 23

Give examples of:

1. Knowledge based errors
2. rule based errors
3. skills based errors
4. routine violations
5. situational violations
6. reasoned violations
7. malicious violations

Answer 23

1. forming wrong plans as a result of inadequate knowledge or experience
2. encounter a relatively familar problem but apply the wrong rule
3. attention slips and memory lapses
4. violation that has become normal behaviour within a peer group
5. contact dependent - e.g. time pressures, low staffing
6. deliberate deviation from protocol thought to be in the patient’s best interest
7. deliberate act intended to harm

Question 24

1. What are latent errors?
2. What is blame culture?
3. What is normalisation of deviance?

Answer 24

1. conditions that develop over time and lay dormant until they combine with other factors or active failures to cause an adverse event
2. individuals cover up errors for fear of retribution
3. failings because staff become blind to what is going on around them and assume that the practices being tolerated are normal

Question 25

What is designing out error?

Answer 25

designing things in the workplace to try and minimise the likelihood of error or its consequences

Question 26

Name 6 ways to improve patient safety

Answer 26

1. increase staffing 2. create patient safety culture 3. electronic early recognition of deteriorating patient 4. standardise approaches to high risk patients 5. promote safer prescribing 6. promote hand hygiene

Question 27

1. What is palliative care? | 2. what does palliative care involve?

Answer 27

1. the active holistic care of patients with advanced progressive illness 2. management of pain/symptoms; provision of psychological, social and spiritual support

Question 28

1. What is general palliative care? | 2. What does it include? (3)

Answer 28

1. core aspect of care for all patients and their families with advance disease by ALL HEALTH PROFESSIONALS 2. holistic needs assessment provision of basic symptom control referral to specialist palliative care if necessary

Question 29

1. Who is specialist palliative care provided for? | 2. who is specialist palliative care provided by?

Answer 29

1. patients and carers with unresolved symptoms and complex psychosocial issues 2. healthcare professionals for whom palliative care is their core work

Question 30

1. Describe 4 GENERALIST palliative care services | 2. Describe 4 SPECIALIST palliative care services

Answer 30

1. primary care team nursing homes secondary care social services 2. clinical nurse specialists specialist physicians in palliative care hospices marie curie nurses

Question 31

Name 5 services that hospices provide

Answer 31

1. medical clinics 2. complimentary therapies 3. bereavement services 4. benefits advice 5. out of hours service

Question 32

Name the services involved in determining preferred place of care/death (6)

Answer 32

1. hospice consultant 2. community palliative care nurse specialist 3. hospice out of hours advice phone line 4. GP 5. district nurse 6. Community OT

Question 33

Describe the following strategies at implementing waiting times: 1. Targets 2. Choice and Competition 3. Prioritisation

Answer 33

1. agree on a maximum waiting time; monitor whether services are meeting this and apply sanctions to those who are not 2. if a patient is waiting longer than the maximum waiting time, they can go elsewhere, including private, at the expense of the original provider 3. you are seen sooner if your condition is more serious

Question 34

1. Why are waiting lists important? (5) | 2. Why are waiting lists a problem? (2)

Answer 34

``` 1. patients condition may deteriorate whist waiting; effectiveness of proposed treatment may be reduced experience of waiting can be distressing adverse effects on family life adverse effects on employment inefficiencies in healthcare system ``` 2. major source of dissatisfaction used to prioritise patients which raises ethical issues

Question 35

1. What is the maximum waiting time for non-urgent, consultant led treatments? 2. what is the sanction of this target is breech? 3. Name 5 instances where this sanction doesn't apply 4. What is the maximum waiting time for suspected cancer? 5. What is the waiting time for admission, transfer or discharge from A&E?

Answer 35

1. 18 weeks 2. reduction of up to 5% of revenues 3. patient choses to wait longer delaying start of treatment is in best clinical interests clinically approrpate for condition to be actively monitored in secondary care without clinical intervention DNA treatment is no longer necessary 4. 2 weeks 5. 4 hours

Question 36

1. What was the Targets and Terror Policy? | 2. Name 5 problems with this policy

Answer 36

1. Hospitals receive an overall performance score, and managers could lose their jobs if targets are missed. 2. - sacrifice to professional autonomy - unmeasured performance suffers - adverse behavioural responses (e.g. patients waiting in ambulances as they technically haven't been admitted yet) - data manipulation - mis-prioritisation (target has already been missed, so patient stays on waiting list)

Question 37

1. What is "Duty of Care" | 2. What is "negligence"

Answer 37

1. legal obligation imposed on an individual requiring adherence to a standard of reasonable care whilst performing acts that could foreseeable harm others 2. failure to exercise the care that a reasonably prudent person would exercise in like circumstances