Platform 5: Improving Safety & Quality of Care

A patient falls on the ward but is unhurt. What should happen next?

• ARecord the fall in the notes only, since no injury means no incident occurred
• BReport the fall only if the patient or their family ask for it to be reported
• CAssess the patient, report the fall through the incident-reporting system and review their falls risk✓
• DMove the patient to a bed nearer the nurses' station and take no further action

Answer: Every fall is a reportable incident whether or not harm results, because patterns of falls reveal risks that can be reduced. The patient is assessed for injury, the incident is reported, and their risk assessment and care plan are reviewed.

Which of these is one of the six principles of adult safeguarding set out under the Care Act 2014?

• AProportionality — the least intrusive response appropriate to the risk presented✓
• BCompliance — the person must agree to the action the team decides on
• CConfidentiality — safeguarding concerns must never be shared outside the care team
• DDetention — a person at risk may be kept safe by restricting where they go

Answer: The six safeguarding principles are empowerment, prevention, proportionality, protection, partnership and accountability. Safeguarding often requires sharing information, works with the person's wishes rather than requiring compliance, and never permits restricting a person's liberty outside the legal frameworks.

An older patient has unexplained bruising and seems frightened of a family member who visits. What should the nursing associate do?

• ADiscuss the concern with the patient's other relatives when they visit to find out what they think is going on at home
• BReport the concern to the nurse in charge or safeguarding lead so that a safeguarding referral can be considered✓
• CAsk the family member directly, at their next visit, whether they have been hurting the patient and note down their reply
• DWait until there is definite proof that abuse has taken place before raising the matter with anyone outside the ward

Answer: Suspicion of abuse must be reported through the safeguarding process; the nursing associate does not need proof and should not investigate or confront anyone themselves. The safeguarding lead and the local authority decide what happens next.

What is the 'duty of candour'?

• AA requirement to report every complaint to the Care Quality Commission within 24 hours
• BAn obligation to disclose a colleague's error to the patient before telling the colleague
• CA duty to give patients a full copy of their records at the end of each admission
• DA legal and professional duty to be open and honest with patients when something goes wrong with their care✓

Answer: The duty of candour requires providers and registrants to tell the patient (or their family) when a notifiable safety incident has occurred, apologise, explain what happened, and set out what will be done. It is both a statutory duty on organisations and a professional duty in the Code.

Which of these is classed as a 'never event'?

• AA patient falling while walking to the bathroom
• BA medication given one hour later than prescribed
• CA patient developing a category 2 pressure ulcer
• DSurgery performed on the wrong site✓

Answer: Never events are serious, largely preventable incidents that should not occur if the available safety guidance is followed, such as wrong-site surgery, retained foreign objects and wrong-route medication. Pressure ulcers, late doses and falls are reportable incidents but not never events.

A nursing associate is asked to take part in an audit of hand-hygiene compliance on the ward. What is the purpose of this kind of audit?

• ATo satisfy the inspection requirements of the Care Quality Commission only
• BTo prove that the ward's infection rates are lower than other wards
• CTo identify individual staff who can then be disciplined for poor practice
• DTo measure practice against an agreed standard so that gaps can be identified and improved✓

Answer: Clinical audit compares what is actually done with what should be done, and the results drive improvement through a cycle of measurement, change and re-measurement. It is a learning tool, not a disciplinary one.

A nursing associate is concerned that staffing levels on a night shift are unsafe. What should they do?

• AAccept the situation, since staffing levels are a management decision that sits outside the nursing associate's role and cannot be changed on the night
• BRefuse to start the shift until more staff are provided, since working with unsafe numbers would make the nursing associate responsible for any harm
• CRaise the concern with the person in charge at the time and, if unresolved, escalate it through the organisation's raising-concerns process✓
• DPost about the staffing levels on social media so that the public and the press become aware of the risk to patients on the ward that night

Answer: The Code requires registrants to raise concerns about anything that may put patient safety at risk, using the proper channels: the person in charge first, then the raising-concerns (whistleblowing) process and the Freedom to Speak Up Guardian. Public posting breaches confidentiality and professionalism.

Which statement about the Deprivation of Liberty Safeguards (DoLS) is correct?

• AThey provide a legal framework for depriving a person who lacks capacity of their liberty in a hospital or care home when it is in their best interests✓
• BThey allow any patient to be prevented from leaving hospital whenever staff believe that it would be unsafe for that patient to go home, whatever the patient's own view
• CThey allow a person's family to decide, without any formal assessment, whether the person can leave a care home or hospital and when they are allowed to do so
• DThey apply only to patients who have already been detained under the Mental Health Act and are being treated in a psychiatric hospital or unit for a mental disorder

Answer: DoLS, under the Mental Capacity Act 2005, are the authorisation process for a deprivation of liberty of a person who lacks capacity to consent to their care arrangements in a hospital or care home. They do not apply to people with capacity, are separate from the Mental Health Act, and require formal assessment and authorisation rather than a family's say-so.

What is the primary purpose of reporting a near miss, such as a medication almost given to the wrong patient?

• ATo satisfy the requirement that a form is completed for every event
• BTo create a disciplinary record against the staff member involved
• CTo identify system weaknesses so they can be fixed before a similar event causes harm✓
• DTo provide evidence for the organisation's insurers in case of a claim

Answer: Incident reporting is about learning and prevention: near misses reveal where the process nearly failed. A just culture treats them as opportunities to improve rather than as grounds for discipline.

A patient is assessed as at high risk of pressure ulcers. Which action is part of the SSKIN bundle?

• ARestricting fluids to reduce moisture on the skin
• BApplying a barrier cream to the whole body twice a day
• CRegular repositioning, checking the skin and using a suitable support surface✓
• DKeeping the patient in bed as much as possible so that the skin is protected from friction

Answer: SSKIN stands for Support surface, Skin inspection, Keep moving, Incontinence and moisture management, and Nutrition and hydration. Immobility, indiscriminate creams and fluid restriction increase rather than reduce the risk.

Which of these situations should be reported as a safeguarding concern rather than dealt with as an ordinary complaint?

• AA patient asks for a different member of staff because of a personality clash
• BA patient complains that their lunch was cold two days running
• CA relative is unhappy about the length of time they waited at reception
• DA care home resident with dementia has money going missing from their room✓

Answer: Financial abuse of an adult at risk is a safeguarding matter under the Care Act 2014 and must go through the safeguarding process, not the complaints system. Cold food, waiting times and personality clashes are service complaints.

Why is a 'just culture' important in improving patient safety?

• AIt ensures that every error leads to disciplinary action so standards stay high
• BIt allows patients to be told less about errors so that they do not lose trust
• CStaff are more likely to report errors and near misses when they will be treated fairly rather than blamed✓
• DIt removes the need for individual accountability for mistakes

Answer: A just culture distinguishes honest mistakes and system failures from reckless behaviour, so people speak up and the organisation learns. It does not remove accountability, and openness with patients is still required by the duty of candour.

A ward is trialling a change to reduce falls using a PDSA cycle. What does PDSA stand for?

• APlan, Decide, Share, Approve
• BPrepare, Deliver, Sustain, Assess
• CPrevent, Detect, Solve, Audit
• DPlan, Do, Study, Act✓

Answer: PDSA is the improvement cycle used across the NHS: plan a change, do it on a small scale, study the results, and act on what was learned before the next cycle.