Reading Part B: Workplace Extracts

Extract from a ward policy: "Controlled drugs must be checked by two registered practitioners at the point of administration. The second checker must witness the preparation, the administration and the entry in the register, and must not sign in advance." What does the policy require of the second checker?

• ATo be present for the whole process and sign only after the drug has been given✓
• BTo sign the register before administration so that the record is complete
• CTo check the drug once it has been given and countersign at the end of the shift
• DTo prepare the drug so that the first practitioner can concentrate on the patient

Answer: The extract states that the second checker must witness preparation, administration and the register entry and must not sign in advance — so presence throughout and signing afterwards. Preparing the drug is not required of the checker, and signing early or at the end of the shift is exactly what is ruled out.

Extract from a memo: "Following last month's audit, referrals to the falls clinic will now be triaged within two working days. Referrals lacking a completed multifactorial risk assessment will be returned to the referrer rather than placed on the waiting list." What is the purpose of this memo?

• ATo inform staff of a new triage timescale and a condition for accepting referrals✓
• BTo announce that the falls clinic is closing to new referrals
• CTo ask staff to complete the audit before the end of the month
• DTo explain to staff how to carry out and record a multifactorial falls risk assessment

Answer: The memo tells staff two things: referrals will be triaged within two working days, and incomplete referrals will be sent back. It does not close the clinic, does not request audit work, and does not teach the assessment itself.

Extract from a manufacturer's guideline: "The infusion set should be replaced every 72 hours, or sooner if the line is disconnected, the dressing is compromised or signs of phlebitis develop. Do not use the set beyond 96 hours under any circumstances." Which statement is consistent with the guideline?

• AA set should be replaced only when signs of phlebitis appear
• BA set may be kept for 96 hours as long as the dressing remains intact
• CA set must always be replaced at exactly 72 hours regardless of its condition
• DA set may stay in place up to 72 hours if there are no problems, and never beyond 96✓

Answer: The routine limit is 72 hours, with earlier replacement for specific problems, and 96 hours is an absolute maximum rather than a target. Replacing at exactly 72 hours ignores the 'or sooner' clause, keeping a set for 96 hours is not the standard, and waiting for phlebitis ignores the routine limit.

Extract from an email to staff: "Given the number of near-misses reported since the electronic prescribing system went live, the pharmacy team will be present on the wards during the morning drug round for the next fortnight. Please treat this as support, not surveillance." What does the final sentence show the writer is concerned about?

• AThat the pharmacy team lacks the capacity to cover every ward for a fortnight of morning drug rounds
• BThat staff may resent the pharmacists' presence and see it as checking up on them✓
• CThat the electronic prescribing system should be withdrawn until the near-misses have been investigated
• DThat near-misses are being over-reported by ward staff

Answer: The final sentence — 'support, not surveillance' — anticipates that staff might read the pharmacists' presence as monitoring, and heads that off. The email does not propose withdrawing the system, question the reporting, or mention pharmacy capacity.

Extract from a patient-information leaflet: "You may eat and drink normally until midnight before your procedure. After midnight, take only sips of water with your usual morning tablets, unless you have been told to stop them." What should a patient do on the morning of the procedure?

• ATake their tablets with a full glass of water and no food at all until after the procedure
• BTake their usual tablets with sips of water, unless told to stop them✓
• CHave a light breakfast and their tablets as normal
• DTake nothing at all by mouth, including their tablets

Answer: The leaflet permits sips of water with the usual morning medicines after midnight, with the exception of any tablets the patient has been told to stop. Breakfast is excluded, stopping all medicines is not what is said, and 'a full glass' contradicts 'sips'.

Extract from a clinical procedure: "Verbal consent is sufficient for venepuncture. For procedures carrying material risk, written consent must be obtained by a clinician competent to perform the procedure or one who has been specifically trained to seek consent for it." Who may take written consent for a high-risk procedure?

• AA clinician able to perform the procedure, or one trained specifically to seek consent for it✓
• BOnly the consultant who is ultimately responsible for the patient's care during the admission
• CA healthcare assistant who has explained the procedure to patients before and knows the wording of the form
• DAny registered clinician who happens to be on the ward at the time the consent form needs to be signed

Answer: The extract sets two acceptable categories: competent to perform, or specifically trained to seek consent for that procedure. 'Any registered clinician' is broader than the policy allows, restricting it to the consultant is narrower, and a healthcare assistant is not a clinician in the sense intended.

Extract from a handover template: "Escalate any patient whose NEWS2 total has risen by 2 or more since the previous set of observations, even if the total remains below the trigger threshold." What does this instruction add to the standard NEWS2 triggers?

• APermission to ignore the standard thresholds if the trend is stable
• BA lower trigger threshold for every patient on the ward
• CA requirement to act on a rising trend as well as on the absolute score✓
• DA rule that observations must be repeated every two hours

Answer: Standard NEWS2 escalation is triggered by the aggregate score reaching a threshold (or by any single parameter scoring 3); this template adds escalation for a rise of 2 or more, which is a trend-based trigger. It does not change the thresholds, remove them, or set an observation frequency.

Extract from a staff notice: "Interpreters must be booked through the language line for any consultation where consent is sought or a diagnosis is given. Family members may interpret only for routine matters such as meal choices, and never for children under 16." Which situation complies with the notice?

• AA patient's nephew, aged 15, interprets a discussion about her new diagnosis
• BA patient's adult son interprets while she chooses from the menu✓
• CA patient's daughter interprets while the surgeon explains the risks of an operation
• DA family member interprets the consent conversation because the language line is busy

Answer: Meal choices are exactly the kind of routine matter the notice allows relatives to help with. Explaining operative risks and giving a diagnosis both require a booked interpreter, a 15-year-old must never interpret, and a busy language line is not an exception the notice provides.

Extract from a tissue-viability policy: "Waterlow scores must be recalculated within six hours of admission, whenever a patient's condition changes, and at least weekly thereafter. A score of 10 or more triggers a repositioning schedule; a score of 20 or more requires a dynamic mattress to be ordered the same day." When must a dynamic mattress be ordered?

• AAs soon as a score of 10 triggers the repositioning schedule
• BOn the day a patient's score reaches 20 or more✓
• CWithin six hours of every admission, before the score is calculated
• DAt the weekly reassessment, if the score has risen since admission

Answer: The policy attaches the mattress to a score of 20 or more and requires it to be ordered the same day. Scores of 10 to 19 trigger repositioning only, and the six-hour and weekly rules concern when the score is calculated, not when equipment is ordered.

Extract from a staff notice: "Nurses wearing a red tabard are carrying out the medicines round and must not be approached except in an emergency. Queries about a patient's medicines should be raised with the nurse in charge, who will pass them on once the round is complete." What is the notice designed to achieve?

• AFewer interruptions for the nurse giving out medicines✓
• BFaster answers to relatives' questions about medicines
• CA reduction in the number of nurses needed on the round
• DA record of every query raised during the round

Answer: The red tabard identifies the nurse who must not be disturbed, and queries are routed through the nurse in charge until the round is over: the purpose is to protect the medicines round from interruption. The notice slows rather than speeds up answers, and says nothing about records or staffing.

Extract from an occupational health guideline: "After a needlestick injury, encourage the wound to bleed, wash it with soap and running water, and cover it with a waterproof dressing. Do not scrub or suck the wound. Report immediately to occupational health, or to the emergency department out of hours, because post-exposure prophylaxis for HIV should be started as soon as possible, ideally within 24 hours." Why does the guideline stress immediate reporting?

• ABecause the wound must be dressed by a trained member of staff before the injured person leaves the ward
• BBecause occupational health closes at the end of the working day and cannot see anyone the next morning
• CBecause preventive treatment for HIV works best if it is started very quickly✓
• DBecause every needlestick injury has to be recorded for the annual audit within an hour of it happening

Answer: The final sentence links immediate reporting to post-exposure prophylaxis working best when it is started as soon as possible. Out-of-hours reporting goes to the emergency department, so closing times are not the reason; the dressing is applied by the injured person, and no audit is mentioned.

Extract from a discharge lounge policy: "Patients are suitable for the discharge lounge if their discharge letter and medicines to take home are complete and they do not require oxygen, continuous monitoring or hoisting. Patients awaiting transport may wait in the lounge for up to four hours; beyond this the ward must be informed and a bed reallocated." Which patient may be sent to the lounge?

• AA patient whose paperwork is complete, who is hoisted for transfers, and whose transport is due in five hours
• BA patient whose letter is ready but whose medicines are still being dispensed, with transport due in one hour
• CA patient whose paperwork is complete, who needs two litres of oxygen a minute, and whose transport is due within the hour
• DA patient whose letter and medicines are ready, who walks with a frame, and whose transport is due in three hours✓

Answer: The lounge requires complete paperwork and medicines and no oxygen, monitoring or hoisting; a four-hour wait is allowed. Walking with a frame is not an exclusion. Medicines still being dispensed, oxygen and hoisting each breach the criteria, and a five-hour wait exceeds the limit as well.

Extract from a physiotherapy memo: "Hydrotherapy is contraindicated for patients with open wounds, uncontrolled epilepsy, incontinence or a fear of water, and referrals must confirm that none of these applies. Sessions last no more than 30 minutes, and patients must be able to transfer to the pool with the help of one person." What must a referral confirm?

• AThat the patient can transfer to the pool without any help from the physiotherapy staff
• BThat the patient has attended a 30-minute assessment session in the department beforehand
• CThat the patient can swim and is not afraid of deep water, since the pool is 1.5 metres deep
• DThat the patient has none of the four listed contraindications✓

Answer: The memo requires referrals to confirm that none of the four contraindications applies. Swimming ability is not mentioned, help from one person is allowed for transfers, and the 30 minutes is the session length rather than an assessment.

Extract from an email from the bed manager: "With respiratory admissions up 30 per cent this week, elective orthopaedic admissions for Thursday and Friday are postponed. Please contact affected patients today and explain that they will be offered the next available date rather than returning to the bottom of the waiting list." What must staff tell the affected patients?

• AThat their operation will go ahead as planned on Thursday or Friday
• BThat respiratory patients will be admitted to the orthopaedic ward
• CThat they have been placed at the end of the waiting list again
• DThat their operation will be rebooked for the next available date✓

Answer: The email asks staff to explain that patients will be offered the next available date rather than going back to the bottom of the list. The operations are postponed, not going ahead, and the email says nothing about where respiratory patients will be admitted.