CG in ophthalmology

Information about CG in ophthalmology

Published on April 30, 2008

Author: Freedom

Source: authorstream.com

Content

Clinical Governance in Ophthalmology:  Clinical Governance in Ophthalmology M. Jabir 27 November 2003 Introduction:  Introduction RCOphth charter : maintain proper standards in the practice of ophthalmology for the benefit of the public Definition:  Definition A framework through which the NHS organisations are accountable for continually improving the quality of their services & safeguarding high standard of care by creating an environment in which excellence in clinical care flourish Clinical Governance Pillars:  Clinical Governance Pillars Strategic capacity in the trust Resources & processes Clinical Audit Clinical Risk Management Education, Training, CPD Patient Consultation & Involvement Research & Effectiveness Staffing & Staff management Use of information to support CG & health care delivery Patients experience Trust context: activity, finances Purpose of the Session:  Purpose of the Session Clinical Governance issues & arrangements specific to ophthalmology Outline:  Outline Clinical governance links National quality standards in ophthalmology Facilities Clinical outcomes Delivering & monitoring standards Audits Critical Incidents Complaints Improving standards CG Links:  CG Links RCOphth NICE CHAI DOH Private sector ? Trust management Boards :Annual reports on clinical quality by eye units Slide8:  GMC Appraisal & Revalidation CME & CPD EBM & research Slide9:  National quality standards Slide10:  1 Facilities OPD:  OPD Elective, A & E, DCS high volume children or elderly & many relatives Equipment's : FFP, photos, B scan, laser, optometry, orthoptic, VF, minor ops & pre-op assessments Room for the visually impaired & wheelchairs , well signpost Well lit waiting area & kids facilities Slide12:  Consulting rooms : test chart, trial lens set, slit lamp with tonometry, direct & indirect ophthalmoscopes, lenses & reclining chair CLs, focimeter, perimetry , B scan & biometry Minor operation facilities Orthoptic rooms with Hess charts Fundus photography & FFP Lasers both yag & posterior segment Slide13:  Workload : 1 pt / 15 min + booking space for emergencies & ward discharge Consultant’s list : 5-6 new + 6-7 returns Total number of pts / Dr no more than 15 Consideration for presence of medical students & trainees Adequate administrative, secretarial & clerical support. Inpatients:  Inpatients Eye pts should be looked after by ophthalmic nurses Whether in ophthalmic ward or dedicated ophthalmic beds in a mixed ward will be determined by the No of pts & turnover Equipped examination room Children should be admitted to wards where they are attended by staff trained in paediatric & ophthalmic care with access to a consultant paediatrician. Theatres:  Theatres Dedicated ophthalmic theatre without any absolute restrictions on other non infected surgery being undertaken in the ophthalmic theatre Microscope with coaxial illumination, binocular assistant’s eyepieces Phacoemulsifier and vitrectomy machines Slide16:  High standard of microsurgical instrumentation with training in care & handling Information technology : recording data about pt, surgeon, procedure & co-morbidity Anaesthetic facilities according to their college’s guidelines A video camera, a video & a monitor Day case:  Day case All pts should have access to DCS preferably in a day case unit or a ward with DC facilities Provision of general & ophthalmic pre- op assessment DC theatres should have same standards Provision of a bed if necessary Resuscitation facility & trained staff Staffing levels:  Staffing levels 1 consultant / 70000 population provided there is support from trainees, middle grades, nurse practitioners, orthoptists & other ophthalmic assistants In teaching hospitals 1 / 50000 Some juniors tasks can be delegated to non medical staff Slide19:  No unit should be staffed by one consultant Locum consultants should be restricted to 6 months only, further 6 after college approval Effective link with Medical staff in other specialities Service design:  Service design Hub & spoke : unit amalgamation Clinical networks : several hubs at a supra-regional level Ophthalmic emergencies : 24 hr cover by ophthalmic staff , first on call by SHO or years 1 & 2 SPRs or staff grades Consultants should not be first on call Slide21:  2 Measurement of clinical outcomes Slide22:  Data collection on outcomes in a way that allows it’s quality to be measured which is easier in surgical specialities College’s national audits can set standards Allowance for co-morbidity & case mix Chronic diseases as D.R., OAG, ARMD outcomes may not be apparent for years Slide23:  Blind registration statistics may be used as an indicator of medicine or NHS status in general & not the individual doctor or the trust’s performance IT or A4 paper with tick boxes for data The next few tables are the proposed indicators of clinical quality in ophthalmology Slide26:  Delivering & monitoring standards Bodies responsible:  Bodies responsible Locally Trusts Clinical Effectiveness departments Clinical Governance committees Trust Boards Health Authorities Nationally CHAI Audit:  Audit Utilise current procedures, role of clinicians , unwise to rely on clerical staff alone Collection of data and comparing with national outcomes ( benchmarking) Two separate sets of data : *Combined results of a unit ( CHAI ) *Individual clinicians detailed data Critical Incident Analysis Trigger List:  Critical Incident Analysis Trigger List Operating on the wrong eye Wrong operation on the correct eye Missing case notes at surgery Globe perforation during local anaesthesia Expulsive Haemorrhage during surgery Patient’s collapse Death Endophthalmitis Slide30:  Open category for incidents: Unplanned return to theatre within 28d Unplanned admission to an eye unit within 28 d Unplanned transfer to another eye unit within 28 d Stories of success are also part of CIA Complaints monitoring:  Complaints monitoring Regular monitoring and auditing of complaints Litigation monitoring College Inspections:  College Inspections Juniors training Monitoring service provision & facilities In non training units if requested to assess quality Continuing Professional Development:  Continuing Professional Development GMC : clinicians should be up to date Personal development plans CME / CPD Voluntary system now, will be obligatory soon Revalidation:  Revalidation GMC document : Regular demonstration by all registered doctors that they remain fit to practise in their chosen field is best be assured by a link with registration Portfolio files Five yearly Linked with appraisal Slide35:  Improving standards Slide36:  Improving standards through local audits & CME / CPD NICE & RCOphth EBM standards to compare with Local failing trust involving college investigating dept Conclusions:  Conclusions Patient welfare is the core objective Clinicians & units should have CG impeded in their practice Continuous auditing of outcomes Trigger lists of Incidents in all units Fair Vs No blame culture Benefits from clinical governance Teams should be Up to date Evidence based practice No harm comes to patients References:  References BMJ V 317 19-26 December 1998 BMJ V 317 4 July 1998 BMJ V 313 & September 1996 RCOphth guidance for clinical governance April 1999 GMC good medical practice July 1998 A first class service 1998 The national cataract audit 1998-1999 RCOphth CME 1998 The national DR audit Eye 1998 12: 77-84 Cataract surgery 1995 Clinical governance 1999 CHI report

Related presentations


Other presentations created by Freedom

Matter
15. 06. 2007
0 views

Matter

emerging diseases
10. 03. 2008
0 views

emerging diseases

Skoda Report
15. 11. 2007
0 views

Skoda Report

20070813181441372320
12. 10. 2007
0 views

20070813181441372320

Classification6
12. 10. 2007
0 views

Classification6

NMR SOLOMON Chap13
15. 10. 2007
0 views

NMR SOLOMON Chap13

Fiduciaire
17. 10. 2007
0 views

Fiduciaire

Burkert talk
15. 10. 2007
0 views

Burkert talk

EnhancedFujitaScale
05. 10. 2007
0 views

EnhancedFujitaScale

AncientChineseTangra ms
10. 10. 2007
0 views

AncientChineseTangra ms

meek
21. 08. 2007
0 views

meek

time series 2002
21. 08. 2007
0 views

time series 2002

taft hartley
21. 08. 2007
0 views

taft hartley

NLP
07. 11. 2007
0 views

NLP

ETHANOL
07. 11. 2007
0 views

ETHANOL

ALMA Paola FacultyApr07
13. 11. 2007
0 views

ALMA Paola FacultyApr07

Of Mice
17. 11. 2007
0 views

Of Mice

Basic Five Pargraph Essay
19. 11. 2007
0 views

Basic Five Pargraph Essay

lect2
23. 11. 2007
0 views

lect2

Flower
17. 12. 2007
0 views

Flower

05 Pro Waltz
23. 12. 2007
0 views

05 Pro Waltz

ICAI 2004 presentation
31. 12. 2007
0 views

ICAI 2004 presentation

AIMS Prey predator Models
01. 01. 2008
0 views

AIMS Prey predator Models

Romantic
11. 08. 2007
0 views

Romantic

personality testing
11. 08. 2007
0 views

personality testing

040617 GALLAS E talk
29. 09. 2007
0 views

040617 GALLAS E talk

PhaseTransformations
05. 01. 2008
0 views

PhaseTransformations

DiscardRoutes
07. 10. 2007
0 views

DiscardRoutes

Cold War marshall plan
28. 12. 2007
0 views

Cold War marshall plan

tort crime puzzle
07. 01. 2008
0 views

tort crime puzzle

22801
26. 11. 2007
0 views

22801

Beloved Beware
02. 08. 2007
0 views

Beloved Beware

meinshausen
21. 10. 2007
0 views

meinshausen

en ann041230
16. 10. 2007
0 views

en ann041230

solidwas
11. 12. 2007
0 views

solidwas

religiosity sexualbehaiviors
11. 08. 2007
0 views

religiosity sexualbehaiviors

Geog3225 Globalization2
22. 10. 2007
0 views

Geog3225 Globalization2

parmon
26. 10. 2007
0 views

parmon

cs428 Internetworking
30. 12. 2007
0 views

cs428 Internetworking

DaisyModellingUk1
04. 01. 2008
0 views

DaisyModellingUk1

chapter6ile
02. 08. 2007
0 views

chapter6ile

Inland Empire
21. 08. 2007
0 views

Inland Empire

AIDS Ed 3 5 03 Murphy
02. 08. 2007
0 views

AIDS Ed 3 5 03 Murphy

Coulombe CND VIP 26Oct05
01. 11. 2007
0 views

Coulombe CND VIP 26Oct05

Ch6CP
16. 02. 2008
0 views

Ch6CP

plato
11. 08. 2007
0 views

plato

ImmPres
24. 02. 2008
0 views

ImmPres

Smita Gupta
24. 02. 2008
0 views

Smita Gupta

psy230 eysencks theory 06
11. 08. 2007
0 views

psy230 eysencks theory 06

JimGill
28. 02. 2008
0 views

JimGill

color
06. 03. 2008
0 views

color

impacto ampliacion
25. 10. 2007
0 views

impacto ampliacion

This Changed Life
07. 03. 2008
0 views

This Changed Life

Ken singapore
13. 03. 2008
0 views

Ken singapore

Portal mobile
20. 03. 2008
0 views

Portal mobile

turismo
22. 10. 2007
0 views

turismo

Kievan Russia
26. 10. 2007
0 views

Kievan Russia

4 Buku yang baik
14. 11. 2007
0 views

4 Buku yang baik

The Final Project Education
21. 08. 2007
0 views

The Final Project Education

41 xslt
01. 12. 2007
0 views

41 xslt

Crete
10. 04. 2008
0 views

Crete

2006911201819960
13. 04. 2008
0 views

2006911201819960

Milov Carnegie Feb 1 2005 eng
16. 04. 2008
0 views

Milov Carnegie Feb 1 2005 eng

PANCEA ovrvw URGE2 02 v1
17. 04. 2008
0 views

PANCEA ovrvw URGE2 02 v1

24081
02. 08. 2007
0 views

24081

Business 2007
12. 03. 2008
0 views

Business 2007

MercuryWeiler
18. 04. 2008
0 views

MercuryWeiler

Presentation Overall 7 26 07
22. 04. 2008
0 views

Presentation Overall 7 26 07

ompi tm cas 04 8
24. 10. 2007
0 views

ompi tm cas 04 8

6apng mongolia
30. 03. 2008
0 views

6apng mongolia

4a
28. 04. 2008
0 views

4a

approx matches
02. 08. 2007
0 views

approx matches

5 QM06 JHLee
11. 10. 2007
0 views

5 QM06 JHLee

march 01
07. 01. 2008
0 views

march 01

Concordia KV
02. 08. 2007
0 views

Concordia KV

ammos
15. 10. 2007
0 views

ammos

ANS 217Poultry Genetics
02. 08. 2007
0 views

ANS 217Poultry Genetics

18 Hergott Shepard Residence
21. 08. 2007
0 views

18 Hergott Shepard Residence

06WorldDataSheet presentation
02. 08. 2007
0 views

06WorldDataSheet presentation

Neil Lerner
21. 08. 2007
0 views

Neil Lerner

One Stop worker presentation
18. 06. 2007
0 views

One Stop worker presentation

Paternalism
13. 10. 2007
0 views

Paternalism

Learn-Mean Median Mode Range
15. 06. 2007
0 views

Learn-Mean Median Mode Range

Learn Math Flash Measurement
15. 06. 2007
0 views

Learn Math Flash Measurement

Learning Multiplication
15. 06. 2007
0 views

Learning Multiplication

Moths and Butterflies
15. 06. 2007
0 views

Moths and Butterflies

Mock Election
15. 06. 2007
0 views

Mock Election

YaronArielAoIR5
21. 08. 2007
0 views

YaronArielAoIR5

DAMA Overview
29. 10. 2007
0 views

DAMA Overview

5 MerrillCross
19. 11. 2007
0 views

5 MerrillCross

chol ncep
02. 08. 2007
0 views

chol ncep

PoriesPres
11. 08. 2007
0 views

PoriesPres

CLIL Issues
21. 10. 2007
0 views

CLIL Issues

abby
02. 08. 2007
0 views

abby

evenson k4dev 031014
04. 10. 2007
0 views

evenson k4dev 031014

Bazelon 11 14 06 final
29. 10. 2007
0 views

Bazelon 11 14 06 final

7 3 iyer
26. 02. 2008
0 views

7 3 iyer

ahm poster gridblast 2004
28. 12. 2007
0 views

ahm poster gridblast 2004

week five
24. 10. 2007
0 views

week five

facts figures bpc2006
27. 09. 2007
0 views

facts figures bpc2006

JLA Overview
04. 01. 2008
0 views

JLA Overview

MOB7566Intro2006
17. 10. 2007
0 views

MOB7566Intro2006