Weeks 1-2 Flashcards
(44 cards)
recognise quality and safety in healthcare as an important responsibility of doctors
15 years ago - care was poorly monitored and managed
Bristol inquiry
evidence that pt are being harmed and receiving sub-standard care
(whistle blowing the way doctors do things)
what is an adverse event?
an injury caused by MEDICAL management, rather than underlying disease, that PROLONGS hospitalisation, produces DISABILITY or both
what is a preventable adverse event?
event that can be avoided given the current state of medical knowledge
what is an example of a preventable adverse event?
operation on wrong side e.g. appendicitis
wrong medication given to patient
what is an unpreventable event?
first time drug allergy e.g. to penicillin
describe theories why patient safety problems occur
problems in quality and safety are rarely individuals at fault, more often system failure
e.g. Swiss cheese model - James Reason’s framework of error
what are the ‘holes’ in the swiss cheese model in explaining why patient safety problems occur?
active failures
latent conditions
what are active failures within the swiss cheese model?
acts that lead directly to patient being harmed e.g. overdose
what are latent conditions within the swiss cheese model?
predisposing conditions which increase chance of active failure
examples of latent conditions within the swiss cheese model?
poor training
poor supervision
lack of staff
(things that increase risks)
explain the swiss cheese model in why patient safety problems occur
each cheese slice is a successive layer of defence, barrier, safeguard
the holes are active failure and latent conditions
if they holes line up then hazards fall through leading to patient safety being loss / compromised
how can a system-based approach promote patient safety and quality in healthcare?
removes human thinking factors:
- avoid reliance on memory
- makes things visible e.g. bold/ red text
- review and simplify process
- standardise common processes and procedures
- routinely use checklists
- decrease reliance on vigilance (look out)
what are policies and organisations for encouraging quality in NHS?
standard setting - by NICE
commissioning - contracts
financial incentives - punish and rewards
clinical audit
how does commissioning encourage quality in the NHS?
best and cheapest contract wins
contracts to incentivise quality improvement
what are the financial incentives in encourage quality in the NHS?
punishments and rewards:
- best practice tariff: GP
- national tariff: hospitals
what is the national tariff? (financial incentives in encourage quality in the NHS)
set money for procedures
leftover money kept by the trust, to be reinvested elsewhere
no income in a never event
what is a never event?
avoidable events:
e.g. prescribing wrong drug, operating on wrong side
normally leads to fatality and death
(no payment at all)
what is a fault of the financial incentives?
if the trust is doing worse than predicted, then there isn’t any money leftover (to make amends etc.), so trust just keeps getting worse
(won’t get paid extra for making things right)
what is a clinical audit?
a quality improvement PROCESS that seeks to improve patient care and outcome through SYSTEMIC review of care
against explicit standards and implementation of charges
what is a systemic review?
analyses multiple research studies or papers
what is important within a clinical audit?
evaluation: measure current practice and comparing to set standard
(to see what needs to change - whether current practice aligns with set standard)
describe the process of a clinical audit
choose topic –> set standard
set standard –> audit / 1st evaluation –> implement changes –> re-audit / 2nd evaluation –> set standard (loops until perfect, which is never, so just keeps going)
what is clinical governance?
a framework through which NHS organisations are ACCOUNTABLE for CONTINUOUSLY improving the quality of their services and SAFEGUARDING high standards of care
by creating an environment in which EXCELLENCE in clinical care will flourish
what are quantitative social science methods for investigating health and illness?
RCT, cohort studies, case-control studies, cross-sectional surveys
secondary analysis of data
collect numerical data
