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3A > Public Health 3 > Flashcards

Public Health 3 Flashcards

1
Q

Error

A

Unintended outcome

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2
Q

Why is safety in healthcare so often compromised?

A

Complex
High-risk environment
Resource intensive

System, patient and practitioners’ interactions
Shared responsibilities
Practitioners unknowingly take risks

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3
Q

Common issues leading to accidents and safety in healthcare?

A

Wrong diagnosis = Wrong plan

Medication reconciliation
High concentration medication

Patient identification
Patient care handovers

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4
Q

Classification of errors

A

Based on intention
Based on action
Based on outcome
Based on context

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5
Q

Error based on intention

A

Failure of planned actions to achieve desired outcome

Skill-based errors - Action made was not intended
Rule-based mistakes - Incorrect application of a rule
Knowledge-based mistakes

Limited attentional resources
Memory containing mini-theories rather than fact

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6
Q

Error based on action

A

Generic factors

  • Omission
  • Intrusion
  • Wrong order
  • Mistiming

Task specific factors

  • Wrong vessel/organ/side
  • Bad knots
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7
Q

Error based on outcome

A 
Near miss 
Successful detection and recovery 
Death/injury or loss of function 
Prolonged intubation - ICU 
Cost of litigation 
Unplanned transfer
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8
Q

Error based on context

A

Anticipations and perseverations
Interruptions and distractions

Team factors
Organised factors
Equipment and staffing issues

Nature of procedure

Accumulation of stressors

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9
Q

Person approach to error

A

Focus on the individual

  • Error are the product of wayward mental processes
  • Focuses on unsafe acts of people on the front-line
  • Shortcomings - Anticipation of blame promotes cover-up
  • Requires detailed analysis to prevent recurrence
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10
Q

System approach to error

A

Focus on working conditions

  • Errors are commonplace - The product of many causal factors
  • Remedial efforts directed at removing error traps and strengthening defences
  • Interaction between active failures and latent conditions
  • Protective risk management - Remedy latent factors
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11
Q

Tools of risk identification

A 
Incident reporting 
Complaints and claims 
Audit, service evaluation and benchmarking 
External accreditation 
Active measures/compliance
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12
Q

Never events

A 
Serious 
Largely preventable 
Patient safety incidents 
Should not occur 
IF available preventative measures have been implemented

Surgery - Wrong site, retained item
Medication - Wrong preparation or ROA
Mental health - Suicide

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13
Q

Leadership styles

A

Inspirational
Transactional
Laissez-faire

Transformational - Inclusive leadership is distributed throughout all levels of organisation

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14
Q

Sloth error

A

Not bothering to check results or accuracy of information
Incomplete evaluation
Inadequate documentation

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15
Q

How to prevent sloth errors

A

Conscientiousness

  • Attention to detail
  • Completeness
  • Not assuming all information to be correct
  • Full documentation
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16
Q

Fixation and loss of perspective error

A

Early unshakable focus on a diagnosis
Inability to see the bigger picture
Overlooking warning signs

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17
Q

How to prevent fixation and loss of perspective

A

Open mindedness
Situational awareness

Recognition of clinical patterns
But considering facts that don’t fit

Re-evaluation if deviation from the expected

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18
Q

Communication breakdown error

A

Unclear instructions or plans

Not listening to or considering others opinions

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19
Q

How to prevent communication breakdown error

A

Effective communication

Being approachable and open
Listening 
Clear explanations 
Appropriate terminology 
Reinforcement
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20
Q

Poor teamwork error

A

Team members working independently
Poor direction
Some individuals out of their depth
Staff under-utilised

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21
Q

How to prevent poor teamwork

A

Clear team structure and roles
Sharing views, concerns and management plans
Clear logical leadership

22
Q

Errors which occur by playing the odds

+ How to prevent

A

Choosing the common and dismissing the rare event

Probability assessment!
- Evaluation based on scenario features as well as likelihood

23
Q

Bravado error

+ How to prevent

A

Working beyond your competence or without adequate supervision
A show of confidence to hide underlying deficiencies

Humility!

  • Accurate self-evaluation
  • Open communication of mistakes
24
Q

Ignorance error

+ How to prevent

A

Lack of knowledge
Unconscious incompetence
Not knowing what you don’t know

Self-awareness!

  • Awareness of your own abilities and limitations
  • Considering factors which may affect your judgement - Stress/fatigue
25
Q

Mis-triage error

+ How to prevent

A

Over-underestimating the seriousness of a situation

Prioritisation!
- Appreciate the relative importance of urgency in each situation

26
Q

Lack of skill error

+ How to prevent

A

Lack of appropriate skills, teaching or practice

Effective technical skills - being properly trained!

27
Q

System error

+ How to prevent

A 
Environment
Technology 
Equipment 
Organisational failures 
Inadequate built-in safeguards

System design!

  • Easy to use
  • Design features that identify potential risks
28
Q

Swiss cheese model

A

Organisation’s defence against failure is a series of barriers
Represented as slices of swiss cheese
Holes in each slice represent weaknesses in parts of the system
Weaknesses are varied in size and position

Failure happens when holes from each slice momentarily align
“TRAJECTORY OF ACCIDENT OPPORTUNITY”
Hazard passes through the holes in all slices = Failure!

29
Q

Causes of negligence

A

System failure
Human factors
Judgement failure

Neglect
Poor performance
Misconduct

30
Q

Requirements for negligence to have occurs

A
  1. Duty of care?
  2. Breach in the duty of care?
  3. Did the patient come to harm?
  4. Did the breach cause the harm?
31
Q

Money awarded for negligence claim

A

Loss of income
Cost of extra care
Pain and suffering

32
Q

Different types of learner

A

Theorist - Complex, questions ideas, offers challenges
Activist - Experiences, extrovert, “deep-end”, leader
Pragmatist - Wants feedback, purpose, likes to copy
Reflector - Watches others, reviews work, analysis, collects data

33
Q

Tripartite model approach to learning

A

Surface - Fear of failure, desire to complete a course, rote learning and focus on particular tasks

Strategic - Desire to be successful, leads to patchy and variable understanding

Deep approach - Intrinsic vocational interest or personal understanding - Making links across materials, searching for deeper understanding and general principles

34
Q

Kolb’s learning cycle

A
  1. Experience - Activist
  2. Review and reflection - Reflector
  3. Conclusions - Theorist
  4. What can I do differently next time? - Pragmatist
35
Q

Key responsibilities of small group tutors

A

Managing the group, activities and learning

Facilitator of learning

  • Leading discussions
  • Asking open-ended questions, guiding process and task
  • Enabling active participation of learning
  • Engagement with ideas
36
Q

Fundamental questions to think about when teaching

A

Who - Numbers and level
What - Topic or subject - Type of learning expected
How - Method of teaching
Review - How will I know if students understood?

37
Q

Different question strategies when teaching

A 
Evidence 
Clarification 
Explanation
Linking and extending 
Hypothetical 
Cause and effect 
Summary and synthesis
38
Q

Model used to describe cultural factors

A

Iceberg model of culture

Above sea level - Gender, age, ethnicity

Below sea level…

  • Socio-economic status
  • Occupation and education
  • Health
  • Religion and cultural beliefs
  • Social groupings
  • Sexual orientation
  • Political orientation
  • Expectations and behaviours
39
Q

Why do we need to learn about diversity

A

Better health outcomes for patients

More satisfying doctor-patient encounters

40
Q

Culture

A

Socially transmitted pattern of shared meanings
Communicate, perpetuate and develop knowledge and attitudes

May be based on heritage, individual circumstance and personal choice

DYNAMIC!

41
Q

Ethnocentrism

A

Tendency to evaluate other groups according to the values and standards of your own cultural group

With conviction that your group is superior

42
Q

Stereotype

A

Generalisation

Typical characteristics of members of a group

43
Q

Prejudice

A

Attitude towards another person

Based solely on their membership of a group

44
Q

Discrimination

A

Positive or negative actions towards the object of prejudice

45
Q

Kleinman’s explanatory model of illness

A

What do you call your illness?

What do you think caused it?
Why and when did it start?

What do you think the illness does?
How severe it is? How long does it last?

What kind of treatment do you expect?
What results do you want from the treatment?

What are the main problems caused by the illness?
What do you fear most about the illness?

46
Q

Why have rationing needs increased

A

Shift from acute illness to chronic long-term
Normal physiological events being medicalised
Increased in choice
Increase in price of drugs

47
Q

What is rationing

A

Resource refused due to lack of affordability

Rather than clinical ineffectiveness

48
Q

Allocation theories

A

Egalitarian principles - Provide all care that is necessary and appropriate
- Tension between egalitarian aspirations and finite resources

Maximising principles - Criteria that maximises public utility

Libertarian principles - Everyone responsible for their own health, well-being and fulfilment

49
Q

Rights engaged in healthcare

A

Article 2 - The right to life
Article 3 - The right to be free from inhuman and degrading treatment
Article 8 - The right to respect for privacy and family life
Article 12 - The right to marry and found a family

50
Q

Risks of social media

A

Loss of personal privacy
Potential breaches of confidentiality

Online behaviour might be perceived as unprofessional, offensive or inappropriate
Risk of posts being reported by the media or sent to employers

51
Q

GMC duties of a doctor

A

Make patient care your first concern
Protect and promote the health of patients and the public
Provide a good standard of care

Treat patients as individuals and respect their dignity
Work in partnership with patients
Be honest and open and act with integrity

3A (31 decks)

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