Clinical Governance Dr Lisa Joels Postgraduate Organiser Singleton Hospital 6 th 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 Mistakes Errors Unavoidable 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 Intranet based protocols MOCIS Junior Medical Staff Handbook

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

Local training Breaking bad news Dealing 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

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 consent Parental consent on behalf of child (<16) Procedure where consciousness not impaired Adults unable to consent

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

Consent Forms require statements of: Intended benefit Possible serious harm Any extra procedures which may become necessary Confirmation 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 information Retain information Weigh up information Communicate decision

MCA principles Right to make own decisions Every effort to support decision Right to make unwise decision Best interests Least 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

Legible Black ink (biro) All entries dated and timed All entries signed Use stamp with GMC number Print name Print 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 response Take senior advice Contact 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 HealthMike Tidley Chief ExecutivePaul Williams