Management

Question 1

Framework for Management

Answer 1

SPIES
S - Seek information
P - Patient Safety
I- Initiative
E - Escalate
S- Support

Question 2

Patient wishes to make a complaint

Answer 2

• Patient advice liaison service (PALS) offers advice to patients on making complaint
• Free to do so

Question 3

Duty of candour

Answer 3

Duty of healthcare professionals to

• Inform patients of mistakes
• Apologise for such mistakes

Question 4

WHO Surgical Checklist

Answer 4

Pre-anaesthetic

Before skin incision

Before patient leaves theatre

Question 5

Preparing a patient for theatre

Answer 5

Mark
Consent
Fasted
Pre op investigations (inc. ECG)
Bloods inc. Group and Save x 2
Discussed with anaesthetist
Booked

Question 6

NCEPOD Stands for?

Answer 6

National Confidential Enquiry into Peri-operative Deaths.

Question 7

CEPOD Categories

Answer 7

Immediate

Urgent

Expedited

Elective

Question 8

Probity

Answer 8

Being honest, acting with integrity

Question 9

Define Bullying

Answer 9

Where a person or group abuse a position of power over another person leaving them feeling hurt, powerless or angry

Question 10

Examples of bullying

Answer 10

Aggressive behaviour
Exclusion from activity or events
Malicious rumour
Aggressive or rude communication

Question 11

Unlawful victimisation

Answer 11

Where someone is treated unfairly or less favourably because they asserted their rights e.g. making a complaint

Question 12

Examples of unlawful victimisation

Answer 12

Refusing requests
Blocking career progression
Refusing training
Subjecting a person to unwarranted disciplinary action

Question 13

Age of consent

Answer 13

16

Question 14

Can someone under 16 consent?

Answer 14

Yes, they may have capacity depending on ability to understand the information given.

Question 15

Gillick Competence

Answer 15

Related to giving contraceptive advice to under 16s in 1982 leading to Fraser Guidelines

Question 16

Fraser Guidelines

Answer 16

Doctor can give advice and treatment provided:

• Patient (although under 16) will understand advice
• Cannot persuade her to inform parents or allow the doctor to do so
• Likely to continue having intercourse
• That unless contraceptive advice is given patient mental or physical well being will suffer
• Best interests require advice with or without parental consent

Question 17

DNACPR

Answer 17

Not to attempt CPR
Applies to scenario where patient “heart stops”
Up to that point patient given treatment that is felt provides benefit for them

Question 18

Can family’s refuse DNACPR

Answer 18

No, decision lies with medical team but best practise is for family to be kept informed of decision
Ultimately rests with the patient if they have capacity to have such discussions

Question 19

Capacity

Answer 19

Presumed in all adults

• Ability to retain Information
• Understand the information
• Weigh up options
• Communicate

Question 20

How often can a patient self discharge?

Answer 20

As often as they wish, ultimately
Important to treat the patient the same way and not to feel unwelcome
Explore why patients self discharge

Question 21

Why might patients self discharge?

Answer 21

Fear
Anxiety
Drugs and alcohol

Question 22

Safety check pre-op?

Answer 22

WHO Checklist
Can identify concerns pre-op, identify patient and operation to be undertaken
Can voice concerns
Equipment check done by scrub nurse towards end of op
Sign out at the end

Question 23

Drunk Colleague?

Answer 23

S - Witnessing provides enough information
P - Remove from the clinical area, quiet room, with supervision. Check any patients he may have come into contact with.
I - Contact consultant on call, or clinical director. Provide consultant water, and find a way to get them home safely
E - Escalate to appropriaste level as before
S - May need support, need to explore why event occurred, may need counselling

Question 24

Colleague in the mess - White powder falls out of pocket

Answer 24

S - What exactly is substance, if concerned and feel not innocent, raise with seniors early to investigate.
P - Patient safety is at stake hence the need to investigate and clarify what is going on
Does this affect colleagues performance

Question 25

Colleague has been late every day for past 4 days

Answer 25

S - Discuss with colleague. Anything causing them to be late. Transport issue? Personal problems? Burnout? P - May not impact patients so early, but may hinder the on call team, patient information isn't being handed over effectively. may be some night issues, may be patients waiting to be seen, puts strain on other members of team I - Help cover initially. Discuss with colleague and find alternatives. E - Escalate to senior if concerned, also discuss any change in plans or accommodating features, perhaps discuss with rota coordinator S - Colleague may need support either via supervisor or counselling if personal problem, may need amended hours, colleagues can help temporarily

Question 26

Consequence of Going against parent wishes

Answer 26

* Damage to doctor patient relationship * Need to emphasise that was in patient best interests * Ongoing communication needed

Question 27

When is a child competent to refuse treatment?

Answer 27

* Complex * Refusal under age 18 not necessarily binding * Legal advice should be sought * If life at stake can still be given * Balance of treatment vs. irrevocable damage of doctor patient relationship

Question 28

Consent form 1

Answer 28

Patient agreement to investigation or treatment (full capacity)

Question 29

Consent form 2

Answer 29

Parental agreement to investigation or treatment for child Can be signed by child themselves

Question 30

Consent form 3

Answer 30

Form for patient/parental agreement to investigation or treatment where consciousness NOT impaired i.e. procedure where anaesthetist is not present

Question 31

Consent form 4

Answer 31

Best interest decision Treatment or intervention for patients unable to provide consent

Question 32

Forms of abuse

Answer 32

- Physical - Emotional - Psychological - Financial - Neglect

Question 33

Define research

Answer 33

- Seeking new knowledge - Helps establish best practice - Develop new standards of treatment

Question 34

Breaking Confidentiality

Answer 34

- Sharing with other healthcare professionals - Clinical Audit - Disclosures required by law - Court order - Disclosure to statutory regulatory body - Public Interest e.g. HIV, Epilepsy + Driving - Treatment of Child - Abuse or neglect of incompetent person

Question 35

GMC Guidelines on handling Patient information

Answer 35

1) Patient involvement 2) Share the minimum necessary 3) Manage and protect information 4) Comply with the law 5) Ask for consent 6) Support patients in accessing their information 7) Share information for direct care 8) Be aware of responsibility

Question 36

IMCA

Answer 36

Independent Mental Capacity advocate

Question 37

Role of IMCA?

Answer 37

Represent patient regarding decisions in which they lack capacity when there is nobody independent of service available e.g. family member

Question 38

Qualities of a good leader

Answer 38

- Drive change - Inspiring - Managerial ability - Listen to feedback - Approachable - Act with integrity

Question 39

Examples of good leadership

Answer 39

Major trauma call - Vocal - Delegated - Formulated a management plan quickly - Took control of the situation and acted quickly based on the situation

Question 40

Examples of poor leadership

Answer 40

- See multiple examples in small ways rather than one big example - Quiet - Does not receive comments well - Unwilling to relinquish managerial control - Unable to remain calm under pressure