Flashcards in 1) Patient Safety and Quality in NHS Deck (23):
Give examples of scandals that have changed monitoring and managing of health services:
Bristol Royal Infirmary (children's heart surgery)
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
What is the hierarchy that healthcare quality can be defined by?
What evidence is there for variations in accessing the best care?
Variations in diabetic amputation and hip replacements based on location
What is equity in healthcare?
Everyone with the same need gets the same care
What is an adverse event?
Injury caused by medical management that prolongs hospitalisation and/or produces a disability
When are adverse events unavoidable?
Drug reaction in patient prescribed drug for the first time
Give examples of preventable adverse events:
Operations on wrong part of body
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
What faults in the system allow for adverse events?
Focus on short term fixes
Makes people rush and make mistakes which get tolerated
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
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
How can systems be safer?
Avoid reliance on memory
Review and simplify processes
Standardize common processes/procedures
What is clinical governance?
Framework through which NHS organisations are accountable for continuously improving quality of services and safeguarding high standards of care
What are the 6 quality improvement mechanisms?
Registration and inspection
What is standard setting and who carries it out?
By NICE, defines what high quality care should look like, derived from best available evidence
What is commissioning in the NHS?
Clinical Commissioning Groups provide services for local populations
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
What is disclosure in terms of quality improvement?
Disclosing info about performance to patients, focussing on safety, effectiveness and experience of patients
Who carries out registration and inspection in NHS practices?
Care Quality Commission
What is a clinical audit?
Process of identifying quality of care, trying to change it and seeing whether it has changed
Describe the process of auditing:
Setting standards -> measure current practice -> compare with standard -> change practice -> reaudit