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Clinical Governance - clinical governance module part 2

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1)

A 50-year-old woman with the likely diagnosis of cervical cancer is admitted to the emergency unit
with abdominal pain and vaginal bleeding. She has experienced postmenopausal bleeding for the
last four months and has not had cervical smears in the past. Her condition deteriorated rapidly the
day after admission. She collapsed and could not be resuscitated. You were the doctor on duty. You
were asked to join the risk management team to participate in the root cause analysis of the case.
What is your understanding of root cause analyses?

2)

You are asked to audit the triggers for incident reporting in maternity. Which of the following are
trigger factors for incident reporting?

3)

A 32-year-old second gravida has a spontaneous delivery in a district hospital. Uterine atony is
encountered. As part of resuscitation, a team member was asked to arrange blood cross-matching
and a sample error occurs. The wrong blood bag has been dispatched. At the beginning of
transfusion, the patient develops severe reactions and the problem is recognised immediately.

4)

The SBAR format is commonly used on the delivery suite as a method to convey critical clinical
information between different healthcare professionals.
An ST5 telephones the consultant on call with the following communication.
Good evening, Dr Smith. This is John, the ST5, calling from the delivery suite. I have just been to see
Mrs Jones who is in labour. The CTG is pathological. This woman is being monitored because of a
previous stillbirth. I propose to take her to theatre for an immediate caesarean section.
What component of SBAR is missing from this communication?

5)

A 29-year-old girl is brought for an examination after being assaulted by her husband. You are the
registrar on call. The police have been involved and requested access to the patient s information.
According to the Caldicott principles and the Data Protection Act of 1998, when may you allow
access to confidential patient information?

6) Next port of call if local resolution of a complaint is not achieved.

7)

You are working at the ST5 level as part of the gynaecology team. One of your patients had a
hysterectomy for heavy menstrual bleeding. As a part of trust policy you are advised to find out
about the patient s experience through the patient- reported outcome measure.
What is the purpose of the patient-reported outcome measures?

8)

A 19-year-old girl was admitted in early labour at term. She had not returned to the antenatal
clinic after her anomaly scan at 20 weeks gestation. She does not speak English and examination
showed severe external genital synechia. She progresses quickly and delivers a 6-pound (2722 g)
baby. Further examination reveals a fourth-degree tear, which gets recognised and dealt by a senior
obstetricians. Incident reporting was done. She undergoes repair in theatre

9)

A source of audit data that could be used to improve antenatal, intrapartum and neonatal
care.

10)

Every trust should have a risk management team for a particular specialty.
The following personnel should be part of a gynaecology risk team except:

11)

Processes which are open to public scrutiny, while respecting individual patient and
practitioner confidentiality and which can be justified openly.

12) Looks at task factors, patient factors, team factors and communication.

13)

Recognising and responding appropriately to early signs of deterioration in hospitalised
patients.

14)

The identification, assessment, and prioritization of risks, followed by coordinated and
economical application and resources to minimize, monitor and control the probability and/or
impact of unfortunate events.

15)

You are asked to design an audit within your department to review the use of prophylactic
antibiotics prior to the instrumentation of the uterus in patients undergo- ing procedures for fertility
treatment.
Which of the following would you recommend, regarding conducting an audit?

16)

There has been an increased incidence of perineal tears in the month of July within your
department. You are part of the risk management team and needed to review risk assessment
regarding this issue.
How do you calculate the risk score?

17)

A 26-year-old primigravida attends the day assessment unit at term +2 for loss of fetal
movements. Subsequent ultrasound examination confirms intrauterine fetal demise. Her antenatal
course was normal and her third-trimester growth scan showed an adequately grown fetus with
normal liquor. She has attended the day assessment unit a few days ago with the same complaint
when cardiotocograph was found to be normal. She was reassured and advised to return to hospital
if any further problems occurred. She and her partner are informed about the fetal demise and
counselled by the team. She is very upset and opts for induction of labour the next day.

You are working at the ST6 level in a District General Hospital. You are asked to help with finding an
effective obstetric emergencies training programme.

18) Which of the following do you recommend?

19) One of the seven domains by which health care is evaluated.

A ST4 trainee is performing an audit on the outcome of Group B streptococcus infection in
Obstetric patients

20) She should be proceeding in the following sequence:

21)

A fetal medicine specialist performs an amniocentesis at 17 weeks of gestation. Two days later,
the woman has a miscarriage. The midwives feel that the particular specialist has a high miscarriage
rate following antenatal invasive tests.

22) Ensuring that the right person does the right thing in the right way to get the right outcome.

23)

A specialty trainee is collecting data for a research project. She has scanned copies of the
patients notes and saved these on an unencrypted memory stick. When she arrives home one
evening, she cannot find the memory stick.

24)

You are working at the ST5 level. You have conducted a trial of forceps delivery in theatre on a 28-
year-old primigravida. She had successful epidural analgesia. The procedure went well. The
estimated blood loss was 700 mL. The woman is haemo- dyanamically stable and the episiotomy is
repaired appropriately. While counting swabs at the end of the procedure, the midwife has found
that one swab is missing.
An X-ray located the swab, buried under one of the sutures. You called the consultant who removed
the swab.
What is the most appropriate clinical governance action you should take?

25)

A framework through which NHS organization 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.

26)

The review of clinical performance, the refining of clinical practice as a result and the
measurement of performance against agreed standards – a cyclical process of improving the
quality of clinical care.

27)

. A quality improvement process that seeks to improve patient care and outcomes through
systematic review of care against explicit criteria and the implementation of change.

28) The primary duty of the Caldicott guardian in any NHS trust is:

29)

A 28-year-old woman reports to the delivery suite at 32 weeks gestation with painless vaginal
bleeding. Her first baby was born at term by Caesarean section. Placenta accreta was suspected by
earlier ultrasound examination and further MRI confirms accreta. She was offered counselling and
New Section 119 Page 4
earlier ultrasound examination and further MRI confirms accreta. She was offered counselling and
advised inpatient care. She undergoes an emergency Caesarean section and hysterectomy for
complete placenta accreta.

30)

A woman is admitted for a planned caesarean section. During the course of the operation, she
has a cardiac arrest and it is not possible to resuscitate her. She is
thought to have had an amniotic fluid embolism

31) A measure of the extent to which a particular intervention works.

If involved in a serious incident requiring investigation(SIRI),initial steps would involve
completing an incident form, ensuring comple- tion of notes accurately and participating in team
debrief

32) If a trainee is involved in an SIRI, what action should be taken as soon as possible?

33)

A continuing process, outside formal undergraduate and postgraduate training, that enables
individual doctors to maintain and improve standards of medical practice through the
development of knowledge, skills, attitudes and behaviour.

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