Q:1(A) •Poor infection control methods

•inadequate patient management

•Failure by health care providers to communicate effectively before during and
after operative procedures
•Poor infection control methods:
Lack of attention in carefulnessto control the infection at the surgical place.Resulting in
poor infection control methods.
•Inadequate patient management:
When the patient is not attended properly by the medical staff
•Failure by health care providers to communicate effectively before during and after:
When there is lack of communication between a doctor and a patient before and after
operative procedure and lack of communication between the medical staff during
operative procedure.

Q 1 (B)
The verification process that which can be taken for improving surgical care includes a
guidelines.
A guideline is a statement which determines the course of a particular surgery it aims to
stream line particular process to improve surgical care.
In short a guideline is a general rule or a principle that consists of precautionary measures
and health care advise which helps before during and after surgery. Surgeries should be
carried out properly according to the guidelines for treatment of that particular surgery.
Surgeries carried out without any guidelines results into adverse effects listed above in
the first part. So, It is necessary to follow a proper guideline during a surgery

Q 2 ( Part A)
As corona virus is deadly airborne disease which can spread easily
through respiratory droplets,
by direct contact with infected persons or
by contact with contaminated objects and surfaces
As Kathy is not wearing her mask properly it is highly likely that she may get corona
virus which is dangerous for her as well as her colleagues and patients.Doctor John
should tell her to wear the mask properly so that proper precautionary measures against
the corona virus a taken.

Q 2 (Part B)
Protect yourself and others around you by knowing the facts and taking appropriate
precautions. Follow advice provided by your local health authority.
To prevent the spread of COVID-19:
•Clean your hands often. Use soap and water, or an alcohol-based hand rub.
•Maintain a safe distance from anyone who is coughing or sneezing.
•Wear a mask when physical distancing is not possible.
•Don’t touch your eyes, nose or mouth.
•Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
•Stay home if you feel unwell.
•If you have a fever, cough and difficulty breathing, seek medical attention.
•Make sure you , and the people around you , follow good respiratory hygiene
•Avoid going to crowded places
•Maintain at least 1 metre distance between yourself and others outdoors.

Q 4 ( Part A)
Human factors is the study of how humans behave physically and psychologically in
relation to particular environments, products ,or services. A human factors specialist
typically has an advanced academic degree in psychology or has special training.
The patient safety depends upon human factors.
Two human factors with the most impact are fatigue and stress.There is strong scientific
evidence linking fatigue and performance decrement making it a known risk factor in
patient safety .Prolonged work has been shown to produce the same deterioration in
performance as a person who drinks alcohol.
In summary, the lessons from human factors in other industries are relevant to patient
safety in all health care environments this includes understanding the interaction and
interrelationships between humans and the tools and machines they use.Understanding
the inevitably of error and the range of human capabilities and responses in any given
situation is essential to knowing how application of human factors engineering principles
can improve health care.

Q 4 (Part B)
Check list are used to reduce human error
Examples:
Check lists are actually use to benefit patients in a timely and efficient way it follows
established frame work for safe care in hospitals
Check lists are used before induction of anaesthesia , before skin incision , before patient
leaves operating room
E.g
A check list looks like this
Does the patient have a
Known allergy?
No
Yes
Difficult airway?
No
Yes

Q 5 (Part A)
Team: A team can be defined as a distinguishable set of two or more people who interact
dynamically, independently And adaptively towards a common and valued
goal/objective/mission, who have been assigned specific roles or functions to perform and
who have a limited lifespan of membership.
A team is formed and developed in the following way

Develop a team mission – your purpose for being. When people all agree on a
common purpose and feel that they are all working towards that purpose, there is a greater
sense of camaraderie and teamwork. E.g team mission is treatment of patient.
Develop team agreements. One of the most common traits of successful teams, is that
they have established norms by which they agree to operate under. E.g coordinations
among team members on medications provided and timings.
Clarify team roles When team members clearly understand each other’s roles and
responsibilities, they can then find opportunities to help each other out. E.g everyone in
medical team do the roles assigned to them properly
Learn from mistakes and failures. Teams that learn together, bond together. It is critical,
especially in a health-care setting, that mistakes are seen as an opportunity to learn and
improve, versus an opportunity to shame and blame. The team agreements should address
this issue. E.g in case of a mistake learn from it
Provide opportunities for the team to get to know each other on a more personal
level. One great way to do this is through a personality workshop E.g having a better
understanding among each other

Q 5 (Part B)
In an effective team the team members, including the patients, communicate with each
other, as well as merging their observations, expertise and decision making
responsibilities to optimise patients care.Understanding the culture of the workplace and
its impact on team dynamics and functioning will make a team member a good team
player.
And effective teams works by:
•Clear direction
•Open and honest communication
•Support risk taking and change
•Defined roles
•Mutually accountable
•Communicate freely
•Common goals
•Encourage different in opinions
•Collaboration
•Team trust

Q 6 (Part A)
A complex system is one in which there are so many interacting parts that it is difficult, if
not impossible, to predict the behaviour of the system based on knowledge of its
component parts. The delivery of health care fits this definition of a complex system.
All health-care professionals need to have an understanding of the nature of complexity in
health care, as it is important for preventing adverse events. Health care is complex due to
•The diversity of tasks involved in the delivery of patient care.
•The dependency of health care providers on one another.
•The diversity of patients, clinicians, and other staff

Q 6 (Part B)
A high reliability organisation(HRO) is an organisation that has succeeded in avoiding
catastrophes in an environment where normal accidents can be expected due to risk
factors and complexity.
Examples:
•Many hospitals are embracing the values of high reliability organisation (HRO)
Which promote patient safety and efficient healthcare delivery.
•HROs are described as organisations that are known for hazardous work, yet enjoy a
high level of safety over long periods of time.

Characteristics of HRO are:

•Prioritisation of both safety and performance and shared goals across the organisation.
•Culture of reliability that simultaneously decentralise and centralises operation allowing
authority
Decision to migrate forward lower ranking members.
•Using trial and error learning to change for the better following accidents, incidents, and
near misses.
•Strategy of redundancy in behaviours, such as one person stepping in when a task needs
completion.

Q 7 (Part A)
For conducting the disposal of sharp objects following should be done:

Throw away all needles, syringes, lancets, and other sharp objects in a hard-plastic or
metal container. It should have a lid that screws on or fits tightly. 

You can also use a coffee can to dispose of sharp objects. Before throwing the can away,
you must cover the plastic lid with heavy-duty tape, such as duct tape. This makes it
stronger. It will stop sharp objects from sticking through the plastic lid.

Do not put sharp objects in glass or clear-plastic containers.

Do not put sharp objects in any container that will be recycled or returned to a store

Keep containers with sharp objects out of the reach of young children.
Never throw sharps directly into the garbage

Never use a container that is not rigid and puncture resisted

Never flush, bury, or burn sharps

Never use clear plastic or glass containers

Never mix sharps with recyclable items

Never leave sharps accessible to others.

If the above measures are taken incidence like the ones mentioned in the question can be
avoided.

Q 8 (Part A )
He is committing a violation
Violation are errors caused by deliberate deviation by an individual from an accepted
protocol or standard of care.

The tree types of violations are:

Routine violation
Optimising violation
Necessary violation
The doctor is committing optimising violation

Q 8 (Part B)

Errors include
-Skill based slips and lapses
Causes: attentional slips of action and lapses of memory

-Mistakes
Includes: rule based mistakes and knowledge based mistakes

Q 9 (Part A)
The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change — by planning it,
trying it, observing the results, and acting on what is learned. This is the scientific
method, used for action-oriented learning

Steps in PDSA Cycle

Step 1: Plan
Plan the test or observation, including a plan for collecting data.
State the objective of the test. 
Make predictions about what will happen and why. 

Develop a plan to test the change. (Who? What? When? Where? What data need to be
collected?)  

Step 2: Do
Try out the test on a small scale.
Carry out the test. 

Document problems and unexpected observations. 

Begin analysis of the data. 

Step 3: Study
Set aside time to analyze the data and study the results. 
Complete the analysis of the data. 

Compare the data to your predictions. 

Summarize and reflect on what was learned.  

Step 4: Act 
Refine the change, based on what was learned from the test.
Determine what modifications should be made. 

Prepare a plan for the next test.

EXAMPLE:

Arthritis: Planned visits for treatment

Plan: Ask one patient if he or she would like more information on how to manage his or
her disease
Do: Dr. J. asked his first patient with arthritis on Tuesday.
Study: Patient was interested; Dr. J. was pleased at the positive response.
Act: Dr. J. will continue with the next five patients and set up a planned visit for those
who say yes.

Q 9 Part B
Categories of Change
The categories of change include
-Eliminating waste according to a proper management plan
-Bringing improvements in the system for improving work flow
-Inventory Management System to optimise inventory of hospital
-Changing the work environment by improving the noise, lightening, color, air quality,
furniture etc and making the workplace more pleasant and attractive
-Time Management
-Variation management in health care
-Designing systems to avoid mistakes and if mistakes are made, then learning from them
-Focusing on work to produce better products and services

Q 10 (Part A)
It is important to understand the culture and beliefs of a patient in order for a treatment. It
is necessary to respect patients cultural and ethnic background. It is important to make the
patient understand about the impact of culture beliefs on health and that the medications
exists to be used if a taweez could make him healthier then the medications would not
exists. Medications are used because taweez might not prove beneficial for the treatment
of the patient it is important to make the patient use antibiotics as he uses taweez as
well.It is important to cooperate with the patient and understand their culture beliefs and
make the patient understand the value of medication so that the patient will also
cooperate.

Q 10 ( Part B)
Spikes
•Sharpen your listening skills
•Pay attention to patient perceptions
•Invite the patient to discuss details
•Knows the facts
•Explore emotions and deliver empathy
•Strategise next steps with patient or family.
The goal of spikes protocol is to enable the clinician to fulfil the four most important
objectives of the interview disclosing bad news: gathering information from the patient,
transmitting the medical information, providing support to the patient, and eliciting the
patients collaboration in developing a strategy or treatment plan.

Q 11 (Part A)
The type of infection include
1: Viral infections
Viral infection caused by viruses a virus is composed of genetic material
Surrounded by a protein shall viruses are parasitic some viruses include corona virus ,
common cold , polio, etc.
2: Bacterial infection
Bacterial infections are caused by bacteria bacteria are single celled microorganisms
bacteria can be found in all sorts of environments.Some bacterial infections includes
Tuberculosis, Whooping cough , Tetanus etc.
3: Fungal infection
Fungal infections are caused by fungi.They can be found throughout the environment
they are present in moist areas some fungal infections includes: Ringworm, athletes foot ,
thrush. Etc.
4: Parasitic infection
Parasitic infection are caused by parasites live on or in a host organism and get food or
other nutrients at the host’s expense.
Some parasitic infections consists of:
Malaria
Scabies
River blindness. Etc
5: Prions
A prion actually is not organisms at all it’s a protein.Prions can affect normal body
proteins and cause them to fold into abnormal shapes.
Prion disease are very rare.

Three preventive measures:

•Wash your hands well.You probably wash your hands after using the bathroom before
preparing or eating food, and after gardening or other dirty tasks.
•Do not pick at healing wounds or blemishes or squeeze pimples
•Don’t share dishes, glasses or eating utensils.

Q 11 (Part B)
Ways to minimise
•Do not share cups, glasses , dishes , or cutlery.
•consider wearing a non medical mask when in a public space
•Get the appropriate vaccine
•Practice physical distancing 2 meters.
•Stay home if you are sick
•Use a tissue , or cough and sneeze into your arm not your hand
Turn away from other people
•Use single use tissues.Dispose of the tissue immediately
•Wash your hands after coughing sneezing or using tissues.
•Do not touch your eyes, nose or mouth.