1) Patient Safety and Quality in NHS Flashcards Preview

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

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

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

2

Why are quality and safety important?

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

3

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

Safe
Effective
Patient centred
Timely
Efficient
Equitable

4

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

Postcode lottery
Variations in diabetic amputation and hip replacements based on location

5

What is equity in healthcare?

Everyone with the same need gets the same care

6

What is an adverse event?

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

7

When are adverse events unavoidable?

Drug reaction in patient prescribed drug for the first time

8

Give examples of preventable adverse events:

Wrong dose
Infections
Operations on wrong part of body

9

What are some reasons for adverse events?

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

10

What faults in the system allow for adverse events?

Focus on short term fixes
Makes people rush and make mistakes which get tolerated

11

What is James Reason's Framework of error?

Active failures: lead directly to patient harm
Latent conditions: predisposing conditions meaning active failures are more likely

12

What is Reason's Swiss Cheese model?

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

How can systems be safer?

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

14

What is clinical governance?

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

15

What are the 6 quality improvement mechanisms?

Standard setting
Commissioning
Financial incentives
Disclosure
Registration and inspection
Clinical audit

16

What is standard setting and who carries it out?

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

17

What is commissioning in the NHS?

Clinical Commissioning Groups provide services for local populations

18

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

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

What is disclosure in terms of quality improvement?

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

20

Who carries out registration and inspection in NHS practices?

Care Quality Commission

21

What is a clinical audit?

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

22

Describe the process of auditing:

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

23

What is quality improvement?

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