1) Patient Safety and Quality in NHS Flashcards Preview

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Flashcards in 1) Patient Safety and Quality in NHS Deck (23)
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1
Q

Give examples of scandals that have changed monitoring and managing of health services:

A

Bristol Royal Infirmary (children’s heart surgery)
Mid-Staffordshire
Harold Shipman

2
Q

Why are quality and safety important?

A

Evidence patients are being harmed or receiving sub standard care
Variations in healthcare
Direct costs, legal bill and politics

3
Q

What is the hierarchy that healthcare quality can be defined by?

A
Safe
Effective
Patient centred
Timely
Efficient
Equitable
4
Q

What evidence is there for variations in accessing the best care?

A

Postcode lottery

Variations in diabetic amputation and hip replacements based on location

5
Q

What is equity in healthcare?

A

Everyone with the same need gets the same care

6
Q

What is an adverse event?

A

Injury caused by medical management that prolongs hospitalisation and/or produces a disability

7
Q

When are adverse events unavoidable?

A

Drug reaction in patient prescribed drug for the first time

8
Q

Give examples of preventable adverse events:

A

Wrong dose
Infections
Operations on wrong part of body

9
Q

What are some reasons for adverse events?

A

Poorly designed systems that don’t account of human factors
Culture and behaviour
Humans are fallible
Medical practice is complex

10
Q

What faults in the system allow for adverse events?

A

Focus on short term fixes

Makes people rush and make mistakes which get tolerated

11
Q

What is James Reason’s Framework of error?

A

Active failures: lead directly to patient harm

Latent conditions: predisposing conditions meaning active failures are more likely

12
Q

What is Reason’s Swiss Cheese model?

A
Holes in cheese due to active failures and latent conditions and if they line up, allow hazards to move through 
More layer (barriers/defences) + less chance of hazards causing losses
13
Q

How can systems be safer?

A

Avoid reliance on memory
Review and simplify processes
Standardize common processes/procedures
Use checklists

14
Q

What is clinical governance?

A

Framework through which NHS organisations are accountable for continuously improving quality of services and safeguarding high standards of care

15
Q

What are the 6 quality improvement mechanisms?

A
Standard setting 
Commissioning 
Financial incentives
Disclosure
Registration and inspection 
Clinical audit
16
Q

What is standard setting and who carries it out?

A

By NICE, defines what high quality care should look like, derived from best available evidence

17
Q

What is commissioning in the NHS?

A

Clinical Commissioning Groups provide services for local populations

18
Q

Give examples of financial incentives in the NHS and why they are used:

A

To reward and penalise
QOF in GP practices
CQUIN based on safety, effectiveness and patient experience
Tariffs which can be used to make a surplus and encourage efficiency

19
Q

What is disclosure in terms of quality improvement?

A

Disclosing info about performance to patients, focussing on safety, effectiveness and experience of patients

20
Q

Who carries out registration and inspection in NHS practices?

A

Care Quality Commission

21
Q

What is a clinical audit?

A

Process of identifying quality of care, trying to change it and seeing whether it has changed

22
Q

Describe the process of auditing:

A

Setting standards -> measure current practice -> compare with standard -> change practice -> reaudit

23
Q

What is quality improvement?

A

Systematic efforts to make changes that will lead to better patient experiences and outcomes, system performance and professional development