- Stuff that isn't in the BNF online
- Assess the patient
- Identify evidence-based treatment options available for clinical decision making
- Present options and reach a shared decision
- Prescribe
- Provide information
- Monitor and review
- Prescribe safely
- Prescribe professionally
- Improve prescribing practice
- Prescribe as part of a team
- Prevention: reducing the incidence of ill health supporting healthier lifestyle
- Protection: surveillance and monitoring of infectious disease, emergency response and immunisation
- Promotion: health education and commissioning services to meet specific health needs.
| Where in stream | Level | Target | Methods |
|---|---|---|---|
| Upstream | Primary | Well Population | Health promotion Addressing risk factors, social and genetic factors |
| Midstream | Secondary | Those at risk of an illness | Screening Control of risk factors Early interventions |
| Downstream | Tertiary | Those with the illness | Rehabilitation Preventing Complications Improving Quality of Life |
Systematic review of health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities
- Improve what will have highest gain
- Integrate improvement into current services
- Involve all parties
- Highest Impact
- Changeability - is change possible
- Acceptability
- Resource feasibility
- prevention
- screening
- acute admission
- Justify - purpose of the confidential information
- Only when necessary
- Use minimum necessary
- Limit access to need-to-know
- Those with access aware of responsibilities
- Use lawfully
- Responsibility to share is equal to responsibility to protect
- Inform patients/service users how information being used
- Autonomy
- Beneficence
- Non-maleficence
- Justice and Veracity
| Type | Name | Features | Example |
|---|---|---|---|
| A | Augmented | Dose-related Common, predictable Related to the pharmacology Unlikely to be fatal |
Digoxin Toxicity Opioid Constipation |
| B | Bizarre | Not dose-related (within the therapeutic dose range) Uncommon, unpredictable Not related to the pharmacology Often fatal |
Penicillin hypersensitivity Malignant hyperthermia and hepatitis caused by anaesthetic agents |
| C | Chronic | Uncommon Related to cumulative dose Time-related |
Suppression to the hypothalamic pituitary adrenal axis with long-term corticosteroids |
| D | Delayed | Uncommon Usually dose-related Occurs or becomes apparent some time after use of the drug |
Carginogenesis |
| E | End of Treatment | Uncommon Occurs soon after withdrawl of the drug |
Opioid withdrawal |
| F | Failure | Common Dose-related Often caused by drug interactions |
Failure of the oral contraceptive in the presence of an enzyme inducer Failure of therapeutic effect in patients taking anticoagulants leading to stroke |
RPS competency framework – 2 circles, filled in 2 what are the others
Pt case and review medication
Down stream individual tx and upstream whole community public health
Improving community health public health powerpoint
- Chronic heart failure
- Hypertension
- Age > 75 x 2
- Diabetes
- Stroke x 2
- Vascular MI, PAD
- Age 65
- Sex Female
- Hypertension
- Abnormal Renal/Hepatic
- Stroke
- Bleeding predisposition
- Labile INR
- Elderly 65
- Drugs
A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
This definition is intended to embody three key attributes: recognisably high standards of care, transparent responsibility and accountability for those standards, and a constant dynamic of improvement.
- Education and Training
- Clinical audit
- Clinical effectiveness
- Research and development
- Openness
- Risk management
- Information Management
- Improve communication with patient and other HCPs
- Increase patient involvement
- Understand patient perspective
- Provide information
- Review medications
- Simplify dosing regimens
| Classification | Explanation | Example |
|---|---|---|
| Mistake | Error in formulating a plan of action Action was executed correctly but the plan was wrong |
Prescribing verapamil even though patient on a beta-blocker, unknowing of interaction |
| Slip | One or more step is executed incorrectly | Promazine vs PromETHazine |
| Lapse | One or more step is omitted | Distracted and forgetting to do prescribe route/rate |
| Violations | Deliberate - although perhaps not reprehensible - deviation from regulated codes of practices or procedures | Writing brand name instead of generic |
| Action | Description |
|---|---|
| Knowledge-based | Require conscious analytic processes and stored knowledge in novel or unfamiliar situations where low-level rules are not appropriate. They refer to what is typically thought of as 'analytic thought'. |
| Rule-based | Involve the conscious application of specific rules to familiar situations. |
- Senior review
- O2
- IV access and bloods
- Broad spectrum Abx - note guidelines and allergy
- IV fluids
- Monitoring NEWS2 - urine output and lactate
Red Flags
- Low BP < 90
- Increased resp rate >25
- Increased heart rate >130
- Temp > 38
- O2 saturations <92 or requires O2 to maintain
- Mental state change - confusion or unresponsiveness to voice/pain
- Rash/Cyanosis
- No urine in 18 hours
- Immunosuppression - recent chemo
- Enacted 2000
- 20 working days
- can ask for extensions
- can refuse if it will cost >£600
- Enacted 2018
- Replaced the 1998 one
- Processing lawful, fair and transparent
- Purposes of processing specified, explicit and legitimate
- Data adequate, relevant and not excessive
- Data accurate and kept up to date
- Kept no longer than necessary
- Processed in secure manner
- Accounted for – compliance with legislation
- Assumed to have capacity unless established they lack capacity
- Treated to be able to make a decision unless all practicable steps to help have been taken without success
- Making an unwise decision does not indicated lack of capacity
- Decisions made under the Act must be done in the persons best interests
- Intervention chosen needs to be, as possible, less restrictive to rights and freedoms
A person is unable to make a decision for themselves if they are unable to:
- understand the information relevant to the decision (in a form suitable for them)
- retain that information for the time required to make the decision
- use that information as part of the process of making the decision
- communicate their decision (non-verbal including blinking ok)
- Dementia different types
- Gram positive and gram negative
- Know you antibiotic indications
- Common, uncommon, reactions
- Yellow card scheme