Clinical Governance

Dr Lisa Joels

Postgraduate Organiser

Singleton Hospital

6th August 2008

Clinical Governance

Risk management Avoiding adverse incidents Education & CPD Protocols & Guidelines Communication skills Consent Complaints procedure

Notes and coding Audit

Risk management

Adverse incidents: Avoidable

MistakesErrors

UnavoidableE.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 protocolsIntranet based protocols

MOCIS Junior Medical Staff Handbook

Avoiding adverse incidents

Keep up to date Use protocols and guidelines Communication skills

Communication skills

Local trainingBreaking bad newsDealing with difficult patients

• Violence and aggression training

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

E.g holds arm out for blood test Verbal

E.g intimate examination(document in notes – self defence)

Written

Taking consent

All Wales consent forms 4 forms

Patient’s consentParental consent on behalf of child

(<16)Procedure where consciousness not

impairedAdults unable to consent

Consent

Good practice – when to consentComplex or risky procedure or

treatmentAnaesthesia or sedationPossible significant consequencesResearch

Consent

Forms require statements of:Intended benefitPossible serious harmAny extra procedures which may

become necessaryConfirmation of alternatives discussed

– including no treatment 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 informationRetain informationWeigh up informationCommunicate decision

MCA 2005

5 principlesRight to make own decisionsEvery effort to support decisionRight to make unwise decisionBest interestsLeast restrictive of basic rights

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 numberPrint namePrint bleep number and designation

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 Timely responseTake senior adviceContact defence organisation

Clinical Governance

Risk management 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