MH/Ethics/law/clinical governance Flashcards
(169 cards)
1
Q
What is a notifiable safety incident?
A
Unexpected event that occurs during provision of activity regulated by the CQC and may/has resulted in moderate harm or greater
2
Q
If under 16 years who should be notified of a notifiable safety incident?
A
NOK
3
Q
What are the NHS Never Events?
Surgical = 3
Medical = 6
General = 5
A
Surgical:
1. Wrong site
2. Wrong prosthesis
3. Retained foreign object
Medical:
1. Mis-selection of high strength K+
2. Mis-selection high strength midazolam for sedation
3. OD insulin due to abbreviations or incorrect device
4. OD methotrexate
5. Giving medication via wrong route
6. Unintential of patient requiring 02 to air
General:
1. Fall from poorly restricted window
2. Neck entrapment in bed rail
3. Scalding of patient
4. Transfusion of ABO incompatible blood/organ
5. Misplaced NGT/OGT
4
Q
What is the exception to accidental use of high strength midazolam being used in sedation being a never event?
A
Unless used in area where use of high strength midazolam appropriate and been formally risk assessed in organisation
5
Q
Describe the timeline for incident reporting (PSIRF)(4)
A
- Formally report incident - <2 days
- Ensure level of investigation determined < 3 days
- Investigation concluded < 60 days
- Commissioner review report and action plan < 20 days
6
Q
What is the name of the framework to report never events
A
Patient Safety Incident Response Framework (PSIRF)
7
Q
What are the 7 pillars of clinical governance?
A
- Service user involvement
- HR management
- Personal and professional development
- Clinical effectiveness
- Clinical audit
- Clinical information management
- Risk management
8
Q
What 3 features does the Healthcare Quality Improvement Partnership used to define ‘quality’ with respects to an organisation?
A
- Clinical effectiveness
- Patient safety
- Patient experience
9
Q
If an adult patient lacks capacity to consent to a study what is the law?
A
- Doctor not involved in research, or research ethics committee, can provide consent for a process to follow.
- If time allows seek consent from NOK/POA
- Must seek consent retrospectively
10
Q
What is the law regarding consent into research trials in children?
A
- Non-urgent consent from parents and if child has capacity should be included as well
- Emergency/time critical consent can be gained from child and retrospective consent obtained from parents
- If parents non contactable/child no capacity then treatment can be given if research ethics committee approval in place
11
Q
What are the 5 domains of the Clinical Leadership Competency Framework, as set out by the NHS Leadership Framework?
A
- Demonstrating professional qualities
- Work with others
- Managing services
- Improving services
- Setting direction
12
Q
What 5 questions do the CQC ask when assessing a service?
A
- Are they safe?
- Are they effective?
- Are they caring?
- Are they responsive to peoples needs?
- Are they well led?
13
Q
What is the name of the test to determine negligence?
A
Bolam test/principle
14
Q
What are the 3 things that must be proven to show negligence?
A
- Medical professional owed a duty of care to that patient
- Care patient received is cause of the harm that occured
- Standard of care falls below that of a reasonable body of peers (Bolam test)
15
Q
What are the 3 aspects of the Good Samaritan act that need to be considered?
A
- Whether individual was acting for the benefit of society
- Whether the individual demonstrated a responsible approach towards protecting the safety or interests of others
- Whether the individual was acting heroically by intervening in an emergency to assist a person who is in danger
16
Q
What is a ‘risk owner’ in an organisation?
A
Responsible point person for an individual risk. Will report to a trust board who are responsible for providing leadership on the management of all risk within an organisation
17
Q
What is the responsibility of the ‘risk owner?’
A
- Identify risk
- Assess risk
- Mitigate risk
- Record risk in the risk register
18
Q
What are the stages of a generic risk assessment?
A
- Identify risk
- Identify who would be harmed
- Decide how likely this is
- Decide level of harm
19
Q
What are the parts of the Quality Governance Framework? (4)
A
- Strategy - quality should drive strategy and management aware of risks to quality
- Capabilities and culture - promotion of quality focused culture and development of quality leadership/skills/knowledge
- Processes and structures - roles and accountability within quality governance, defined processes for escalating quality issues and engagement with stakeholders
- Measurement - information regarding quality should be reviewed and challenged and used effectively
20
Q
Describe the cultural practices re: death in the Hindu community (3)
A
1 Bereavement last 2 weeks
2. Cremated
3. PPM okay
21
Q
Describe the Jewish communities beliefs around death (3)
A
- Chevra Kadisha (Holy Brotherhood) informed immediately of death and will arrange funeral
- Funeral ideally before sunset on day of death but body will not be moved on the Sabbath
- PPM not allowed unless legally required
22
Q
What are muslims beliefs about organ donation/transplant/blood?
A
Should consult Imam
23
Q
If a muslim is dying, what should be ensure? (3)
A
- Face towards Mecca
- Head above rest of body
- Should say prayers if able
24
Q
What are muslim customs around death? (4)
A
- NOK/community will make arrangements for buriel
- Burial ASAP, < 24 hours ideal
- No PPM unless legal requirement
- Many mosques have private mortuaries which can be used in emergencies
25
What are the 5 K's in Sikhism?
1. Kesh (uncut hair;)
2. Kangha (a comb to keep the hair neat)
3. Kara (a steel bangle which symbolises the unity of God);
4. Kirpan (a short dagger which symbolises the readiness of the Sikh to fight against injustice)
5. Kachhera (breeches or shorts to symbolise modesty).
26
What should be kept in mind when removing clothes from a Sikh patient?
The Kachhera (Shorts) should only be removed by the patient if at all possible
27
What are Sikh customs with regards to death?
1. 5 K's should be kept on the body and cleaned if possible
2. Deliberate expression of grief discouraged
3. Cremation not burial
4. No specific time limit to cremation
5. Ashes may be placed in flowing water (Ganges is the ideal)
28
What products are the MHRA responsible for?
Statutory responsibility for safety of:
1. Medicines (inc. herbal)
2. Medical devices (inc second hand)
3. Blood and blood products
29
What does the MHRA do? (4)
**Regulation**: The MHRA regulates medicines, medical devices, and blood products to ensure they meet required standards of safety, quality, and efficacy before they can be marketed.
**Licensing**: Reviews and grants licenses for new medicines and medical devices
**Surveillance**: The MHRA monitors the safety of medicines and medical devices on the market, collecting data on adverse effects and taking action when necessary (can force withdrawal of products)
**Research and Development**: Gives permission for clinical trials relating to safety of new meds
30
How is a drug/device shown to be new by the MHRA?
Black triangle symbol
31
What information is required to report a medication/device using the yellow card scheme? (4)
1. Side effects
2. Age/sex/initials of patient
3. Name of meds/device
4. Reports full name and address
32
What are SABRE and SHOT and what is the difference between them?
Serious Adverse Blood Reactions Events:
MHRA system for mandatory reporting of adverse blood events
Serious Hazards of Transfusion:
Not mandatory and run by NHS Blood and Transplant Service
33
What is the Defective Medicine Report Centre?
Part of MHRA - minimises harm to patient once defective medicine has been distributed
34
What are the 4 class of recalls and timeframes used by the Defective Medicine Report Centre?
Class 1/ National Patient Safety Alert. Immediate Action required - included OOH, National Patient Safety Alert issued
Class 2. Action required within 48 hours - pharmacy and wholesale level recall
Class 3. Action required within 5 days - pharmacy and wholesale level recall
Class 4. Information only - caution in use, defect information distributed to wholesalers and pharmacies.H
35
If breaking confidentiality when should we not inform the patient?
If impracticle or would undermine the reason for disclosure
36
What are the 4 legal justifications for breaking confidentiality? (4)
1. Disclosure is required by law, including by the courts
2. Patient has given explicit consent
3. Disclosure approved through a statutory process that sets aside the common law duty of confidentiality
4. Justified in the public interest
37
What information does the Road Traffic Act state we should give the police?
Information to help identify driver (only)
38
In what 2 circumstances is it an offence not to disclose information about a patient to police?
1. FGM < 18 yrs
2. Anything of 'material assistance' in preventing terrorism
39
Which knife + gunshot wounds should be reported to police?
1. All gunshot wounds including accidental (issues around responsible gun license)
2. Knife wounds from an attack - not self harm or accidental
40
Who do HCPC represent? (15)
1. Arts therapists
2. Biomedical Scientists
3. Chiropodists/Podiatrists,
4. Clinical Scientists
5. Dieticians
6. Hearing Aid Dispensers
7. Occupational Therapists
8. ODPs
9. Orthoptists
10. Paramedics
11. Physiotherapists
12. Pyschologist
13. Prosthetists/Orthotists,
14. Radiographers
15. SALT
41
What is the mandate of the GMC? (5)
1. Set standards of patient care and professional behaviours
2. Ensure education and training good enough
3. Check eligibility / continue to meet requirements
4. guidance to help understand what’s expected
5. investigate where there are concerns that patient safety
42
Who do GMC cover?
Doctors
PAs
Anaesthesia Associates
43
Who governs JRCALC?
Association of Ambulance Chief Executives [AACE]
44
What are exclusive and inclusive trauma networks?
Exclusive = all patients with major trauma go to MTCs and bypass TUs e.g. London, shown to increase survival
Inclusive = larger geographical area/transfer times mean use all 3 tiers of trauma centre. If trauma +ve but >45mins (not hard rule) away will go to TU if needs treatment 'right patient/right time/right care
45
When must HEMS clinicians disclose pregnancy to their employer by law?
At least 15 weeks before baby born
46
Describe the College of Paramedics tier of career progression
Tier 1 Paramedic (BSc)
Tier 2 Specialist & Enhanced Paramedic / Manager (Dip)
Tier 3 Advanced Paramedic (MSc) / Senior Manager
Tier 4 Consultant (PhD)
47
If resusitation is terminated of a child who has been assaulted and the police do not want the body to be conveyed, what is the guidance?
If crime scene declared, leave child at home and inform ambulance control
48
In terms of data protection what is a:
1. Controller
2. Processor
3. Joint controllers
4. Sub-processor
5. Sponsor
1. Person/agency that determines the purposes and means of the processing of personal data.
2. Person/agency that processed personal data on behalf of the controller.
3. Two or more controllers jointly determine the purposes and means of
processing
4. Processor who wishes to sub-contract processing to another processor.
5. Determines what data is collected for the research study, acts as the controller in relation to the research data.
49
Which religion would want minimum handling of a body post death?
Buddhism - family members may request that the body is not touched during this period and that it is available to them to perform religious rights.”
50
What is the defining characteristic of a CCP?
Completed a Masters
51
What is the greatest threat to a lone work?
Physical and verbal abuse
52
What is Lean process?
Lean uses process mapping with associated stakeholders to identify inefficiencies in care, enabling actions for improvement.
53
What type of QIP design works in partnership with patients and families to improve services from their perspective.
Experience Based Co-Design (EBCD)
54
What is are run charts and statistical process charts used for?
Plots data over time in order to show the effect of interventions
55
What is the difference between run charts and statistical process charts?
Run charts simply data plotted over time, SPC uses statistical processes as well.
56
What is a SWOT analysis?
Strengths
Weaknesses
Opportunity
Threats
57
What is a forcefield analysis?
Method of establishing the drivers and resistors for change (and the magnitude), to assist with planning of change process
58
What is a Ishikawa (Fishbone) diagram? What are the 6 factors it looks at?
- Visual representation of causes and sub-causes and what actions could be considered to affect change (or could have led to an error)
- includes:
1. Management
2. Materials
3. People
4. Process
5. Equipment
6. Environment
59
What is the '5 whys' method of root cause analysis?
Ask why 5 times, the answer to the fifth is the root cause
60
What is a PDSA cycle?
Plan
Do
Study
Act
61
Which 2 religions require burial ASAP?
Islam and Judaism
62
What is section 2 MHA?
-Assessment up to 28 days
- Recommendation of 2 doctor and application made by Approved Mental Heatlh Professional (AMHP)
63
What is section 3 MHA?
- Allows treatment for up 6 months
-Recommendation of 2 doctor and application made by Approved Mental Heatlh Professional (AMHP)
64
What is section 4 MHA?
- Emergency power of detention for 72 hours
- Recommendation of 1 doctor and application from AMHP
65
What is section 6 MHA?
Authorises applicant (AMHP) or person authorised by AMHP to take patient to hospital following an application for admission
66
What is section 17 MHA?
Patients permitted to leave from hospital, or to receive treatment in community
67
What is section 18 MHA?
If patient AWOL allows any AMHP/hospital staff/police or anyone authorised in writing by managers of hospital to return patient to hospital
Ambulance staff need written authorisation
68
What is section 135(1)
Warrant allowing police to enter and property and remove patient to a place of safety
69
What is Section 135(2)
Warrant authorised by judge allowing a police offiver to enter a property to retain a pateitn already under MHA
70
What is section 136 MHA?
Allows officers to detain for <24hours for assessment:
-where patient appears to be suffering from mental disorder
-AND needs immediate care/contro
-AND in patients best interests.
Not in patients house/garden
71
What is the acronym for doing a MSE?
ASMPTOI - All Silly Medics Try Psych At Once Indeed
72
What are the parts of the MSE? (7)
Appearance and Behaviour
Speech
Mood (both subjective and objective)
Thoughts
Perception e.g. delusion/paranoia
Cognition and Orientation
Insight
73
Which risk assessment tool do NICE advise for suicide?
None
74
What are the 5 P's for risk assessment?
1. Presentation
2. Precipitating factors
3. Perpetuating factors - any ongoing stressors
4. Predisposing factors - FHx. PMHx, Psych hx, social, trauma
5. Protective
75
To what age does the MHA apply?
>16 years
76
What are the 5 key principles of capacity?
1. Assumed capacity
2. All practical steps to help make decision should be made
3. Unwise decisions allowed
4. In patients best interests
5. Least restrictive option
77
What is the definition of lacking capacity?
Unable to make decision for themselves in relation to the matter because of an impairment/disturbance in functioning of the mind
78
When deciding capacity what 4 components should be explored?
1. Time of decision
2. What is the decision
3. Functional test - can they make the decision?
4. Diagnostic test - what is the cause of the impairment/disturbance in functioning of the mind?W
79
What are the parts of the functional test re:capacity?
1. Can they understand information?
2. Can the retain information?
3. Can they weigh up the information?
4. Can they communicate that decision?
80
For an advanced decision to refuse treatment (ADRT), what is needed for it to be valid? (4)
1. Written down
2. Signed by patient
3. Signed by witness
4. > 18 years old
81
Where is LPA recorded?
Office of Public Guardian
82
For LPA to refuse life saving treatment what must be present?
It must have been specifically expressed within authorisation
83
What is the 'acid test' that decides whether a patient is experiencing deprivation of liberty? (2)
1. Are they under continuous supervision/control?
AND
2. Are they free to leave
84
What is the age of:
- consent
- refusing treatment
1. >16
2. >18
85
What 3 parts of law apply to paediatric consent and to what age do they apply?
1. Childrens Act 1989 = < 18yrs
2. Family Law Reform Act 1969 = <16
3. Gillick Competence = no age
86
What are the component parts of AMTS?
What is your age?
Was is your DOB?
What is your address?
What is the year?
Who is the prime minister?
What is the time?
Where are we now?
What is my job?
39 Donnybrook road
Count backwards 20-1
Remember address
87
What is the JRCALC basic suicide assessment risk tool?
IPAP
Intent - still having intent
Plan - do they have a plan
Action - have they carried out anything in preparation
Protective factors
88
What is the mortality of ABD and CV collapse?
10%
89
What factors are associated with an increased frequency of ABD? (3)
1. Male
2. Summer months
3. Stimulant drugs
90
What does 1. NICE and 2. RCEM recommend for rapid tranquilisation.
1. IM lorazepam first line, IM haloperidol and promthezine if no QT prolongation
2. Ketamine IM/IV or droperidol
For exam go with NICE (RCEM in hospital)
91
What do they use in police custody for ABD?
PO lorazepam
92
What do NICE state is the maximum time for physical restraint?
10 mins
93
If physically restraining someone what should be done/avoided? (5)
1. < 10 mins
2. Little force as possible
3. Not prone
4. Avoid airway/chest
5. Have member of staff observing patient (obs/breathing) not involved in restraint. Can reassure patient simultaneously.
94
Describe the SADPERSONS risk assessment tool?
Sex (1pt)
Age 15-15 or >59 (1pt)
Depression (2pts)
Previous suicide attempt (1)
Excess drugs/-OH misuse (1)
Rational thinking loss (2)
Singe/widowed/divorced (1)
Organised/serious attempt 2)
No social support (1)
Stated future attempt (2)
95
What is conisdered:
1. low
2. medium
3. high
risk SADPERSONS score
1. 0-5
2. 6-8
3. >8
96
What pain score is used in non-verbal adults?
Abbey Pain Score
97
At what age does the mental capacity act apply?
16 or over
However parents can over-rule 16-17 yr olds refusing tx if in their best interests.
98
What are the key points from the JRCALC ABD guideline? (4)
1. Verbal de-escalation usual enough
2. Clinical emergency - CV collapse can occur. Needs time critical transfer and pre-alert
3. Once identified ABD request extra clinical support
4. Early management for hyperthermia/hypovolaemia and acidosis with IVI and oxygen
99
Can ambulance staff apply physical restraint if needed?
Yes
100
What is recommended with regards to the management of ABD in police custody? (faculty of forensic and legal medicine
1. Should not be taken custody
2. Take to ED if develops whilst in custody
3. Oral sedation offered (1-2mg lorazepam with HCP present whilst awaiting ambulance ('pre-rapid tranq, pre-RT')
4. Not IM/IV medications
101
Which of the following does not classically present with visual hallucinations?
1. Acute mania
2. Temporal lobe epilepsy
3. Drug induced psychosis
4. Serotonin syndome
5. Neuroleptic malignant syndrome
NMS - can occur but not classic
(previous question)
102
What agents do NICE recommend for rapid tranquilisation?
1. IM lorazepam
2. IM haloperidol + promethazine second line (not if no ECG/QTc not known)
103
How does GMC define EOL?
Likely to die in next 12 months
104
What is the definition of death?
Irreversible loss of capacity of consciousness and breathing, therefore of cessation of integrative function of brainstem.
105
What can / cannot be done pre-hospital in terms of organ donation?
Unable to initiate organ donation as death certificate cannot be issued immediately
However, tissues maybe viable for up to 48 hours and this can be initiated by coroner
106
What law imparts a duty upon care providers to safeguard vulnerable adults from abuse or neglect?
The Care Act 2014
107
What does the Sexual Offences Act 2003 state with regards to carers/clients?
A sexual relationship between carer and a client with mental health issues a criminal offence, regardless of consent.
108
What are the six principles of adult safeguarding are:
1. Prevention
2. Protection
3. Partnership
4. Proportionality
5. Empowerment
6. Accountability
109
What does 'CE' stand for when placed on products?
European conformity (Conformité Européenne)
110
Describe the phases of clinical trials
I SWIM
0 - Initial = pharmacokinetics/dynamics
- small group healthy volunteers
1 - Safe?
= safe maximum dose
< 100 health volunteers
2 - Works? (efficacy)
> 100 patients with disease
3 - Improvement?
-Assess efficacy, effectiveness and safety
- 300-3000 patients with disease
- informs labelling
4 - Marketing suitability - post-marketing surveillance
111
How long do new chemicals/vaccines need a black triangle to show they are new?
2 years
112
Re: yellow card scheme
1. Why was it created?
2. How many reports to the get a year?
3. Can patients report to it?
4. Are herbal medicines included?
1. After the thalidimide disaster
2. 20,000
3. yes
4. yes
113
What are schedule 1 drugs?
Illegal drugs
114
What are schedule 2 drugs?
1. High strength opiates
2. Ketamine
3. Cocaine
115
What are schedule 3 drugs? (6)
Tramadol
Buprenorphine (Butec)
Gabapentin
Pregabalin
Midazolam
Temazepam
116
What are schedule 4 drugs?
1. Benzos apart from midazolam and temazepam
2. Zopiclone
117
What are schedule 5 drugs
1. Codeine
2. Most other drugs
118
Broadly speaking what are:
1. Schedule 17 drugs
2. Schedule 19 drugs
1. Drugs that paramedics can give
2. Drugs EMTS can give, and members of public, IM meds
119
What are the schedule 19 drugs (broadly)? (7)
1. Antidote or CBRN meds
2. Glucose IM
3. Glucagon IM
3. Adrenaline 1:1000 IM
4. Hydrocortisone IM
5. Chlorphenamine IM
6. Promethazine IM
120
What is the regulation that governs paramedics administering meds?
Schedule 17, Part 3 of Human Medications Regulations
121
What are the schedule 17 medications? (22)
1. Gelatin 4% i
2. Sodium chloride
3. Hartmanns
4. Glucose
5. Furosemide
-
6. Diazepam 5 mg per ml emulsion for injection
7. Morphine
8. Nalbuphine hydrochloride
9. Naloxone
-
10. Syntometrine
11. Ergometrine
12. Adrenaline
13. Amiodarone
-
14. Metoclopramide
15. Ondansetron
16. Paracetamol
-
17. Benpen
18. Heparin (cannula flushing
19. Lidocaine
-
20. Reteplase
21. Streptokinase
22. Tenecteplase
122
What drugs can midwives give via schedule 17? (5)
1. Vit K
2. Diclofenac
3. Hydrocortisone
4. Miconazole
5. Nyastatin
123
What drugs can podiatrists give via schedule 17? (6)
1. Codeine (any formulation)
2. Amoxicillin
3. Flucloxicillin
4. Erythromycin
5. Antifungal creams
6. Steroid creams
124
What are class A drugs (misuse of drugs act)? (8)
1. Cocaine
2. Any strong opiate
3. MDMA ("ecstasy")
4. methamphetamine
5. opium
6. LSD
7. hydrocodone
8. magic mushrooms
Any class B drug that is prepared for injections becomes a class A substance
125
What are clas B drugs? (misuse of drugs act) (7)
1. Cannabis/cannaboids
2. codeine
3. amphetamine
4. ketamine
5. barbiturates
6. mephedrone,
7. GHB, and GBL.
Any class B drug that is prepared for injections becomes a class A substance.
trolled under the Psychoactive Substances Act 2016 and Medicines Act 1968.
126
What are class C drugs ?(6)(misuse of drugs act)
1. Benzodiazepines
2. pregabalin, and most other non-barbiturate tranquillisers
3. gabapentin
4. tramadol
5. anabolic steroids
6. nitrous oxide
127
Where are all other psychoactive drugs not mentioned in Class A, B + C legislated, and what are the exceptions?
1. Controlled under the Psychoactive Substances Act 2016 and Medicines Act 1968.
2. Alcohol/caffeine/tobacco
128
If there is faulty equipment on an ambulance, who should it be reported to?
1. Ambulance service provider
2. Health and Safety Executive if serious
129
What does the Professional Standards Authority for Health and Social Care (PSA) do?
Regualtes all ten statutory bodies in health/social care e.g GMC/GDC/HCPC etc/
130
What does the MHRA state should be provided with second hand medical devices? (8)
1. Clear statement that the device is being resold/donated
2. Certificate of decontamination
3. The user manuals and training requirements
4. Full details of maintenance and servicing requirements
5. Service history and manual
6. Usage history
7. Quality assurance test details
8. Safety updates, including MHRA and manufacturer’s documents that have been released since the medical device was first supplied.
131
What year did TARN date collection start?
1989
132
Over what number of staff must a healthcare business appoint a CD Accountable Officer? (CDAO)
> 10 staff
133
What are the requirements to be a CDAO? (3)
1. Must be a senior manager
2. Must be employed by organisation
3. Must not regularly prescribe, supply,
administer or dispose of controlled drugs
134
Who needs to be aware of who is the CDAO and is responsible for keeping a list of all CDAOs in country?
CQC
135
What is the CDAOs responsibilities? (9)
1. Ensure the safe and effective use and management of CDs organisation
2. Ensure monitoring and auditing of the management and use of CDs
3. Maintain a record of concerns regarding relevant individuals,
4. Investigate any concerns
5.Take appropriate action if there are well-founded concerns;
6. Establish arrangements for sharing information
7. Produce quarterly reports of CD occurrences
8. Ensure adequate and up to date (SOPs) are in place
9. Ensure adequate destruction and disposal arrangements for CDs
136
What should occur is there are concerns re: CD management?
1. Inform CDAO within 48 hours
2. They will arrange investigation
3. Can then recommend training/edudcation/support
4. More serious concerns = regulatory body, CQC, NHS protect or police as appropriate
137
What drugs need a CD register?
Schedule 2
Schedule 3 if following a risk assessment felt to be high risk
138
How long should a CD register be kept for?
2 years
139
How long should CD invoices be kept for?
6 years
140
How should CDs be wasted?
1. Witnessed by someone appointed by CDAO
2. Can't be CDAO or involved in the day to day use of CDs in the organisation
3. All CDs in Schedules 2, 3 and 4 (part 1) should be denatured before being placed into waste containers.
141
What is recommended with regards to CD checks?
2 people ideally to check but not mandatory
142
When must movement of CDs be recorded by?
< 24 hours
143
What must a CD register include? (3)
1. Be bound
2. Have separate sections for each class of CD and within this each formulation and strength should be recorded on a separate page
3. Have the name, form and strength of the drug specified at the top of each page.
144
Where should a CD register by kept?
On the premises
Not in CD cupboard but close by
145
How should entries into CD register be made? (4)
1. Chronological order
2. Made within 24 hours
3. Be indelible (any errors should be left visible and the correction made should be signed and dated in the margin - no tippex)
4. Show the strength and form of the preparation at the top of each page
146
Which drugs need a witness when being wasted?
Schedule 2 (but good practice for 3)
147
What are the regulations for CD safes? (3)
1. Secured to a wall and fixed with bolts that are not accessible from outside the cupboard
2. Fitted with a robust multiple point lock (or be a digital code),
3. Made of metal with strong hinges and the walls of the room should be of a suitable thickness so that the cupboard is fixed securely
148
Which schedule 3 drugs must be kept in CD cupboard? (2)
Temazepam
Bupronorphine
149
Who should all SUIs be reported to?
NPSA
National Patient Safety Agency (set up to look at lessons learnt)
150
Which schedule 2 and schedule 3 drugs can be administered using PGD?
Schedule 2: morphine/diamorphine/ketamine
Schedule 3: midazolam (not tramadol)
151
Leadership Qualities Framework domains; which one does Continuous Personal Development (CPD) come under
Demonstrating personal qualities
152
What are the advantages of pre-filled syringes? (AABGI)
1. Reduction in labelling errors
2. Reduction
in bacterial contamination
3. Potential for tamper evidence
4. Potential for medication recognition mechanisms.
153
How can medications be stored to limit potential drug errors? (AABGI) (4)
1. Store medications according to their pharmacological
group (as mistakes
within a group are likely to be less consequential than
those involving a different group), and alphabetically
within groups
2. Standardise concentrations
3. Standardise ampoule size,
4. Supply standard ISO 26825-compliant medication
labels
154
What are the 6 step to drawing up medication recommended by AAGBI?
1. Select
2. Prepare
3. Check and draw up
4. Label
5. 2 hand check
6. Retain
155
What equipment on an ambulance is within the remit of the MHRA? (not exhaustive) (3)
1. Stretchers
2. trolleys
3. defibrillators
156
Within an organisation, what role is specifically appointed to managed the safety of equipment?
Medical Device Safety Officer? (MDSO)
157
When receiving new equipment, what does the MHRA recommend checking? (5)
1. Expiry dates are clearly shown on packaging, as required
2. Appropriate marking for tracing lots, if there is a recall or modification required
3. Instructions and safety information are available, as necessary
4. Packaging is appropriate for storage
5. Environmental conditions for storage are clear.
158
What does the MHRA mandate is present with all second hand medical devices? (7)
1. Record of any reconditioning work carried out, including a record of replacement
parts
2. copy of all maintenance and servicing including the
name of the maintenance/servicing organisation
3. Record, type and frequency of usage over its working life
4. Fault log
5. Record of decontamination status
6. date of installation
7. Technical information supplied by the manufacturer
159
What are the criteria for diagnosis of PTSD?
A – exposure to actual or threatened death, serious injury or sexual violence
And
B presence of intrusion symptoms – re-experiencing
C- persistent avoidance of stimuli assoc with traumatic events
D – negative alterations in cognition or mood eg dissociative amnesia, numbing etc
Chronic is more than 3 months duration
Needs to have been present for at least 1 month
160
What is Article 8 of Human rights Act?
Right to privacy
161
Which article of Human Rights Act guarantees privacy?
8
162
Which protected characteristic can you discriminate against if you can demonstrate it is a proportionate means of meeting a legitimate need?
Age
163
What are the roles of a charity trustee? (6)
1. Ensure charity is carrying out its purposes for the public benefit
2. Comply with your charity’s governing document and the law
3. Act in charity best interest
4. Manage charity resources responsibly
5. Act with reasonable care and skill
6. Ensure charity is accountable
164
What section of mental capacity act relates to LPA?
Section 9
165
What is the max dose of lorazepam PO can be given in custody?
4mg
166
How regularly can lorazepam be offered in custody?
Dose - 60 mins - 2nd dose - 120 mins - 3rd dose
167
What 3 features are present in ABD?
1. Tactile hyperthermia
2. Contact or near constant physical activity
3. Extreme agitation / agression
168
What is recommended for a key safe for a CD cupboard key? (3)
1. Steel sheet at least 3mm thick
2. Combination lock without a separate key override
3. Secured by internal bolts to a solid wall.
169
What are the 'protected characteristics' re: discrimination? (9)
1. Age
2. Gender reassignment
3. Being married or in a civil partnership
4. being pregnant or on maternity leave
5. disability
6. race including colour, nationality, ethnic or national origin
7. religion or belief
8. sex
9. sexual orientation
