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Flashcards in Law And Ethics- professionalism Deck (49)
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What is clinical governance?

It provides a FRAMEWORK that NHS organisations can FOLLOW to continually improve the quality of their services.
It also enables them to achieve high standards of care, and create excellent clinical care.


What are the SEVEN pillars of clinical governance?

Clinical effectiveness
Risk management
Patient and public involvement
Education, training
Information management
Staff management


What are the NPSA and NRLS and what are their aims?

National Patient Safety Agency
Aim to improve patient safety by reducing the risk of harm through error

National Reporting and Learning System
The NPSA's central system for recording and collating data on medical harm.
It was established to enable learning from errors.
Patient safety alerts can be issued from this.


What is the definition of a Patient safety incident?

Any unintended incident that could have or did lead to harm for one or more people receiving NHS funded care


What are the other two types of patient safety incidents we can come across?

Patient safety incident (level of severity no harm) and incident that caused no harm but was not prevented

Patient safety incident (prevented) incident that had the potential to cause harm but was prevented


What is classed as moderate harm?

Any patient safety incident that resulted in a moderate increase in treatment which caused significant but not permanent harm, to one or more persons receiving NHS care


What is classed as low harm?

Any patient safety incident that required extra observation or minor treatment and caused minimal harm, to one or more persons receiving NHS funded care


What is a medication error?

An incidence where there has been an error in the process of prescribing, dispensing, preparing, administering, monitoring or providing medicines advice, regardless of whether any harm occured.


The national patient safety agency creates patient safety alerts. What are these? 

When the National Reporting and learning system receiving a lot of reports of errors surrounding a particular medication, The NPSA will issue a document called a patient safety alert to doctors, nurses, pharmacists etc highlighting what they should do to reduce the chances of this error happening.

Eg with warfarin, insulin, lithium, opioids, injectables...


WHat is a Never event?

These are unacceptable and eminently preventable

They are largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.


A Couple of examples of never events?

Wrongly prepared High risk injectables.
Overdose of midazolam
Overdose of opioids
Wrong route of administration for cytotoxic medication
Inappropriate administration of methotrexate
Misidentification of patients!


What is an example of a Proactive Risk management technique?
Ie done before any errors have been done

Failure Modes Effects Analysis


What is an example of a Reactive risk management technique? (I.e done after the errors been made)

Root cause analysis

Reactive as it's done after the event: to find out what caused it.


What's the definition of failure mode and effects analysis?

A systematic method of identifying and preventing process and product problems before they occur


Define root cause analysis?

A structured investigation, aims to find the true cause of a problem, and the action needed to stop it happening in future.
Should be undertaken on dispensing errors.


What factors does the fish bone diagram explore when analysing the problems for contributory factors in a route cause analysis?

Patient factors
Individual factors
Task factors
Communication factors
Team factors
Education and training factors
Working conditions factors
Organisational and strategic factors


Reasons accident causation model:
What is a latent failure (latent conditions)?

refers to less apparent failures of organization or design that contributed to errors or allowed them to cause harm to patients.

Involves failures at an organisational and management level

Example: whereas the active failure in a particular adverse event may have been a mistake in programming an intravenous pump, a latent error might be that the institution uses multiple different types of infusion pumps, making programming errors more likely. It's like an "error waiting to happen"


Reasons accident causation model:
What are the error producing conditions?

Patient factors
Team factors
Task factors
Individual factors
Work environment


Reasons accident causation model:
What are active failures?

These are the actual error that happens I.e that involves the patient. It can be a result of latent conditions.
Active errors:
Unsafe acts
Knowledge based mistakes
Rule based mistakes


What does the standards of conduct ethics a performance Set Out?

Sets out the principles that's you MUST follow as a pharmacist.
Guides decisions that pharmacists and pharmacy staff have to make.
Underpins other standards published by the GPHC
The standards are reviewed annually and whenever changes in the profession or healthcare environment occur


What does "having professional autonomy" mean?

Using professional judgement in light of the standards.
That when you make a decision you act independently and are fully responsible for the consequences of that decision, no matter what kind of employee you are. I.e you can't shift the blame on the NHS organisation you're working for, you must stand within your own professional judgement.
Being able to justify your actions if asked to do so.


What does being "in breach of the standards" mean?

If a professional carries out an ACTION which does not follow the Standards then he or she is in BREACH of the standards.
This is known as ACTION
I.e it puts patient safety at risk by ACTING outside the standards (set out by SOPs) of the organisation.

A pharmacy professional can also breach the standards by NOT doing something. This is a OMISSION




I.e it's YOUR decision at the end of the day, not matter who advises you to do what, you are taking the blame if it goes wrong.


What's the difference between Must and Should?

Must means that these parts of the standards or guidance are compulsory, I.e you should do what it says 100% of the time.

Should means that it is GOOD practice to do what's suggested in the standards or guidance under MOST circumstances but not compulsory on every occasion, I.e professional judgement should sometimes be used.


What is an ethical dilemma?

Where you have to make a decision on whether to do something based on if it's legal/ illegal and ethical/ unethical.

A straightforward decision would be:
If it's legal and ethical then do it
If it's illegal and unethical then don't do it


What is the definition of professional judgement?

The use of knowledge that you have built up over time and your past experience, combined with CRITICAL reasoning to make a professional decision.

It takes into account
Relevant standards
And also reflects the professionals personal core values and attitudes.


What are the four basic principles of ethics?

1) above all, do no harm (Beneficence and Non-Maleficience- act beneficially and do no harm)
2) integrity: act fairly and honestly
3) competence: your ability to do a job
4) accountability: you must be accountable for your actions and act independently


Law vs ethics

Laws are usually there to underpin and help you with ethical decision making. A law is there to protect a patient from harm.

Ethical dilemmas rise when there is conflict in your head between what the law says to do, and what you might see as "morally right thing to do" in this scenario.


A legal consideration you need to be aware of when applying ethics in pharmacy is CAPACITY. What is this?

Capacity is the ability of a person to make a decision that may have consequences for themselves and others.

Things that can impair a persons capacity: dementia, learning disabilities
E.g. You (me) don't have very good capacity!


What is the Mental Capacity Act in place for?

It protects people who cannot make their own decisions, particularly about their healthcare, finances, and property e.g the elderly.
It provides a decision making framework they can follow, so that they're not influenced by for example annoying relatives.

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