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

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

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

4. How to avoid adverse incidents Keep up to date

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

6. Avoiding adverse incidents Keep up to date Use protocols and guidelines

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

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

9. Local training Breaking bad news Dealing with difficult patients Violence and aggression training Communication skills workshop Local courses Royal Colleges

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

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

12. 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

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

14. 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

15. 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

16. MCA 2005 5 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

17. Avoiding adverse incidents Keep up to date Use protocols and guidelines Communication skills Consent Keep good notes

18. 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

20. 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

21. Clinical Governance Risk management Avoiding adverse incidents Education & CPD Guidelines & protocols Communication skills Consent Complaints procedure Notes and coding Audit Appraisal & revalidation

22. If you have problems…… Educational Supervisor Clinical Director Medical Director Bruce Ferguson Postgraduate Organiser Lisa Joels Occupational HealthMike Tidley Chief ExecutivePaul Williams