Public Health Flashcards
(192 cards)
1
Q
What is law of tort?
A
a civil wrong other than a breach of a contract of tract e.g. negligence, breach of confidentiality
2
Q
What is negligence?
A
Where a duty of care existed and it was breached
3
Q
What is the duty of care?
A
prevent harm to patients - technically only obliged to act in the hospital
4
Q
What is consent?
A
respecting the patients autonomy otherwise it is assault, it guards against exploitation of patients and prevents battery
5
Q
What is battery?
A
touching a patient without consent
6
Q
Who has autonomy?
A
every adult of sane mine
7
Q
Types of consent?
A
implied, oral, written - must be voluntary, informed and be made by someone with capacity
8
Q
What does the validity of consent depend on?
A
on the adequacy of explanation given to the patient so they can make an informed decision
9
Q
Who do you need to tell someone about treatment for consent?
A
how, what, risks, benefits, alternatives
10
Q
When was the mental health act created?
A
1983 and amended in 2007
11
Q
What does the mental health act mean?
A
provides compulsory admission, for those cases where their refusal can result in serious injury or death, otherwise competent adults have right to refuse treatment
12
Q
What is the mental capacity act 2005?
A
for incompetent adults who lack capacity, unconscious, severe learning difficulties or lack necessary understanding that require treatment and cannot make decisions
13
Q
What is capacity?
A
ability to understand (adults are assumed to have capacity)
14
Q
What is the order of decision making?
A
previously expressed wishes in a living will, lasting power of attorney, court protection, decision of Dr in patients best interest
15
Q
When is someone unable to make a decision?
A
can’t understand the relevant info, retain it, weigh up all information or communicate the decision
16
Q
What is used for consideration of patient’s bets interest?
A
whether the patient could have capacity and when that might occur, the patients past and present wishes and feelings, patients beliefs and values that could influence decision, consultation with carers, family, lasting power of attorney
17
Q
What is a minor?
A
everyone younger than 18
18
Q
What is Gillik competence?
A
can the child understand the consequence of the decision, including the social and emotional implications , and if so they can consent, if not, parent must consent in best interest of child
19
Q
What is the welfare of child ACT 1989?
A
increasing scope for exercise of autonomy to child as they approach the legal minor age
20
Q
What is confidentiality?
A
respect for autonomy, hippocratic oath, duty to keep confidentiality
21
Q
When can you breach confidentiality?
A
to another health professional, if patient consents, to a court when required by a judge, if others are in harm or if they can’t drive or for statutory duty, infectious disease, births and deaths
22
Q
What is compliance?
A
the extent to which patients behaviour coincides with the medical health and advice, assuming that patients should follow doctors orders, it is not patient focus, doctor knows best and does not look at the patients issues
23
Q
What is adherence?
A
acknowledges the patients belief in the relationship si is more patient centered medicine
24
Q
What is non adherence?
A
not taking prescribed medicine, stopping medicine without finishing it, can be unintentional (forgetting, unable to pay, difficulty understanding) or intentional (beliefs about the condition and treatment, preference)
25
What increases compliance?
good communication
26
What is concordance?
extension of principles of patient centered medicine, a negotiation between individuals to respect the patients agenda
27
Barriers to concordance?
lack of communication skills, time constraints
28
What is a law?
act of parliament or statues or court decisions
29
What is the difference between private and public law?
```
public = criminal and constitutional
private = law of contract, property, family law, welfare law, tort law
```
30
What is the BME group?
black minority ethnic group - non white descent
minority social groups who share the common experience of discrimination or inequality because of their ethnic origin, language, culture or origin
31
What are BME's health like in comparison?
worse health generally mainly due to the poorer socio economic position, so are more likely to experience morbidity at a younger age and premature mortality
32
Why does female genital mutilation occur?
purity to prevent females having sex, unable to marry without it being done, reopened at marriage
33
Complications of female genital mutilation?
bleeding, wound infection, death, pain, anxiety, PTSD
34
Law on female genital mutilation?
illegal in the UK, so doctors should be alert for families asking for travel advice to take young girls on holiday if they have FGM in home country, and teachers should be alerted
35
Problems with professional interpreters, language line and family members translating?
agenda, bias, not confidential, family members may have poor english, limited interpretation
36
Issues of diagnosing those with limited english?
vocab is different, description of symptoms may be different, undiagnosed disease, unmedicated disease, limited knowledge of disease
37
What is the largest minority group in the EU?
the roma slovak community, they move from city to city, have short term tenancy arrangements with landlords, high prevalence of hep B in slovakia
38
How can doctors reduce inequality?
advocacy, activism, education, research, provide best and flexible services for all, especially those who are vulnerable
39
What is population attributable risk?
the proportion of the incidence of a disease in the exposed and non exposed population that is due to exposure
the disease incidence in the population that would be eliminated if the exposure was eliminated
40
What health and social problems are worse in unequally rich countries?
physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence and teenage pregnancies
41
Risk factors of heart disease?
smoking, diabetes, hypertension, obesity, alcohol, age, cholesterol, exercise, psychosocial
42
What accounts for the biggest differences in socioeconomic?
smoking
43
what are the 3 physiological views on differences in socioeconomic background?
absolutists = all about poverty and absolute measures of socioeconomic deprivation
relativists = think about the relative differences and the larger the differences in society the poorer the outcomes for those worse off
spirit level = think health and social problems are worse in unequal rich countries
44
Which type of behaviour/personality is a risk factor for CHD?
type A - competitive, hostile, impatient
45
How can personality/behavior be assessed?
questionnaires, self report, structured clinical interview, assess non verbal, answer content, speech, psychomotor
46
Psychosocial factors that cause CHD?
mental health problems, low control and high demand at work, shift work, lower rank at work, lack of social support
47
How can depression be measured?
MMPI, beck depression inventory, general health questionnair, spielbergers state anxiety intervention
48
primary prevention strategies to prevent STIs?
raise awareness, vaccinations, one to one risk reduction discussions (15-20mins structured discussion, based on CBT), pre and post exposure prophylaxis
49
secondary prevention strategies to prevemt STIs?
easy access to STI/HIV tests/treatments, partner notification, targetted screening, antenatal screening for HIV and pyphilis, national chlamydia screening programme
50
tertiary prevention for STIs?
anti retrovirals for HIV, prophylactic antibiotic for PCP, acyclovir for suppression of genital herpes
51
What is the STI/HIV transition model?
```
R=BCD
reproduction rate
infectivity rate
partners over time
duration of infection
```
52
What is partner notification?
a public health activity that aims to control infection by identifying key individuals and sexual networks, warn the unsuspecting and attempt to break the chain of infection
53
Why trace partners for STIs?
break the chain of transmission, prevent reinfection of the index patient, prevent complications of untreated infection
54
How are partners traced for STIs?
patient referral, provider referral from phone, test, letter, internet sites, visit, conditional or contract referral
emphasis on the patients choice and confidentiality
55
Partner notification challenges?
hard to reach client group (from phoneless, homeless, floor sleepers, social exclusion, criminal activities, chaotic life, health care is low priority)
56
How to increase partner notification?
MDT with public health, PCT, infectious diseases, GUM and drug and alcohol advisory, partner notification undertaken by specialist community outreach nurse and drug worked, GUM health adviser provided notification training and support and coordinated notification management
57
When is peak time for gonorrhea diagnosis?
18-28
58
Where do adults get chlamydia and gonorrhea?
urethra, endocervical canal, rectum, pharynx, conjunctiva
59
Where can neonates get STI?
conjunctiva
60
Symptoms of chlamydia and gonorrhea in males?
dysuria and urethral discharge, complications are epididymoorchitis, reactive arthritis
61
Female complications of STIs?
pelvic inflammatory disease, tubal factor infertility, ectopic pregnancy, chronic pelvic pain, neonatal transmission, opthalmia neonatorum, atypical pneumonia with chlamydia, Fitz high curtis syndrome (peri hepatitis)
62
Diagnosis of chlamydia?
nuclei acid amplification tests (NAAT), high specificity and sensitivity (but not 100% sensitive so negative test does not mean not infection)
female - endocervical swab, self collected vaginal swab, first void urine
male - first void urine
63
Aim of community screening for chlamydia?
reduce complications by reducing the prevalence of the asymptomatic infection (an asymptomatic diagnosis does not mean recent partner change)
64
Treatment of chlamydia?
partner managment, test for other STIs, azithromycin 1g stat or doxycycline 100mgbd for 7 days
65
Treatment of chlamydia if pregnant?
Erythromycin 500mg bd for 14 days
66
gonorrhea diagnosis?
microscopy of gram stained smear of genital secretions looking for gram negative diplococci with cytoplasm of polymorphs, male urethra and female endocervix and urethra, culture on selective medium to confirm, sensitivity testing, NAAT
67
Treatment of gonorrhea?
partner notification, test for other STIs, continuous surveillance of antibotic sensitivity, single dose treatment preferred, with ceftriaxone 500mg IMI with Azithromycin 1g orally stat
68
Is chlamydia or gonorrhea more associated with a partner change?
gonorrhea and it has more clinical manifestations, whereas chlamydia can be asymptomatic
69
What organism cause syphilis?
treponema pallidum subspecies pallidum
70
What are the stages of syphilis?
early - primary, secondary, early latents
| late - late latent, CNS, CVS, gummatous
71
What STIs are gay men more likely to have?
HIV and syphilis
72
Symptoms of primary syphilis?
primary chancre normally on genital skin, nipple and mouth
intubation is 9-90days, usually 21-35
dusky macule-papule-indurated clean bases non tender ulcer 50% solitary (genital ulcer is syphilis until proved otherwise)
regional nodes 1-2 weeks after
untreated heals without scarring in 4-8weeks
73
Symptoms of secondary syphilis?
onset 6-8 weeks after infection, may have primary chancre or none, most present with skin rash
mucus membrane lesions, generalised lymphadenopathy, alopecia, hoarseness, bone pain, hepatitis, nephrotic syndrome, deafness, iritis, meningitis, cranial n palsies, constitutional symptoms
74
What is the transmission of STIs like?
early syphilis - 40-60% of contactable partners are infected (transmission decreases in early latency and after 4 years)
chlamydia - 70%
gonorrhea - 50-90% women, 20-60% male
75
What causes death in syphilis?
late benign gummatous, neurosyphilis, cardiovascular
76
Diagnosis of syphilis?
early moist lesions - identify motile spirochetes on went mount using dark ground microscopy
genital ulcer
rash
use serology for diagnosis
77
Treatment of syphilis?
penicillin by injection with efficient follow up and partner notification
78
Why is type 2 diabetes such a public health issue?
causes mortality, disability, co morbidity, reduced quality of life, increasing prevalence, inequality in prevalence and outcomes, linked to obesity and climate change policies
79
Risk factors for diabetes?
sedentary job, sedentary leisure activities, high calorie diet, low fruit and veg, low fibre, cars, cheap tv watching, expensive fruit and veg, safety of going outside, family eating patterns, age, sex, ethnicity, family history, weight, BMI, waist circumferance, history of gestational diabetes, hypertension, vascular disease, impaired glucose tolerance/fasting glucose
80
Diabetes tests?
random capillary blood glucose, random venous blood glucose, fasting venous blood glucose, oral glucose tolerance test
81
Preventing diabetes?
exercise, change diet, weight loss, focus on ethnic minorities and socio economically deprived communities, focus on culturally appropriate interventions, educate, peer support, self monitoring, identify those at risk, diagnosing earlier,
82
mechanisms that maintain overweightness?
more weight makes it more difficult to exercise due to injurys and stress, low self esteen, guilt, comfort eating, scared of the gym, employment, relationships, social mobility,
83
What is the runaway weight gain train?
steep slope = obesogenic enviroment
ineffective breaks = knowledge, prejudice, physiology, social
accelerators = ineffective dieting, psychological impact, low socioeconomic status, mechanical dysfunction, psychological dysfunction
84
How can we diagnose diabetes earlier?
raise awareness of diabetes and symptoms in community and in health professionals, use blood tests to screen before symptoms develop
85
Why is NHS England putting money into type 2 diabetes prevention?
it is preventable, and easy changes reduces the risk, it is feasible
86
How is NHS England investing into type 2 diabetes prevention?
healthier you: the nhs diabetes prevention programme with lifestyle education, weight loss support and group physical exercise
87
What are the basis of medical ethics?
deontology, consequentialism, virture
88
What is deontology?
the duty of care we owe to each other with the formula of universal law and formula of humanity, to tell the truth but not to be told the complete way
89
What is the formula of universal law?
could i live this way where everyone acted this way
90
What is the formula of humanity?
people are always treated as ends in themselves, never as means to an end
91
What is consequentilism?
consequences are what matters and the means are unimportant, but it is hard to know what the consequences will be and actions can be wrong even in consequences are good
92
What is virtue?
characteristics that promote human flourishing e.g. compassion, patience, kindness, fidelity, centers ethics on the person and what it means to be human, including the whole persons life
93
What are the principles of medical ethics?
autonomy - patient can make own decision
beneficence - seeks to benefit patient
non maleficence - no overall harm, reasonable harm can be justified e.g. side effects
justice - no discrimination and efforts should be directed without reference to likes and dislikes
94
What is the ethical duty of condour?
condour is openness, honesty, transparency
spontaneous without compulsion, applies to disclosure of error or uncertainty and decisions influenced by resources
95
What is the duty of candour?
longstanding ethical duty, established regulatory duty, recent contractual duty, new statory duty
96
What is the GMC duty of candour?
MUST be open and honest with patients if things are going wrong
SHOULD put matters right if went wrong e.g. apology
97
What is whistle blowing?
raising concerns about a person, practice or organisation to make the patient a first concern, shouldn't get int trouble
98
What makes an effective team?
6 or 8-12 in team size, team dynamic, feeling like you belong, common purpose, identified team leader,
99
Why is it important to work as a team?
improves decision making, reduces medical error, essential in complex medical modern healthcare
100
Difficulties in team work in the NHS?
different offices, shifts and rotations, ward based/visiting/based elsewhere, different employers and line managers, part time, full time, other commitments, informal as well as formal contact
101
Aspects of team working linked to patient safety?
shared decision making, shared knowledge, successful team communication,
102
Steps to patient safety?
build a safety culture, lead and support your staff, integrate your risk management activity, promote reporting, involve and communicate with the patients and public, learn and share safety lessons, implement solutions to prevent harm
103
What is the SBAR checklist?
situation, background, assessment, recommendation
104
Human factors for team work?
communication, leadership and followship, authority gradient, situational awareness, declaring an emergency, train together
105
Back pain red flags?
55, thoracic pain, persistent at night, night sweats, recent unexplained weight loss, saddle anesthesia, sphincter disturbance, trauma, significant past medical history
106
What is classed as chronic back pain?
continuous pain for more thna 3 motnhs
107
predictive factors for lower back pain?
psychosocial factors, pain intensity, episode duration, previous history
108
How do musculoskeletal disorders affect us?
physical pain, psychological burden (loss of independence, chronic pain), economic implication (loss of income, costs of treatment, costs of care), as a society economic burden (from treatment and loss of work), work place productivity (secondary costs to individuals)
109
risk factors of back pain?
more common in women, and increases with age, more common in lower social class, probably due to increased manual labour, more obesity, other things to worry about that poor posture, less atcive
110
Treatment of back pain?
remember the red flags, treat with exercise
111
What are the most common work related MSK disorders?
```
back pain
tension neck (10-17% of the population)
```
112
what is classed as chronic tension neck?
>6 months
113
How does thoracic outlet syndrome present?
pain and tingling, wasting of hands, positive Adson's test
114
What are the different types of thoracic outlet syndrome?
hyperabduction syndrome - pinches nerves that run under the pec minor muscle when you lift your arm overhead
anterior scalene syndrome - pinches nerves and vessels between the scalene muscles and other structures
costoclavicular syndrome - pinches nerves underneath collarbone
115
What happens in rotator cuff tendinitis?
roatator cuff tears and swells, leading to further infringement beneath arch
test using 'empty/full can jobes' - elevate extended arm against resistance
116
What is frozen shoulder?
adhesive capsulitis, with equal resistriction of active and passive movements in capsular patterns
at risk if diabetic, thyroid, adrenal dysfunction, parkinsons
more common in females
117
What test is used for bicipital tendonitis?
the speed test - elbow fully extended, forearm supinated and flexes against resistance
118
What test is used for subacromial impingement?
hawkins-kennedy test - flexed arm and rotation
119
What test is used for the AC joint impingement?
cross arm adduction (scarf) test
120
What is medial and lateral epicondylitis?
```
medial = pain against resisted flexion of the wrist
lateral = pain against resisted extension of the wirst
```
aka olecranon bursitis caused by repetitive bending and straightening of the elbow, in those who continuously lean on their elbows
121
How does carpal tunnel syndrome present?
pain/tingling/numbness in the median nerve distribution in the hand
has TINEL's and PHALEN's signs
122
Risk factors for carpal tunnel syndrome?
pregnancy, obesity, endocrine disease, COCP/NRT, repetitive wrist movements
123
What is tenosynovitis?
local tenderness and swelling and pain on resisted movements, seen in manual workers, more common in women
124
What is DeQuervain's tenosynovitis?
local tenderness and swelling of the tendon sheaths (extensor pol brevis and abductor poll longus), pain on resisted movements, see in manual workers and rowers, more common in women
125
What is trigger finger?
inflammation and hypertrophy of the retinacular sheath progressively restricting the motion of the flexor tendon
126
What is Depuytren's?
tissue between the skin and the tendons known as the fascia is thickened due to collagen proliferation. Nodules or cords are formed and the elasticity of the fascia is reduced
127
What is hand arm vibration syndrome?
when exposed to sufficient vibration, causing finger blanching, pain numbness, tingling, wasting, dexterity, asymmetrical, carpal tunnel syndrome,
128
yellow flags for back pain chronicity?
a belief that the back pain is potentially disbling
fear avoidance behaviour
reduced activity levels
expectation of passive treatments rather than active
low mood and social withdrawal
problems or dissatisfaction with work
problems with claims/compensation/time off work
overprotective family and lack of support
129
What is RULA?
the rapid upper limb assessment
a tool to analyse event driven postures when work related upper limb disorders are reported
assesses biochemical and postural loading on the whole body with particular attention to the neck, trunk and upper limps
takes little time to complete and the scoring generates an action list which indicates the level of intervention required to reduce the risk of the injury due to physical loading on the operator
130
What is static anthropometrics?
measurement of human subjects in rigid, standardized position e.g. static arm length
used in designing a workplace when the body movement is not a major variable e.g. seat breadth, height, head room
131
What is dynamic anthropometrics?
measurement of human subjects at work or in motion e.g. functional arm reach curves
132
What is biomechanics?
the measurement of the range, strength, endurance, speed and accuracy of human movements
133
What is the problem with static anthropometrics?
many factors have variability between groups e.g. average male in USA is 167cm but in vietnam is 152cm
134
What important factors should be considered in work related MSK disorders?
task, individual, load, enviroment
135
Why are students at risk of mental health disorders?
unrealistic expectations, finance academic stress, alcohol, peer pressure, lack of support
136
Which occupations have high stress levels?
managers, nurses, doctors, healthcare professionals
137
Sources of stress for doctors?
lack of resources, too much work, poor management, ill patients, complaints, too much responsibility, poor relationship at work, too little time
138
Symptoms of professional burn out?
less contact with colleagues, decreased work commitment, do not seek help, decreased productivity, stereotypic thinking, increased minor illnesses, objectification, feeling of failure
139
Personality traits susceptible to psychological difficulties?
perfectionism, self criticism, low flexibility, high discipline
140
What are traits of emotional resilient?
self aware, in control of life, practice acceptance, balanced view of the world
141
What neurological diseases can be prevented with a vaccine?
polio, tetanus, measles, meningococcus, TB, H.influenze
142
What is obesity?
a high amount of body fat in relation to lean body mass (BMI 30 or more)
143
morbiditys associated with obesity?
hypertenision, dyslipidaemia, type 2 diabetes, CHD, stroke, gall bladder disease, osteoathritis, sleep apnoea, respiratory problems, cancer
144
Factors contributing to weight maintenance?
energy intake, type of food intake, appetite, mood, activity, metabolic rate, genes, drugs
145
Causes of obesity?
americanisation of diet and society, increased car usage, longer working hours, over consumption of food, grazing replacing meal times, replacement of water with sugary drinks
146
What makes up an adults energy expenditure?
exercise and non exercise activity thermogensis
147
what is non exercise activity thermogensis?
spontaneous physical activity (fidgeting), so there are marked individual differences in contribution to daily expenditure
148
How can you asses the intra abdominal adiposity?
measure waist circumference as it is strongly correlated
149
What is metabolic syndrome?
```
high waist circumference plus 2 of:
triglycerides >1.7mmol/L
HDL cholesterol 130/85
FPG >5.6mmol/L
diabetes
```
150
What effect does adipocytes have on the body?
inflammation, atheroscleoris, thrombosis, type 2 diabetes, atherogenic dyslipidaemia, hypertension
caused by increased in hormones
151
How can patients be assisted for successful weight loss?
assessing weight history, assess motivation, choose weight management strategies, set appropriate targets, behavioural approaches, prescribing issues
patients views and reasons for weight gain, beliefs on food and exercise, socioeconomic influences, previous success, readiness to change, confidence to make changes
152
What is the multi component intervention for weight loss?
activity - set goals
individual diet advice
behavioural strategies
positive feedback
153
factors contributing to losing weight?
medication (orlistat, incretin mimetics (GLP1 agonists 9 reducing effect of glucose)), dietry counselling, support, diabetes managment, encouragement, activity, hypo advice, hard work
154
How do GLP-1 agonists help lose weight?
it is secreted on ingestion of food to enhance glucose dependent insulin secretion, help regulate gastric emptying, decrease glucagon reducing hepatic glucose output, decrease postprandial glucagon secretion and promotes satiety and reduces appetite
155
How to maintain weight?
low calorie, low fat diet, eat breakfast every day, eat same amount on week days, weekends and holidays, highly active, less depression excess eating and binging, self montioring
156
When does end of life care occur?
from the diagnosis of a poor prognosis or a deterioration of a chronic disease (around 1-2 years)
157
What does end of life care aim to do?
increase QoL, give support and palliative care to patient and family, manage pain with psychological, social and practical support, control symptoms but avoid too much investigation and treatment
158
What must be prepared for end of life care?
focus on patient and family, educate family on last hours to reduce fear, ensure preemptive medications are available, explore a preferred place of care
159
What are the 5 priorities of care for a dying person?
individual care plan, needs of the family, the dying person, sensitive communication, decisions regularly reviews
160
How is death verified?
no heart sound or pulse, no breath sounds, no response to painful stimuli, pupils fixed and dilated
161
What is palliative care?
improving the QoL of patients and families who face life threatening illnesses by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to end of life bereavement
162
who are involved in specialist palliative care?
consultants, clinical nurse specialists, hospital nurses, specialist social workers, dieticiens, physio
163
who are general care providers?
Gps, hospital doctors, district nurses, nursing home staff, copd nurses
164
how is lung cancer palliative care different from copd palliative care?
lung cancer patients receive visits from district nurses, they are more likely to know they might die and get more support from the specialists, less likely to suffer depression and less likely to visit ICU and have a better activities than COPD patients
165
Difficulties in palliative care for COPD patients?
unpredictable illness trajectory, difficulties in prognostication, patients have poor understanding and poor access to palliative care, there is a stigma against smoking
166
Challenges of the aging population?
strains on pension and social security, increasing demand for health care, bigger need for trained health workforce, increasing demand for long term care, pervasive ageism that denies older people the rights and opportunities available for other adults
167
Causes of population aging?
improvement in sanitation, housing, nutrition, medical interventions, falls in fertility, decline in premature mortality, more people reaching an older age while fewer children are being bron
168
Physical changes in age?
loss of skin elasticity, loss of hair and hair colouring, decrease in size and weight, loss of joint flexibility, increased susceptibility to illness, decline in learning ability, less efficient memory, affected sight, hearing, taste and smell.
169
How to prevent recurrent hospital admissions for patients?
supporting discharged patients, supporting chronic disease management in the community, providing alternative in acute care in community
170
Roles of GP?
prevent unnecessary loss of function, prevent and treat problems which adversely affect QoL in old age, supplement the existing system of informal care and prevent its breakdown, give older people a good death as well as a good life
171
Documents created for patient safety?
organisation with a memory 2000
building a safer NHS 2001
Bristol enquiry
improving safety of patients in England 2003
172
What is a human error and examples?
failure of a planned action or a sequence of mental and physical actions to be completed as intended or the use of a wrong plan to achieve an outcome
errors of omission - action is delayed or not taken
errors of commission - where the wrong action is taken
professional negligence - actions or omissions do not measure up to the standard of an ordinary, skilled person
173
What errors are made in medication prescribing?
ordering, transcribing, dispensing, administering
so must be storage, labeling and segregation of high alert medication
174
What human factors can lead to error?
load theory - how much a brain can process
| situational awareness - what else is happening
175
What is confirmational bias?
the tendancy to look for confirming evidence to suppory a diagnosis rather than diagnosing
176
What is anchoring?
locking onto salient features in a presentation too early
177
What is diagnosis momentum?
giving a diagnostic label too early
178
What is the difference between a latent and an active failure?
latent - not in the practitioners control e.g. organisation of procedures, allocation of resources
active - direct contact with the patient (sharp end)
179
What are never events?
serious, largely preventable patient safety incidents that should not occur if the available preventable measures are there, they are intolerable and inexcusable
180
What is an organisational system failure?
involving management, protocols and knowledge
181
What are technical failures?
external factors
182
What is an adverse event?
an incident which results in harm to the patient which is not a direct result of their illness
183
What is a near miss?
an event that arises during care and has the potential to cause harm but failures to develop further, avoiding harm
184
What is the difference between a skill and knowledge based error?
skill = it is a well known task, that is given little attention, so can be distracted and have a slip
knowledge = incorrect action due to inexperience and insufficient information
185
What are violations and the different types?
deliberate deviations from practices, procedures, standards and rules which could be routine cut corners, necessary to get the job done or optimizing for self benefit
186
What limits information processing?
automacity, cognitive interference, selective attention, cognitive bias, positive and negative transfer from previous experiences
187
Examples of strategies to reduce error and harm?
simplification and standardization of clinical processes, checklists, aide memoires, information technology, team training, risk management programmes, mechanisms to improve uptake of evidence based treatment patterns
188
What are the 2 approaches to managing error?
the person approach = error is a product of wayward mental processes and focuses on the unsafe acts of people on the front line
the system approach = only occasionally necessary to cause adverse events
189
What are the benefits of work?
obtaining adequate economic resources, part of society, meet psychosocial needs, an individuals identity, social role and social status, the main drive of social gradient in physical and mental health and mortality
190
What causes work related illnesses?
MSK, stress, depression, respiratory
191
Safety issues for work?
have to be safe to do tasks, personal and co worker safety, strict criteria for safety critical job, physical requirements, medical contraindications, so try and match individual to work and task
192
What is involved in an occupational health physician?
regulation, legal, rehabilitation, well being and lifestyle, obligations to employer, medical examination at employers request
