Clinical governance
a system set within the nhs to ensure and maintain a high standard of patient care
7 pillars of clinical governance
clinical effectiveness
audit
education and training
patient and public involvement
staff management
information management
risk management
cares values
communication
attitude
responsibility
equity
safety
4 key areas to ensure smooth department
workflow management
communication
safety
team support
what is cqc and what are their standards
cqc = care quality commission
they inspect nhs trusts to ensure they are safe, effective, caring, responsive, and well led these are the standards that ensure that there is a high quality of patient centred care and continuous improvement
ct questions they’d ask before a contrast scan
previous ct scan
before any allergies
any heart problems
any kidney problems
asthma
if they are diabetic and take any medications for it
what is egfr and why do we look out for it before a contrast scan
egfr = estimated glomerular filtration rate
assesses the kidney level function
contrasts excretes via the kidney
low egfr = low kidney level function
egf> 30 = good kidney level function
egfr < 30 = may lead to potential acute kidney failure
what is duty of candour
a legal requirement for healthcare professionals to be open, honest, and transparent to patients when something wrong happens
caldicott principle
principle that ensures patients data is protected and shared only when necessary
what would you do if you suspected child abuse on a patient
i’d follow the department protcol
would not communicate anything to the parent
inform paediatric consultant and/or registrar
inform safeguarding lead if necessary
id also inform my manager or senior
paediatric consultant/reg would inform social services
initial assessment would be skeletal survey
safety sharp vs non safety sharp
a safety sharp is a sharp with a safety mechanism to prevent needle stick injury
a non safety sharp is a sharp without a safety mechanism
what is irmer 17 and what does it focus on
irmer 17 = ionisation radiation (medical exposure) regulation 2017<
focuses on patient safety
ensures that medical exposures is justified, optimised and carried out safety
ensures radiation benefits outweighs risks
legal roles:
referrer: requests imaging
practitioner: justifies the exposures
operator: carries out the exposure
what is irr 17 and what does it focus on
irr 17 =ionising radiation regulation 2017
focuses on public and staff safety
protects them from occupation radiation safety
controls exposures in controlled and supervised areas<
requires local rules, radiation risk assessment, RPA, RPS
personal dose monitoring (dosimeters)
what would you do if you saw a student working unsupervised
immediately intervene to ensure patient safety
duty of candour, apologise to the patient and explain the situation
stop the examination and try see who the assigned radiographer was, if not stay with the student and continue the examination till its finished
explain to the student in a supportive way that unsupervised practice goes against HCPC standards, irmer and trust policy
inform supervising radiographer/senior radiographer and document the incident
use as a learning opportunity for student and team to prevent re-occurence
mri safety questionnaire
implanted devices
previous orthopaedic surgeries
metallic foreign bodies
eye injuries
pregnancy
tattoos
medication patches
removable metal objects
how would you manage a contrast reaction
id immediately stop the scan
depending on the severity id follow the protcol:
severe reaction: call radiologist or AE dr, put out a crash call and grab the crash trolley and emergency drug box
allergic reaction: treat with antihistamines and drink plenty of fluids
document on solition so prevented for future scans
patient extravasation
stop the scan if there is an immediate reaction
elevate the arm and/or place an ice pack
inform senior radiographer or manager
complete datix and fill in extravasation form on solition
pt may need to be checked by radiologist or referred to plastics
What is aec
AEC is automatic exposure control;
automatically adjusts exposure factors based on patient size and tissue density to achieve consistent images whilst minimising radiation dose
how would you handle conflict within the team
i’d remain calm and objective
listen to both sides
resolve privately and professionally
focus on facts, patient safety, and shared goals
if unable to resolve i’d escalate to management
maintain respect for all staff involved
how would you manage a high pressure situation
i would remain calm
prioritse tasks based on clinical urgency
delegate appropiately whilst maintaining clear communication with room 6/AE and wards, theatres etc
support colleagues who are struggling
ensure safety is never compromised
organisation and teamwork is vital under pressure
7 principles of caldicott principle
1 justify the purpose
2 don’t use personal data unless absolutely necessary
3 use the minimum necessary
4 access on a need to know basis
5 everyone must understand their responsibilties
6 comply with the law
7 the duty to share can be as important as the duty to protect
what would you do if a patient collapses in the department
ensure patient’s safety; watch the patient’s head
call for immediate medical help (crash call?)
check the patient’s responsiveness, check airway, breathing, circualation
if needed, start cpr
communicate effectively to provide best possible care for patient
what is a multi slice ct scanner and the advantages
multi detector scanner
multiple slices of the body in a single rotation
due to multiple detectors
advantages: increased speed, higher resolution, enhanced 3D imaging
What would you do if you scanned the correct scan but under the wrong patient name on the CT console
finish the scan
let the patient know
inform senior radiographer or manager
pt identification error under irmer
correct and amend details via pacs team
document incident & datix as it is a governance and patient safety issue
