12. Clinical Risk Management

Front 1

Which of the following is incorrect regarding the most common groups of presentations

associated with DAMA?
A. Nausea and vomiting
B. Abdominal pain
C. Headache
D. Alcohol-related mental disorders

Back 1

C.

Additionallly : non-specific chest pain

Front 2

Which is incorrect regarding Refusal of

treatment ?
A. The incidence is < 1%
B. Abdominal pain is a common presentation that is associated with DAMA
C. DAMA is associated with nearly 5% of unscheduled readmissions.
D. DNW has a rate of unscheduled readmissions, higher than that of DAMA ( 4.4 % vs 2.6%)

Back 2

D. Unscheduled readmissions is higher for DAMA > DNW

[ 4.4% vs 2.6 % ]

Front 3

What are the 4 Main Principles that form the basis of ethical decision making in Clinical Practice?

Back 3

Beauchamp and Childress's Medical ethics

Principles :

1. Autonomy
2. Beneficence
3. Non-Maleficence
4. Justice

Front 4

What are the 6 Questions to be answered when assessing a DAMA ?

Back 4

1. Is there a duty of care?
2. Why do they want to leave?
3. Can someone else legally determine

consent ?
4. What is the risk to the patient of DAMA?
5. What is the risk to the patient of restraint?
6. ** Is the patient capable of refusing

consent?**

Front 5

Which of the following is correct regarding DAMA?
A. The incidence is 2%
B. DAMA poses Ethical, Legal and Clinical dilemmas.
C. A signature on a Discharge At Own Risk form is sufficient record form DAMA.
D. Unreasonable restraint = negligence.

Back 5

B.

A. Incidence of DAMA < 1%
C. Thorough documentation in medial record

imperative. ***
D. Unreasonable restraint = assault / false

imprisonment

Front 6

Which is incorrect regarding the Discharge at own risk form?
A. The form must document the risks explained to the patient.
B. The form must document the potential benefits of the treatment

refused.
C. The signature can be witnessed by a Dr or Nurse.
D. If the patient refused to sign, the document cannot be used.

Back 6

D. Another Staff member who witnessed the

interaction can make and sign a statement.

Front 7

When does a Duty Of Care Exist?

Back 7

1. When the patient presents for treatment- AND IS INITIALLY engaged in the process

( Registration onwards )
2. The treatment can reasonably be

provided.
3. It only exists when the risk is still present and the patient is competent.

Front 8

What is "Duty Of Care"?

Back 8

Duty of Care:

The extent to which a healthcare provider must reasonably ensure that no harm comes to a patient under the provider's care.

Front 9

Which is incorrect regarding CONSENT?
A. Doctors assess the decision making capacity of an individual to

determine their capacity to give consent.
B. The patient must have a MMSE of > 23
C. < 14 years is considered to be non-competent.
D. Age 14-17 is considered to be a variable age for consent.

Back 9

B. MMSE > 20

Front 10

Which is incorrect regarding competence to

consent ?
A. Parents or Legal Guardians have the Power of Consent in Minors.
B. There are, in fact, no absolute rules with the age of Consent- But

age < 14 is considered incompetent to consent .
C. The patient must have the Cognitive capacity to understand the

options for treatment and potential adverse outcomes.
D. Treatment of a life-saving nature can not be given to a incompetent

minor if the parents object.

Back 10

D. Treatment of a life-saving nature may be given, despite Parental objection.
Guardianship Agencies will need to be

involved.

Front 11

Which is incorrect regarding Competence and Consent?
A. The existence of a signed form constitutes conclusive evidence the

patient was adequately informed.
B. Consent forms must have a signature AND the details of the

discussion.
C. A competent patient can at all times refuse treatment- OR withdraw treatment previously given-even if it is life-saving.
D. The Greatest risk to both the intoxicated patient and treating Doctor is in NOT RESTRAINING a patient who is at risk to themselves.

Back 11

A. It does not

Front 12

Other than the patient- who else can

LEGALLY DETERMINE CONSENT FOR THE

PATIENT?

Back 12

1. Minors ( Parents )
2. Mental Health Act detention
3. Legal Power of Attorney
4. Judicial - legal order
5. Guardianship Board

Front 13

Which is incorrect regarding Telephone advice and Triage?
A. Telephone triage is highly rated by the Community.
B. Telephone advice should be limited to Advice regarding First Aid and about seeking further assistance.
C. Documentation is imperative for any discussion / advice given by phone.
D. There is a large volume of data available on the effects and outcomes of Telephone Triage.

Back 13

D. Little data published on this-despite

widespread use.

Front 14

Clinical Risk Management is a Comprehensive, focused strategy , aimed at which 3

components of the delivery of care in the ED?

( Aimed at Ensuring delivery of safe,

error-free patient care. )

Back 14

1. The System
2. The Process
3. The Individual

Front 15

List the "Phases" of Emergency Care.

Back 15

6 Phases :

Phase 1 : Pre-Emergency Department
Phase 2: Entering the System
Phase 3: Rapid Assessment and Initial Treatment
Phase 4: Further Investigation - Consultation and review
Phase 5: Exiting the System
Phase 6: Following exit from the ED

Front 16

Which is incorrect regarding Medical Error in the ED?
A. Risk increases after hours
B. The majority of cases associated with error involve those discharged from the ED - 50% of these fulfil criteria for admission.
C. Phase 2 of the Emergency Care Process is the " rapid assessment and initial treatment".
D. Phase 4 of the process involves Consultation and review.

Back 16

C. Phase 3 = Rapid assessment and initial

treatment
Phase 2 is "Entering the system" - Allocation to an appropriate Clinical area.

Front 17

The Critical Incident Monitoring Study ( CIMS) in Australia identified the following high risk

incident issues- which is incorrect ?
A. A busy ED
B. Junior , inexperienced Staff with unavailable Senior Staff.
C. After Hours.
D. High Acuity presentations.

Back 17

D.

Front 18

What 4 System factors are associated with

"preventable system issues"?

Back 18

1. Junior Medical AND Nursing Staff
2. Night Duty
3. Weekends - No Senior Cover
4. Busier than usual ED

Front 19

Which of the following is incorrect regarding an "Incident"
A. It is an unintended event.
B. It is Inconsistent with routine Hospital Practice.
C. It may or may not result in an adverse event.
D. It can be intentional.

Back 19

D. Not typical to the definition

Front 20

Which is incorrect regarding an "Adverse Event"
A. It results in harm to the patient.
B. It may result in an adverse outcome
C. It may not result in an adverse outcome
D. It can have an impact on patient care.

Back 20

A. = Adverse Outcome

Front 21

Which is incorrect regarding the standard

definitions for ED Errors?
A. An Adverse outcome involves harm to the patient.
B. A Medical Error is an error of execution or planning.
C. A Medical error may be a simple mistake- or due to a lack of

expertise.
D. An adverse outcome is failure to use reasonable care-either doing / not doing something a reasonable Doctor would do / not do.

Back 21

D = Negligence.

A departure from accepted Practice.

Front 22

Which is not a Phase 6 Error?

A. Failure to notify a patient of a missed abnormality.
B. Failure to refer.
C. Failure to ensure Timely follow-up
D. Failure to follow-up a DNW

Back 22

C =Phase 5

Front 23

Which of the following links is incorrect?
A. Phase 3 error = Failure to adequately manage an airway
B. Failure to correctly Triage = phase 3
C. Failure to perform Vital signs = phase 2
D. Failure to provide discharge instructions = phase 5

Back 23

B. = Phase 2