Continuity of Care, Quality Improvement, Safety and Prescribing

This topic spans quality improvement methodology, patient safety systems, and prescribing principles. It is heavily tested in the AKT because safe prescribing and quality improvement are central to everyday general practice.

The audit cycle is a fundamental QI tool. A clinical audit measures current practice against a defined standard, implements changes, and re-audits to see if practice improved. You need to distinguish audit from research: audit measures against known standards while research generates new knowledge. Audit does not need ethical approval; research does.

Significant event analysis (SEA) is the process of investigating and learning from clinical incidents. It involves identifying the event, gathering data, analysing what happened and why, agreeing on actions, and monitoring implementation. AKT questions may ask about the correct sequence or the purpose of each step.

The Quality and Outcomes Framework (QOF) is a pay-for-performance scheme that incentivises practices to meet clinical indicators across conditions like diabetes, hypertension, and mental health. You should know the general structure and common indicators, though specific thresholds change annually.

Prescribing questions cover a wide range. You need to know the principles of rational prescribing, BNF categories, drug interactions, prescribing in renal and hepatic impairment, prescribing in pregnancy and breastfeeding, and MHRA drug safety alerts. Common alerts include the risks of valproate in women of childbearing age, the cardiovascular risks of NSAIDs, and QT prolongation with certain antibiotics and antipsychotics.

Medication safety includes understanding of controlled drugs legislation, prescription fraud prevention, repeat prescribing systems, and polypharmacy reviews. The STOPP/START criteria help identify potentially inappropriate prescribing in older adults and are a common source of AKT questions.

Patient safety frameworks include the Swiss cheese model (Reason), which explains how incidents occur when multiple system failures align. Never events, duty of candour, and the role of the CQC in monitoring safety are also tested.