Transcript Clinical Governance

Clinical Governance
Dr Lisa Joels
Postgraduate Organiser
Singleton Hospital
6th August 2008
Clinical Governance
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Risk management
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Avoiding adverse incidents
Education & CPD
Protocols & Guidelines
Communication skills
Consent
Complaints procedure
Notes and coding
Audit
Risk management
Adverse incidents:
 Avoidable
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Mistakes
 Errors
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Unavoidable
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E.g inevitable bad outcomes
How to avoid adverse incidents
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Keep up to date
Education and CPD
Teaching programme in Singleton
 Library
 On line resources
 Study leave
 Locally run courses
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Avoiding adverse incidents
Keep up to date
 Use protocols and guidelines
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Protocols and guidelines
NICE guidelines
 Royal College guidelines
 All Wales guidelines & pathways
 Local protocols
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Paper protocols
 Intranet based protocols
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MOCIS
 Junior Medical Staff Handbook
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Avoiding adverse incidents
Keep up to date
 Use protocols and guidelines
 Communication skills
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Communication skills
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Local training
Breaking bad news
 Dealing with difficult patients
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• Violence and aggression training
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Communication skills workshop
• Local courses
• Royal Colleges
Avoiding adverse incidents
Keep up to date
 Use protocols and guidelines
 Communication skills
 Consent
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Consent
May be:
 Tacit
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E.g holds arm out for blood test
Verbal
E.g intimate examination
 (document in notes – self defence)
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Written
Taking consent
All Wales consent forms
 4 forms
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Patient’s consent
 Parental consent on behalf of child
(<16)
 Procedure where consciousness not
impaired
 Adults unable to consent
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Consent
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Good practice – when to consent
Complex or risky procedure or
treatment
 Anaesthesia or sedation
 Possible significant consequences
 Research
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Consent
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Forms require statements of:
Intended benefit
 Possible serious harm
 Any extra procedures which may
become necessary
 Confirmation of alternatives discussed
– including no treatment
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Do not try to take consent if you can’t
fully discuss the issues above
Consent and Mental
Capacity Act 2005
MCA 2005 requires that capacity be
considered when taking consent
 Presumption of capacity
 Functional test
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Understand information
 Retain information
 Weigh up information
 Communicate decision
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MCA 2005
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5 principles
Right to make own decisions
 Every effort to support decision
 Right to make unwise decision
 Best interests
 Least restrictive of basic rights
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Junior Staff Handbook – Consent
GMC Consent:patients & doctors making
decisions together
Avoiding adverse incidents
Keep up to date
 Use protocols and guidelines
 Communication skills
 Consent
 Keep good notes
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Keep good notes
Legible
 Black ink (biro)
 All entries dated and timed
 All entries signed
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Use stamp with GMC number
 Print name
 Print bleep number and designation
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Discharge summaries
What to do if involved in
adverse incident
Inform senior colleague
 Fill in incident form
 KEEP GOOD NOTES
 Respond to complaints
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Factual account
 Timely response
 Take senior advice
 Contact defence organisation
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Clinical Governance
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Risk management
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Avoiding adverse incidents
Education & CPD
Guidelines & protocols
Communication skills
Consent
Complaints procedure
Notes and coding
Audit
Appraisal & revalidation
If you have problems……
Educational Supervisor
 Clinical Director
 Medical Director
Bruce Ferguson
 Postgraduate Organiser Lisa Joels
 Occupational Health
Mike Tidley
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Chief Executive
Paul Williams