Clinical Governance Dr Lisa Joels Postgraduate Organiser Singleton

Clinical Governance Dr Lisa Joels Postgraduate Organiser Singleton Hospital 6 th August 2008

Clinical Governance ¢ Risk management l l l ¢ ¢ Avoiding adverse incidents Education & CPD Protocols & Guidelines Communication skills Consent Complaints procedure Notes and coding Audit

Risk management Adverse incidents: ¢ Avoidable ¢ Mistakes l Errors l ¢ Unavoidable l E. g inevitable bad outcomes

How to avoid adverse incidents ¢ Keep up to date

Education and CPD Teaching programme in Singleton ¢ Library ¢ On line resources ¢ Study leave ¢ Locally run courses ¢

Avoiding adverse incidents Keep up to date ¢ Use protocols and guidelines ¢

Protocols and guidelines NICE guidelines ¢ Royal College guidelines ¢ All Wales guidelines & pathways ¢ Local protocols ¢ Paper protocols l Intranet based protocols l MOCIS ¢ Junior Medical Staff Handbook ¢

Avoiding adverse incidents Keep up to date ¢ Use protocols and guidelines ¢ Communication skills ¢

Communication skills ¢ Local training Breaking bad news l Dealing with difficult patients l • Violence and aggression training l Communication skills workshop • Local courses • Royal Colleges

Avoiding adverse incidents Keep up to date ¢ Use protocols and guidelines ¢ Communication skills ¢ Consent ¢

Consent May be: ¢ Tacit ¢ l ¢ E. g holds arm out for blood test Verbal E. g intimate examination l (document in notes – self defence) l ¢ Written

Taking consent All Wales consent forms ¢ 4 forms ¢ Patient’s consent l Parental consent on behalf of child (<16) l Procedure where consciousness not impaired l Adults unable to consent l

Consent ¢ Good practice – when to consent Complex or risky procedure or treatment l Anaesthesia or sedation l Possible significant consequences l Research l

Consent ¢ Forms require statements of: Intended benefit l Possible serious harm l Any extra procedures which may become necessary l Confirmation of alternatives discussed – including no treatment l ¢ 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 ¢ Understand information l Retain information l Weigh up information l Communicate decision l

MCA 2005 ¢ 5 principles Right to make own decisions l Every effort to support decision l Right to make unwise decision l Best interests l Least restrictive of basic rights l ¢ ¢ 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 ¢

Keep good notes Legible ¢ Black ink (biro) ¢ All entries dated and timed ¢ All entries signed ¢ Use stamp with GMC number l Print name l Print bleep number and designation l ¢ Discharge summaries

What to do if involved in adverse incident Inform senior colleague ¢ Fill in incident form ¢ KEEP GOOD NOTES ¢ Respond to complaints ¢ Factual account l Timely response l Take senior advice l Contact defence organisation l

Clinical Governance ¢ Risk management l l l ¢ ¢ ¢ 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 ¢ ¢ Chief Executive Paul Williams