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Flashcards in Clinical governance Deck (20)
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Define clinical governance

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 the 7 pillars of CG?

1. patient/public involvement
2. clinical audit
3. risk management
4. clinical effectiveness
5. staff and staff management
6. use of information
7. premises standards


what does the NHS community pharmacy contract outline as dictated by the GPhC? (5)

1. governance arrangements safeguard the health, safety and well being of the public
2. staff are empowered and confident to safeguard..
3. environment and condition of premesis from which pharmacy services are provided safeguard...
4. way in which pharmacy services, including management of medicines and devices are delivered, safeguard
5. equipment and facilities used in the provision of pharmacy services safeguard...


what is the importance of CG?

about taking professional responsibility, continuing improvement, having the right systems in place


Describe patient involvement pillar (7)

must involve them in service improvement and redesign.
- Display practice leaflet
- notify the public of the services provided
- annual patient satisfaction survey
- monitor medicines owed and out of stock items
- complaints and errors procedures
- make adjustments in line with the equality act
- cooperate with inspections and reviews


describe the clinical audit pillar

a clinical audit is a process of improving the care of patients by - looking at what you're doing, learning from it and if necessary, change practice.
The contract states each pharmacy must do at least 1 annually.
- Practice based audit - in pharmacy
- NHS England based audit - all pharmacies in a geographical area

Audit cycle - audit design, data collection, analysis, identify causes of non achievement, implement change, monitor, decide criteria and agree on standards


Examples of clinical audits

Practice based - lung cancer awareness, near misses
NHS England based - introduction to stop smoking services, emergency supplies


describe the risk management pillar

We must be able to manage risks for health & safety.
Risks: financial loss e.g due to fridge failure, stock loss, prescription charge loss.
- Theft
- Needle stick injury
- violence

there are risks to patients:
- Health and safety
-poor standards of care and service
- dispensing errors
- infection acquired from pharmacy
- confidentiality breach


How can risks be managed?

1. A clinical governance lead who is knowledgeable on CG issues, NHS services and has authority to make decisions on these issues

2. Comply with health and safety regulation -
risk assessments,
equipment testing,
safe practice training,

3. Systems in place to ensure:
(a) stock integrity - stock expire date checks 3 monthly minimum, reputable suppliers, suitable premises for storage of medicines

(b) Equipment maintenance - fridge temperatures, BP and cholesterol monitor service recalibration

(c) waste disposal appropriate - patient returned waste medicines procedures
Chemicals/sharps/waste handling contracts
Needle injury or contamination processes
confidential waste - shredders


How are incidents reported (as part of risk management)?

Near miss recording
prescribing intervention recording
dispensing error reporting to NRLS
serious incident analysis
timely response to patient safety communications from the NPSA(patient safety alert system)


what is the patient safety report?

analysis of incidents and patterns
evidence of sharing learning locally & nationally
actions taken in response to national patient safety alerts


what are standard operating procedures? (risk management)

detailed documents describing the routine method followed for any procedure we do in pharmacy. - important for safety, quality, delivery, training, cost control and reproducibility

They must be:
legally correct, following best practice, following current clinical and operational guidelines, up to date


what are the key principles of risk management?

REPORT - all errors
LEARN - identify causes
SHARE- discuss and promote learning
ACT- make changes to practice
REVIEW- review the changes made


describe the clinical effectiveness pillar

It is about- doing -
- the right thing - decisions about patient health is based on the best, current, valid & reliable evidence
- in the right way - workforce that is skilled in delivering care
- at the right time - accessible services
- in the right place - appropriate location
- with the right outcome - maximising health gain


what are the community pharmacy contractual obligations for clinical effectiveness?

Clinical effectiveness programme includes arrangements for ensuring the appropriate advice is given in respect to repeat prescriptions or people caring for themselves
(a) RTS training - self care advice
(b) MURS, NMS, counselling
(c) intervention e.g awareness of current evidence and guidelines e.g NICE, monitor patient care e.g if they are on warfarin or lithium


Describe medicines use reviews

structured adherence centred reviews with patients who are on multiple medicines especially for long term conditions. Example:
(a) high risk medicines - NSAIDS, anti coagulants, anti platelets, diuretics
(b)recent discharge from hospital and had changes to their medicines
(c) respiratory diseases
(d) on 4 or more medicines with or at risk of cardiovascular disease


describe new medicines scheme

counselling patients when they are prescribed a new medication - common examples are:
asthma/COPD, hypertension medication, type 2 diabetics, anti platelet/anti coagulant medicines.

The pharmacist then followed up on adherence issues and further support


describe the staff and staff management pillar (the contractual obligations)

1. sufficient staff with appropriate qualifications for the level of work
2. appropriate inductions of new staff and locums - including SOPs, confidentiality, security, health
3. Appropriate staff training - competency assessments e.g ACT dispensing validation
4. qualifications/identity/references checked
5. remedy underperformance - staff management structure, support mechanisms. Co-operate with local poor performance arrangements. Raise concerns - whistle blowing policy and fitness to practice
6. identify and support developmental needs - annual & performance review

(Also - commitment to CPD, essential and advanced services)


describe the use of information pillar

Data protection & confidentiality
- procedures for information management and security information governance
- annual assessment of compliance via the IG toolkit


describe the premises standards pillar

(a) cleanliness - needs to be appropriate for the services provided - cleaning rotas, hand washing
(b) appropriate - safe, enough workspace, tidy
professional, demarcation of prescription reception area, buffering area between medical and non medical goods, quality eating area an appropriate consultation room

(c) opening - must be seen to be open by the public during open hours. If locked, arrangements must be made i.e. provide limited public access, and allow access inside if needed for confidentiality reasons.