Unit 4 Quality

Question 1

What are the WHO six dimensions of quality that healthcare systems must consider?

Answer 1

Require healthcare to be:

• Effective: Providing services based on evidence and which produce a clear benefit
• Efficient: Avoiding waste
• Timely: Reducing waits and sometimes harmful delays
• Acceptable/patient-centred: Establishing a partnership between healthcare
  professionals and patients to ensure care respects patient needs and preferences
• Equitable: Providing care that does not vary in quality because of a service users’
  characteristics
• Safe: Avoiding harm from care that is intended to help people

Question 2

Clinical governance definition

Answer 2

a framework for which healthcare organisations are accountable for continuously improving their quality of services and safeguarding high quality of care.

Question 3

Quality assurance

Answer 3

the process of checking that service standards are met and encouraging continuous improvement - it is essential in order to minimise harm and maximise benefits.

Question 4

Quality improvement

Answer 4

Can help services meet the six dimensions of quality.
QI culture is central to governance and performance management.
Monitoring components of high quality service helps providers to develop a greater understanding of necessary improvements to provide the highest quality service

Question 5

Tools that can be used for quality monitoring

Answer 5

Audit
Self assessment
Patient satisfaction surveys

Question 6

Audit

Answer 6

a way to find out if services are being provided in line with standards and also helps to reduce the risk of errors. Audit should identify errors quickly and manage them effectively.

Question 7

NHSE is responsible for providing national direction on…

Answer 7

• Service improvement and transformation
• Governance and accountability
• Standards of best practice
• Quality of data and information

Question 8

Where does NHSE receive funding from?

Answer 8

Department of
Health and Social Care.

Question 9

Integrated care systems

Answer 9

Where local partners work together creating better services based on local need
Aim to improve healthcare services by focussing on reducing health inequalities

Question 10

Integrated care partnerships

Answer 10

Committee brought together by Local Authorities and NHS, comprised of a broad alliance of organisations and other representatives as equal partners concerned with improving health and social care services to ensure patients receive comprehensive care they need.

Question 11

Integrated care boards

Answer 11

Statuatory NHS organisation responsible for meeting health needs for population, managing NHS budget and arranging for provision of health services in a geographical area.

Question 12

Primary Care Networks

Answer 12

Many GP practices, pharmacies, hospitals working together covering 30-50k patients.
Bigger teams of staff, stay open for longer.

Question 13

What are community pharmacies contracted and commissioned under?

Answer 13

Community Pharmacy Contractual Framework (CPCF)
CPCF is negotiated nationally (rather than locally) between NHSE, the Department of Health and Social Care and Community Pharmacy England (CPE);
the CPE is the pharmacy sector’s representative for the purposes of this
negotiation.

Question 14

How does Clinical governance impact day to day roles and responsibilities of a pharmacist

Answer 14

Ensures pharmacist provides safe, effective and high quality care to patients.

Question 15

What benefits would good Clinical governance provide to an organisation?

Answer 15

Helps maintain high standards of care, improves patient safety, enhances staff training and boosts overall quailty of services.

Question 16

7 key components within clinical governance

Answer 16

1. Risk management
2. Clinical audit (review and improve practice)
3. Premises standards
4. Clinical effectiveness
5. Patient and public involvement
6. Information and communication
7. Staffing and staff management

Question 17

Community Pharmacy Contractual Framework (CPCF) role

Answer 17

Sets out the terms and conditions for operating a Community
Pharmacy, offering NHS services in England and Wales; the
arrangements are different in Scotland.

Question 18

Clinical audit

Answer 18

Systematically looking at procedures used for diagnosis, care and treatment, examining how associated resources are used and investigating the effect care has on outcomes and quality of life for the patient

Question 19

What three aspects of service provision can clinical audit look at?

Answer 19

Structure: people, equipment, consumables, space & training available to provide a
service
* Process: systems and procedures in place, which can include prescribing policies and disease management guidelines
* Outcomes: results of activity, especially patient health but including satisfaction

Question 20

Why are clinical audits completed

Answer 20

• To make sure we are doing the right things in the right way
• To improve the quality of care for the patient
• To reduce costs for the NHS
• To ensure public money is used cost-effectively
• Because the future of pharmacy depends on drug use and service provision that is proven to be safe, effective and efficient

Question 21

Cycle for clinical audit

Answer 21

Identify topic
Set standard/guideline
Measure practice against standards
Identify areas to be changed
Implement change in practice
Re-audit to ensure change has been effective
EVIDENCE
repeat

Question 22

Since when has audit in community pharmacy been a requirement?

Answer 22

2005

Question 23

National clinical audit of 2022/23

Answer 23

focussing on the potential harm caused by taking valproate during pregnancy
community pharmacy teams were asked to identify female patients
of childbearing potential currently being prescribed valproate, and to offer them educational
materials as well as referring them to their GP practice for a specialist review and
consideration of appropriate contraception

Question 24

2 elements of the standards to which clinical audits work towards

Answer 24

• Qualitative criteria – a statement of what should be done
• Quantitative levels of performance – a percentage target for achievement

Question 25

3 questions to answer before testing an improvement concept

Answer 25

What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement?

Question 26

PDSA cycle

Answer 26

Plan- change to be tested or implemented Do- carry out test/change Study-based on the measurable outcomes agreed before starting out, collect data before and after the change and reflect on the impact of the change and what was learned Act- plan the next change cycle or full implementation.

Question 27

What incentives have been offered and by who?

Answer 27

quality payments have been introduced for community pharmacy through the Pharmacy Quality Scheme (PQS) Voluntary scheme supports delivery of the NHS Long Term Plan and rewards community pharmacy contractors that achieve quality criteria in the three domains of healthcare quality – clinical effectiveness, patient safety and patient experience.

Question 28

Adverse Drug Reactions (ADRs)

Answer 28

Any response to a drug which is noxious, unintended and occurs at doses used for prophylaxis, diagnosis or therapy

Question 29

Medication Error

Answer 29

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of health professional, patient or consumer

Question 30

Latent errors

Answer 30

Hidden errors

Question 31

Active errors

Answer 31

Upfront errors

Question 32

6 standards RPS published that must be adhered to when there is an error

Answer 32

1) Be open and honest when things go wrong 2) Report patient safety incidents to the appropriate local or national reporting programme 3) Investigate and learn from all incidents, including those that cause harm and those that are “no harm” or “near- miss” 4) Share what you have learnt to make local or national systems of care safer 5) Take action to change practice or improve local or national systems of care 6) Review changes to practice

Question 33

Near miss

Answer 33

An error that occurs which has the potential for harm but doesn’t actually reach the patient is termed ‘a near-miss’.

Question 34

For errors that reach patient, where are errors reported

Answer 34

NHS England

Question 35

Who seeks to collect and collate data on safety issues and who is this being replaced by?

Answer 35

National Reporting and Learning System (NRLS) replaced by Learn from patient safety events (LFPSE) service

Question 36

very common

Answer 36

>1 in 10

Question 37

common

Answer 37

between 1 in 10 and 1 in 100

Question 38

uncommon

Answer 38

between 1 in 100 and 1 in 1000

Question 39

rare

Answer 39

between 1 in 1000 and 1 in 10000

Question 40

very rare

Answer 40

fewer than 1 in 10000

Question 41

Yellow card

Answer 41

reporting suspected adverse reactions to medications

Question 42

Black triangle drugs

Answer 42

drugs new to the market it is being monitored even more intensively than other medicines

Question 43

Black label drugs

Answer 43

medications that have been reviewed but didnt pass so can't be given out to public

Question 44

how many dispensing incidents occur

Answer 44

26 for every 22,000 items dispensed

Question 45

Aim of SOPS

Answer 45

to ensure that dispensing processes occurred in a safe manner and also that they could be reviewed to facilitate improvements in standards; a principle which lies at the very heart of what Clinical Governance represents

Question 46

SOP

Answer 46

specifies in writing what should be done, when, where and by whom and covers all aspects of a particular process; step-by-step ensure consistency in working practice by all staff whether they are regular team members or relief workers

Question 47

components of SOP

Answer 47

Title Objective/Purpose Scope Responsibilities Procedure Materials/Equipment Safety Precautions References

Question 48

When a patient makes a complaint we should ensure

Answer 48

complaints are dealt with efficiently; complaints are properly investigated; complainants are treated with respect and courtesy; complainants receive a timely and appropriate response; assistance to enable them to understand the procedure in relation to complaints; or advice on where they may obtain such assistance; complainants are told the outcome of the investigation of their complaint; and action is taken if necessary in the light of the outcome of a complaint.

Question 49

what happens to reports once they have been received by the NRLS/LFPSE

Answer 49

analysed to identify trends and patterns in medication errors. helps in developing strategies to prevent similar errors in future.

Question 50

Root cause analysis

Answer 50

Consider contributing factors that led to the error and use question why?

Question 51

Why is revalidation important

Answer 51

Helps pharmacists and pharmacy technicians to: * keep their professional skills and knowledge up to date * reflect on how to improve * show how they provide the safe and effective care patients and the public expect, as set out in the standards for pharmacy professionals

Question 52

Each year as a pharmacist what do you need to carry out, record and submit to GPhC?

Answer 52

* four continued personal development (CPD) records, at least two of which must be planned learning activities * one reflective account * one peer discussion