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Patient safety and health systems management

This is an aggregate of the syllabus for all competencies in Domain 11. To view the syllabus for each competence click here.


Principles of local / national health care provision; strategic planning of the ICU service (structure, function, financing) within the wider health care environment
Roles of different members of the multidisciplinary team and local referral practices
Principles of risk prevention
Common sources of error and factors which contribute to critical incidents / adverse events (ICU environment, personnel, equipment, therapy and patient factors)
Epidemiology and prevention of infection in the ICU
Principles of outcome prediction / prognostic indicators and treatment intensity scales; limitations of scoring systems in predicting individual patient outcome
The non-clinical role of the ICU specialist and how these activities contribute to the efficacy of the ICU, the profile of the ICU within the hospital and the quality of patient management
Physical requirements of ICU design
Triage and management of competing priorities
Process and outcome measurement
Principles of administration and management
Principles of crisis management, conflict resolution, negotiation and debriefing
Pathogenesis, risk factors, prevention, diagnosis and treatment of complications of ICU management including:
nosocomial infection
ventilator associated pneumonia (VAP)
ventilator associated lung injury - pulmonary barotrauma
pulmonary oxygen toxicity
thromboembolism (venous, arterial, pulmonary, intracardiac)
stress ulceration
critical illness poly-neuropathy, motor-neuropathy & myopathy
Risk of colonisation with potentially pathogenic micro-organisms and the factors associated with patient, staff, equipment and environmental colonisation
Staff safety: susceptibility to harmful physical, chemical and infectious hazards in the ICU
Principles of general and organ-specific scoring systems and their usefulness in assessing likely outcome of an illness (eg. Glasgow Coma Scale, APACHE II and III, PRISM, organ system failure scores, injury severity scores)
Modification of treatment or therapy to minimise the risk of complications and appropriate monitoring to allow early detection of complications
Environmental control of temperature, humidity, air changes and scavenging systems for waste gases and vapours
Confidentiality and data protection - legal and ethical issues
Influence of injury or illness being considered on the validity of a scoring system as a predictor of likely outcome (eg. Glasgow Coma Score (GCS) in head injury versus drug overdose)
Recognition of patient groups at high risk for developing complications
Risk of bleeding: indications, contraindications, monitoring and complications of therapeutic anticoagulants, thrombolytic and anti-thrombolytic agents
Autogenous infection: routes and methods of prevention
One general method for measuring severity of illness (severity scoring systems)
Principles of resource management; ethics of resource allocation in the face of competing claims to care
Cross infection: modes of transfer and common agents
Hazards associated with ionising radiation and methods to limit these in the ICU
Principles of case-mix adjustment
Concept of risk : benefit ratio and cost effectiveness of therapies
Principles of workforce planning
Treatment algorithms for common medical emergencies
Difference between absolute requirement and possible benefit when applying expensive technology to critically ill patients
Equipment requirements and selection: clinical need & priority; accuracy, reliability, safety and practical issues (ease of use, acceptance by staff)
Recent advances in medical research relevant to intensive care
Universal precautions and preventative infection control techniques (hand washing, gloves, protective clothing, sharps disposal etc.)
Critical incident or error monitoring
Requirements for microbiological surveillance and clinical sampling
Electronic methods of accessing medical literature
Benefits and risks of different prophylactic antibiotic regimens
Principles of appraisal of evidence: levels of evidence; interventions; diagnostic tests; prognosis; integrative literature (meta-analyses, practice guidelines, decision & economic analyses)
Principles of health economics, departmental budgeting, financial management and preparation of a business plan
Principles of applied research and epidemiology necessary to evaluate new guidelines / forms of therapy
Principles of aseptic technique and aseptic handling of invasive medical devices
Identification and critical appraisal of literature; integration of findings into local clinical practice
Methods of sterilisation and cleaning or disposal of equipment
Factors that determine the optimum staff establishment for specialist and junior medical staff, nurses and allied professional and non-clinical ICU staff
Infections from contaminated blood / body fluids; strategy if contaminated (e.g. needle stick injury)
Local policies and procedures relevant to practice
Practical application of equal opportunities legislation
Methods of effective communication of information (written; verbal etc)
Published standards of care at local, national and international level (including consensus statements and care bundles)
Principles of national / local health care legislation applicable to ICM practice
Local process for ordering consumables and maintaining equipment
Purpose and process of quality improvement activities such as evidence based practice, best practice guidelines & benchmarking and change management
Purpose and methods of clinical audit (e.g. mortality reviews, complication rates)
Professional responsibility and duty of care to patients placed at risk by the actions of fellow clinicians
Plan of action / local procedures to be followed when a health care worker is noticed to be in distress, whether or not patients are considered to be at risk

Skills & Behaviours

Consult and take into account the views of referring clinicians; promote their participation in decision making where appropriate
Identify members of the health care team which require representation at a case conference
Timely organisation - liaise with members of the health care team to identify a suitable time and place for a case conference to maximise attendance
Lead, delegate and supervise others appropriately according to experience and role
Identify necessary notes / investigations to support discussion during a case conference
Demonstrate initiative in problem solving
Acquire, interpret, synthesize, record, and communicate (written and verbal) clinical information
Plan long-term multidisciplinary care for patients in the ICU
Confirm accuracy of clinical information provided by members of the health care team
Summarise a case history
Assemble clinical and laboratory data, logically compare all potential solutions to the patient's problems, prioritise them and establish a clinical management plan
Establish a management plan based on clinical and laboratory information
Consider potential interactions when prescribing drugs & therapies
Consider risk-benefit and cost-benefit of alternative drugs & therapies
Organise multidisciplinary care for groups of patients in the ICU
Collaborate with other team members to achieve common goals
Listen effectively
Professional and reassuring approach - generates confidence and trust in patients and their relatives
Accept personal responsibility for the prevention of cross infection and self infection
Propose realistic initiatives / projects to promote improvement
Demonstrate routine application of infection control practices to all patients, particularly hand washing between patient contacts
Use a systematic approach to locate, appraise, and assimilate evidence from scientific studies relevant to a patient's health problem
Use protective clothing (gloves / mask / gown / drapes) as indicated
Use electronic retrieval tools (e.g. PubMed) to access information from the medical & scientific literature
Apply methods to prevent autogenous infection (e.g. posture, mouth hygiene)
Implement prophylactic regimens appropriately
Recognise the need for clinical audit and quality improvement activities to be non-threatening and non-punitive to individuals
Prescribe antibiotics safely and appropriately
Manage resistance to change in the ICU / hospital environment in order to optimize the outcome of a task
Maximise safety in everyday practice
Record relevant clinical information accurately
Monitor complications of critical illness
Contribute to departmental / ICU activities
Aware of relevant guidelines and consensus statements and apply these effectively in every day practice under local conditions
Seek expert help to ensure all equipment in the ICU conforms with and is maintained to the relevant safety standard
Implement and evaluate protocols and guidelines
Document adverse incidents in a timely, detailed and appropriate manner
Participate in the processes of clinical audit, peer review and continuing medical education
Respect, acknowledge & encourage the work of others
Demonstrate an interest in quality control, audit and reflective practice
Manage inter-personal conflicts which arise between different sectors of the organisation, professionals, patients or relatives
Inform colleagues, patients and relatives as applicable, of medical errors or adverse events in an honest and appropriate manner


Accepts responsibility for patient care and staff supervision
Recognises impaired performance (limitations) in self and colleagues and takes appropriate action
Recognises personal limitations, seeks and accepts assistance or supervision (knows how, when and who to ask)
Consults, communicates and collaborates effectively with patients, relatives and the health care team
Desire to minimise patient distress
Seeks to modify the stresses which the intensive care environment places upon patients, their relatives and members of staff
Establishes collaborative relations with other health care providers to promote continuity of patient care as appropriate
Ensures effective information transfer
Adopts a problem solving approach
Enquiring mind, undertakes critical analysis of published literature

Basic Sciences also underpin the competencies within this domain. These are presented in full in the Basic Sciences Syllabus.

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