Theme C Flashcards
(170 cards)
1
Q
Audit
A
Systematic critical analysis of the quality of medical care, including diagnostics, treatment, the use of resources and the outcome on patients quality of life. Compared against current standards
2
Q
5 Stages of audit
A
1 - Identify current standard 2 - Measure current performace 3 - Compare preformance to standard 4 - Make improvements 5 - Re-evaluate
3
Q
3 Limitations to audit
A
- Only as good as national standard
- Only focuses on one thing at a time
- Costs/time and resources
4
Q
How long after noticing a problem must a patient submit a complaint
A
12 months maximum
5
Q
2 steps of making a complaint
A
- Directly to NHS direct
- If not happy go to CCG or to the commisioner (NHS England)
6
Q
PALS
A
Patient advice and liason service in every NHS trust to inform patients about complaints
7
Q
Medical Indeminity
A
Legal exemption of liability for damages to patients under treatment in the NHS
8
Q
Most common errors in
- Primary care
- Secondary care
A
Primary = Delayed diagnosis Secondary = Negligence
9
Q
3 types of errors
A
- Knowledge based
- Rules based
- Skills based
10
Q
3 types of violations (3 R’s)
A
- Routine
- Reasoned
- Reckless
11
Q
National patient safety agency
A
Responsible for handling adverse events - report to them
12
Q
4 stages of clinical trials process
A
I = small number healthy volunteers 20-80: test safety, dosage, SE II = Larger group 100-300 further assess safety III = 1000-300 look for SE's IV = After drug has been authorised and marketed, looks at long term use
13
Q
Benefits of available performance indicators
A
- Greater openess
- Focus on improving care
- Public reassurance
- Competition will boost performance
- Facilitate informed patient choice
14
Q
Cons of available performance indicators
A
- Negative impact on public trust
- Case-mix between areas
- Data manipulation - eg some trusts will only treat patients with good outcomes
15
Q
Epidemiology of CVD
- % Deaths
- Ethnic cultures at +risk
- Socioeconomic group
A
- 26% of all deaths CVD
- South Asians 4x greater risk
- Afro-Caribbean at greater risk
- Lower socioeconomic at greater risk
16
Q
2 measure that take lifestyle/age/sex etc to assess CVD risk
A
- Framingham cohort charts
- QRISK
17
Q
Smoking + passive smoking % risk on CVD
A
- Increased CVD by 50%
- Passive smoking can increase by 25%
- Smoking more dangerous in women
18
Q
How many of the worlds population are obese
A
26%
19
Q
- Exercise reduction of CVD risk %
- Exercise guidelines UK
A
- 20-30% risk reduction
- 150mins mod / 75mins vigorous exercise >2 days week
20
Q
Alcohol weekly units
A
14 per week M/F
21
Q
Primary, Secondary and Tertiary prevention CVD
A
- Primary = Reduce chance of getting CHD eg lifestyle
- Secondary = Already have CHD reduce MI eg further lifestyle or drugs
- Tertiary = After MI/stroke prevent further events eg cardiac rehab, CABH, angoplasty
22
Q
Name a strategy in the UK that looked at reducing CVD disease in local community
A
Cardiovascular disease outcomes strategy 2013 - focused on prevention and risk management
23
Q
Disease
A
Pathological resulting in an abnormality of structure/function and characterised by symptoms or signs
24
Q
Different HTN groups and treament protocol
- Not hypertensive
- Stage 1
- Stage 2
A
- Not hypertensive = <135/85 Monitor - Stage 1 = >135/85 Treat stage 1 if they are 80+ with other condition* -Stage 2 = 150/95 Treat everyone regardless of age
25
When to give DVT prophylaxis
- High risk individuals going in for surgery need assessing for DVT risk
- Pregnant women who have had previous DVT and assess all obese pregant women
26
Travel advice for DVT
- Low risk
- Medium risk (history DT, recent surgery, pregnant, obese)
- High risk (previous DVT + additional risk eg cancer/recent surgery)
- Low risk = keep moving/hydrated, dont smoke
- Medium risk = compression stockings
- High risk = hydration/compression/enoxaparin before and after flight
27
4 strategies to control TB spread
- Surveillance and recognition
- Ensure completion of treatment + compliance
- Improve access to healthcare
- Screen new entrants to country coming from high risk areas
28
3 approaches to stopping smoking
- One:one councelling from nurse/gp with written info
- Group sessions run by health care professionals
- Nicotine replacement therapy (doubles chances of successful quitting)
29
How to deal with community outbreak
- Identify and isolate source
- Identify and treat those infected
- Advice to prevent further infection
30
How to deal with hospital outbreak
- Rapid isolation
- Rapid identification/notification of outbreak
- Monitor cleaning regimes and protocol
- Good communication with staff/visitors and outside bodies
- Suspend admission until 72hrs no new cases and disease free
31
Section 11 public health control of disease 1984 act
Doctors role to notify local authority during infective outbreak
32
Limit of MDT
Can only advice, decision is left to consultant and patient
33
4 Strategies for reducing patient risk of liver disease
| acohol, hepatitis, drugs, fat
- Alcohol reduction - public awareness, education and detox
- Hepatitis vaccinations, sterile needle use
- Paracetamol trading laws and prescribing with care
- Exercise and diet to reduce fatty liver
34
Screening
Application of test to identify individuals at risk of a disorder to warrant investigation or direct peventative action. Amongst people who have not sought medical attention about related symptoms
35
How to assess cost effectiveness
Cost-effectiveness analysis looks at numbers of years saved
36
RF Breast cancer and overall % prevelance
- Oestrogen, low socioeconomic group, radiation, alcohol
| - 9% will develop
37
Breast cancer screening for
- Average risk (general pop)
- Moderate (FHx same side)
- High (BRCA/TP53)
- Average = 50-70yrs mammo every 3yrs
- Moderate = Anual screening from 40-60 then normal^
- High = Annual MRI/mammo 30-60 then normal^
38
Bowel cancer screening
- One off flex sigmoidoscopy 55
- 60-74 offered FOB every 2 yrs
- 75 can ask for every 2yrs
39
Cervical screening
Smear every 3yrs 25-49 then after every 5yrs
| -Vaccine 12-13yrs
40
Other national screening programmes-
- Downs
- Diabetic retinopathy
- Newborn bloodspot
- Chlamy4 thdia
41
4 themes of pyschological impact of breast cancer diagnosis
- Worry of death
- Reactions of family members
- Views of society
- Worries about the future
42
Rate of diagnosis is corrolated negatively with what factor
Socioeconomic class (single mum cant get time off work)
43
Health visitor
Monitors child health and development and helps postnatal depression
44
Practice counceller
Sees mild/moderate health problems - active listening
45
Primary care mental health worker
Sign-posts correct services and can do some short term input - CBT
46
IAPT workers
Trained to deliver packages of care - CBT
47
Registered mental health nurse
Hospital based - care and support
48
Psychotherapist
CBT - psychodynamic therapies, family therapy, psychotherapy
49
Clinical Psychologist
Giver regular sessions and pyschotherapies, perform psychometric testing
50
Key worker
1 in a team, often nurse or social worker gets to know client and what they need
51
Depression vs Bipolar
- F:M
- Prevalance
- Lifetime risk
```
Depression
-2:1
-2-9%
-10-20%
Bipolar
-Equal
-0.3%
-1%
```
52
Minorities and lower socioeconomic group relationship to factors affecting psychiatric treatment
- More likely to be diagnosed
- Worse outcome from treatment
- More likely to disengage
- Language barriers
- Substance misuse more indicated
53
What is the largest cause of diability in the UK
Mental health - 105Billion per year
54
When is treatment without consent appropriate
Lack of capacity
55
4 instances where a person can be sectioned
- Needs to be assessed or treated urgently
- Health would get worse without treatment
- Safety at risk (patient ro someone else)
- Regular hospital monitoring is needed
56
Section 3 limitation
Cannot be employed unless treatment is available
57
What section can use only one doctor and approved mental health professional and how long does it last
Section 4 = 72hrs
58
What other section is 72hrs and is it renewable
```
Section 5 (holding power)
-No
```
59
Community treatment orders
- After section 3 release
- Supervised treatment if broken
- Can be returned to the hospital for up to 72hrs
60
Coping
- Problem focused
- Emotion focused
- Unhelpful
- Problem: Seeking info, practical support, actively participating in treatment
- Emotion: Sharing feelings and concerns, giving up unrealistic hopes, being angry, finding religion
- Unhelpful: hoping/praying the illness will leave, dispear, denial, preoccupation
61
What is the IPQ and what does it measure
Illness perception questionarre, derived from Leventhals self regulatory model.
-Looks at illness identity
62
Primary prevention for mental wellbeing (3 examples)
- Mindfullness/relaxation
- Exercise and no substance abuse
- Encourage positive relationships
63
5 aims of NHS 5 year forward mental health view
```
1 - 7 day NHS service (esp crisis)
2 - Intergrate mental and physical services
3 - Focus on children and youth
4 - Creating a culture to end stigma
5 - Encourage online program use
```
64
3 Requirements for consent
- informed
- volunatary
- with capacity
65
5 instances were consent is not required
- Emergancy - life saving
- Additional procedures (eg during operation new found tumor removal)
- Mental health act
- Risk to public health
- Severely ill living in unhygienic conditions (national assistance act)
66
Who does MC act effect
All those above 18
67
5 key principles of MCA
- Capacity is presumed
- Supported to make their own decisions
- Right to make unwise decisions
- Best interest when lacking capacity
- Desicions should be least restrictive option
68
2 questions concerning capacity
- Is there a disturbance in the functioning of the brain?
| - Is that enough to cause lack of capacity for this decision
69
Advanced desicion - when is it not considered
legally binding directive when someone loses capacity
| -MH act allows for detainment regardless
70
When can consent be breached (3)
- Demanded by court
- Lack capacity
- Prevent harm
71
What do doctors need to do about issues regarding confidentiality
Document in notes
72
3 forms of carers financial assistance
- Carers allowance
- Disability living allowance - if diasabiled themselves
- Attendance allowance - for severly disabled who need help with self care
73
Care act 2004
Carers have the right to an assessment of their own needs
74
Give examples of each of the following for dementia care:
- Community care
- Residential care
- Respite
- Primary care/crisis/support with daily living
- Ordinary housing with intensive support/nursed accomodation
- Day centres or help with care at home
75
5 services offered by CAMHS
- Art therapy
- Child/adolescent pyschotherapy
- CBT
- Meds
- Family therapy
76
5 prevention programmes used in CAMHS
- Parenting groups
- Home visits
- Anxiety/depression programmes
- Youth offending programmes
- School programmes
77
Procedure if child discloses to you
- Do not promise confidentiality
- Tell them it wasnt their fault
- Tell appropriate agency (police/NSPCC/social services)
- Within 48hrs confirm in writing any referral made
- Document all concerns in notes
- Common assessment framework may be used after referral
78
What 4 areas of development do family contribute to (VSSS)
- Values
- Skills
- Socialisation
- Security
79
Children and family act 2014/Children act 1989
Assesses if a child is in need and supports parents
80
Reasons people with sensory impairements may not access mental health services-
- Excluded from outreach and media programmes
- Limited understanding mental health
- Communication barriers
- High risk social exclusion
- Delivery of programme may not work eg deaf-CBT
81
Reasons for drug addiction
- Personality types
- Learned behaviour - parents/family
- Low socioeconomic class
- Drugs become group norm (emotional aesthetic)*
- Glamourous image*
- Childhood abuse*
- Occupation-stress
- Poor policing
*Pyschodynamic theories
82
7 catagories of dependance syndrome
- Salience (takes priority)
- Compulsion (despite - consequence)
- Tolerance
- Withdrawal
- Narrowing of reportoire
- Reinstated after abstinence
83
Primary/secondary/tertiary harm prevention - alcohol
```
Primary = education
Secondary = CAGE/Audit identify high risk groups
Tertiary = Treatment alcoholism, alcohol tax, fortify food
```
84
Primary/secondary/tertiary harm prevention - drugs
```
Primary = Education
Secondary = HEP vaccine, needle exchange, methadone
Tertiary = Better access to treatment centres and relapse support
```
85
3 types of drinkers (HHD)
- Hazardous
- Harmful
- Dependant
86
4 strategies of alcohol harm reduction england
- Better public communication
- Prevent/tackle alcohols harm to health
- Reduce alcohol related crime
- Work with alcohol industry
87
6 steps cycle of change
- Pre-contemplation - not considering change
- Contemplation - on the fence
- Preperation - testing the wters
- Action - new behaviours 3-6mnths
- Maintance - continued commitment 6mnth-5yrs
- Relapse - resume old behaviours
88
- Haemodyalysis
- CAPD
- APD
- Haemo = 3 days per week 4h each
- CAPD = fluid change 30-40mins 4x per day (2h)
- APD = overnight sluid change while sleeping
89
Which transplants are considered most urgent
Liver and heart
90
What 2 things are the basis for transplant allocation
- Tissue match
| - Points (length of time on list and physiological age)
91
Factors that affect choice of transplant
- Compliance
- Organ abuse likelyness
- Type of organ
- Transport time - ischeamia
92
What does Human tissue act 2004 cover
-Removal
-Storage
-Use
Human tissue - inc cells
93
5 offences under Human tissue act
- Removing, storing, using tissue without consent
- Using or storing tissue for a purpose not originally specified
- Trafficking tissue
- Analysing DNA without consent (theft)
- Carrying out these activities without licencing from HTA
94
UK organ donation approach
Opt in: via
- Making wishes known to relatives
- Registering donor register
- Carry donor card
95
2 types/examples of opt out systems
- Soft opt out: Spain, relatives can change the desicion
| - Hard opt out: Austria, relatives views dont matter
96
Arguments FOR and AGAINTS opt out
FOR
- Save lives at no cost to individual
- UK Law - corpses arent property
- Stigma might encorouge less opting out
- Still a choice
- Peopl may want to opt in at the moment but dont have access
AGAINST
- Religion = forfeit access afterlife
- Upsetting to family
- Stigma may be attached to opting out
- Shifts from altrustic giving organs to taking them
97
What is the basis for organ donation in the UK
Altruism
98
Reasons against a "market" donation system - people pay for their organs, others sell them.
- Healthcare becomes a business
- Represses altruism
- Erodes sense of community
- Redistributes organs from poor:rich
99
```
What ABO bloods are in
-Lowest stock
-Highest stock
and
-When do stocks generally fall short
```
- Lowest = O-
- Highest = A+/O+
- Winter
100
Why is dialysis not a viable alternative to transplant
- No endocrine function
- Poor quality of life
- Expensive
101
PSA - when is it offered
- Anyone over 50 can ask for it
| - Over 45 with a family history
102
Problems with PSA as a screening tool
- Overdiagnosis
- Overtreatment
- Invasive diagnostic measures may follow
- Treatment SE
- False - and false + (anxiety)
103
- Prediabates fasting glucose + HbA1c
| - Diabetes fasting glucose + HbA1c
- PRE: 6.1-6.9 glucose , 42-47 HbA1c
| - DIABETES: >=7 glucose , >=48 HbA1c
104
What instances can HbA1c not be used
(Increased RBC turnover)
- Haemoblobinopathies
- Haemolytic anemia
- Fe defiency anemia
- Hyperglycemia (steroids)
- Kids
- HIV
- CKD
105
Targets for Diabetic patients
- BP
- HbA1c
- Total cholesterol
- Drug treatment used BP
- BP: 140/85 - use ACEi
- HbA1c: >7%
- Total cholesterol: >5%
106
Prevention of diabetic complications
- Smoking cessation
- Glucose control
- BP
- Lower lipids
- Screening eyes and podiatry
107
What is considered in diabetic annual review
- HbA1c
- BP
- Lipids
- BMI
108
Pyschological/social impact of chonic endocrine disease
- Regular medicatio may affect life
- May impact body image (weight)
- May impact sex life
- Shock/disbelief
- Some may try to hide diagnosis
- May have effect on mood
- May have to carry card (addisonian crisis)
109
Modernisation and Urbanisation (effect on obesity)
- Abundance of food/conveniance/no manual labour needed so less exercise
- More transport links so no need for exercise
110
BMI guidelines
- Overweight
- Obesity 1
- Obesity 2
- Obesity 3
Overweight - 25-29.9
Obese 1 - 30.34.9
Obese 2 - 35-39.9
Obese 3 - 40+
111
Exercise recommendations
30mins of moderaye activity 5x weeks
112
Acceptable calorie deficit for weight loss
600kcal
113
When should medication be considered
Only if lifestyle measures have been tried
114
Criteria to get Orlistat
- BMI>28 and known risk factors
| - BMI 30+
115
When to consider bariatric surgery
- BMI 40+ or 35-40 with risk factors
- Fit for surgery
- Other measures tried
116
4 Public health strategies to tackle obesity
- Increase exercise - make gyms cheaper / more cycle paths
- Education
- Legislation on advertising and tax
- Schools encourage healthy food
117
Impaired glucose tolerance
Pre-diabetes, raised glucose levels but not yet at threshold
118
Diabetes prevention programme
- Goals
- Secondary goals
- Findings
- Goal: Prevent or delay diabetes in those with impaired glucose tolerance
- Secondary: Reduce CVD events, risk factors and atherosclerosis
- Findings: Lifestyle modification is more effective than Metformin
119
Alloimmunisation
Immune response against foreign RBC antigens
120
What 2 factors increase the risk of alloimmunisation
- Repeated transfusions
| - Pregnancy
121
Criteria to give blood
- Fit + Healthy between 7.12 and 25 stone
- Between ages 17-66 (66-70 if given blood before and 70+ if given blood in last 2yrs)
- No HIV/Hep
- Had anal sex in last 3mnths
- Ever been injected with drugs
122
Process of transfusion
- ABO and Rh grroup of patient found
- Antibody screen looks for Ab that may damage donor blood
- Crossmatching to donor blood
123
Emergencies types of blood used
- Immediate
- 10-15mins time
- 45mins time
- O-neg
- Use blood same ABO and Rhd = group compatible
- Full cross match
124
4 strategies to avoid unnecessary transfusions
- Strict criteria for use blood products
- Stop drug therapy that increases bleed risk
- Treat anemia prior to surgery
- Use fibrinolytics
125
NHSBT
NHS blood transfusion service
126
Role of NHSBT
- Collect blood from locations
- Organise service and recruit doners
- Transport/storage/processing/distribution
- Teaching and training
- Research and development
127
Patient problems MUS
- Needs not met
- Poor QOL
- Poor outcome
- Iatrogenic harm
128
System problems MUS
- Patients continue to return
- Repeat costs
- Ineffective use of resources
129
Patients want a convinving explanation but recieve:
| R,C,E
- Rejection: Deny symptoms
- Collusive: Sanctions patients belief about symptoms
- Empowers: tangible opportunities for management and legitimises patient suffering = alliance
130
Legal requirements for PM
- Sudden death
- Unkown cause of death
- Unnaturall death
- Death from industrial disease
- death from negligence
- Death during procedure
- Death within 24hrs of admission
- Not seen by doctor in 14 days
- Patient detained under MHA
131
4 criteria certifying death
- Pupils fixed and dilated
- No ventilation observed or auscultated 3mins
- No central pulse 1min
- No heart sounds on auscultation 3mins
132
Personal requirements for certifying death
- Must have seen patient in 14days prior
- Must have provided care before death
- Must be registered medical practitioner
- Knowledge or belief in cause of death
133
Aims of Calman-Hine Framework 1995
Developing cancer networks that inorporate primary care, cancer units and cancer centres
134
What are the aims of strategic cancer networkds
- Reduce cancer incidence
- Maximise survival
- Enhance QOL
- Improve patient experience
- Provide high quality service for patients and carers
135
What do strategic cancer networkds do
- Develop strategic plans
- Implement national policies
- Deliver improvements
- Provide communication across all networks
- Provide research for audits
136
Cancer unit vs cancer centre
- Cancer unit = diagnose and treat common cancers and refer to specialists
- Cancer centre = provide cancer unit services and also specialist diagnostics and treatment for large areas
137
Partnership groups
- Combine users of cancer services
- Act to improve cancer services by considering opinions and looking at what worked well
- Design literature for patients
138
Cancer registries
Collection and analysis of data for whole assigned region, submit data to national stats
139
National cancer research network
- Supports recruitment of patients for trials
- Integreates research into care services
- Integrates and supports work from cancer charities
140
-National cancer research institute
Promotes coperation between govenment, charity and industru
| -Maintains national research database and informs about new research desicions
141
3 ways in which the quality of cancer services are measured
- Clinical service quality measure (CSQM) provide info about how well service is performing
- CQC publish data comparing hospitals
- National audits
142
Social workers role and how they help the MDT
Support families and review enviroments including finances, can contribute knowledge from patients home environment so providing context
143
Advocacy
Getting support from another person to help you express views and wishes, helps you stand up for your rights and can accompany you to meetings/appointments
144
What can advocate not do (3 things)
- Give their personal opinon
- Solve problems for you
- Judge you
145
Stigma
Strong feeling of dissaproval that is shared by socety about a certain thing. Does not exist in itself is associated with behaviours
146
Social process of labelling
| L,S,O,S,D
- Labelling X
- Stereotyping (Peaple who are X are..)
- Othering (Us vs X)
- Stigmatising (devaluing X based on atrribute
- Discrimination (Acting differently to X)
147
Types of stigma
- Discreditable
- Discrediting
- Felt
- Enacted
- Courtesy
- Discreditable: keep stigma hidden (eg HIV)
- Discrediting: Cannot be hidden (wheelchair)
- Felt: By person (eg shame at STI clinica)
- Enacted: By others (eg shizophrenic gets off from bus)
- Courtesy: Felt by someone with patient open to stigma (eg spouse of alzhiemers patient)
148
Internalising
Absorbing social views of being lower status and the impact on personal belied and behaviour
149
4 methods of coping with stigma (P,C,W,R)
```
Passing = Pretending to be normal (+Pyschological toll)
Covering = Not disclosing (blin wearing sunglasses)
Withdrawal = acknowledging symptom but withdrawing from society (+ psychological cost)
Resistance = Contesting against stigma related outcomes
```
150
Sensitivity
- Definition
- Formula
Tests with high sensitivity correctly classify a high proportion of people who really have disease
Number of true positives
------------------------------------
All those with the disease (true +ive + false -)
151
Specificity
- definition
- formula
Tests with high specificity correctly classify people who dont have the disease
Number of true negatives
-------------------------------------
All those without disease (true -ive + false +)
152
Positive predictive value
- definition
- formula
Chances of having disease if test is positive
Number of true positives
------------------------------------
Everyone with + test (true +ive + false +)
153
Negtaive predictive value
- definition
- formula
Chance of NOT having the disease if test is negative
Number of true negatives
-------------------------------------
Everyone with a - test (true -ive + fals -)
154
Which measures of test performance are usually affected by prevalance and which are not
```
AFFECTED = +/- predictive value
CONSTANTS = Specificity/sensitivity
```
155
How do -/+ predictive values change with prevalance
As prevalance ↑
+ predictive value ↑
-predictive value ↓
and vice versa
156
likelyhood ratios
| -definition
looks at how likely you have/have not got disease if your test is +/-
- The larger the +LR the more likely you have the disease with + test
- The smaller the -LR the less chance you have the disease with a -test.
157
+ LR formula
Sensitivity
---------------
1 - Specificity
158
- LR formula
Specificity
---------------
1 - Sensitivity
159
Work out chance of disease with LR's
Chance of disease before test x LR = chance of disease after test
160
Soujorn time
Duration of disease before symptoms are apparent yet can still be picked up by screening
- shorter = rapidly progressing disease
- longer = milder/less dangerous disease course
161
Lead time bias
Point detected by screening is far beyond its usual clinical presentation - faslely "prolonging" survival. Screening is not the cause for their long survival.
162
Length time bias
A form of selection bias
Patients with long soujorn time (slowly progressing) disease more likely to be detected in screening. These people have a better prognosis anyway, screening is not the reason why.
163
Risk Ratio
- Definition
- formula
Probability that an event will occur during a specific time
Number of people who get the thing
----------------------------------------------------
Number of whole groups
164
Relative risk
- Definition
- formula
Ratio of developing an outcome in those exposed to an event vs those not exposed
Ratio = Risk in exposed
---------------------
Risk in non-exposed
165
Risk ratio = 1
| -Meaning
There is no difference in risk between 2 groups (top and bottom are same)
166
Odds ratio
(O = Outcome)
-Definition
-Formula
The odds that an outcome will occur given a particular exposure, compared to odds of it occuring without exposure
Odds in exposed
-------------------------
Odds in non-exposed
167
NNT
- definition
- calculation
Number of patients who need to be treated to prevent one additional bad outcome
NNT = 1/ARR (absolute risk reduction)
168
NNH
- definition
- calculation
How many people need to be exposed over time to a specific risk factor to cause harm to an avg of one person who otherwise wouldnt have been harmed
NNH = 1/Attributable risk
169
3 WHO checklists for theatre
- Before induction
- Before knife to skin
- Before departure of theatre
170
Who is required for the WHO
Nurse + Anaesthetist (+ surgeron for last 2)
