In this part of the test, there are six short extracts relating to the work of health professionals. For questions 1-6, choose the answer (A, B or C) which you think fits best according to the text. Read the question first, then go to the text. 

Question 1

Patient Confidentiality

Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to seek medical attention or to give doctors the information they need in order to provide good care. However, faced with a situation in which a patient’s refusal to consent to disclosure leaves others exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining confidentiality, or if it is not practical or safe to seek the patient’s consent, information should be disclosed promptly to an appropriate person or authority. The patient should be informed in advance that the doctor will be disclosing the information, provided this is practical and safe, even if the doctor intends to disclose without the patient’s consent.

Doctors are advised to break patient confidentiality if

Question 2

Transfer of patients

1.15
The critical care area transferring team and the receiving ward team should take shared responsibility for the care of the patient being transferred. They should jointly ensure that:
• there is continuity of care through a formal structured handover from critical care area staff to ward staff (including both medical and nursing staff), supported by a written plan;
• the receiving ward, with support from critical care if required, can deliver the agreed plan.

1.16
When patients are transferred to the general ward from a critical care area, they should be offered information about their condition and encouraged to actively participate in decisions that relate to their recovery. The information should be tailored to individual circumstances. If they agree, their family and carers should be involved.

According to the guidance notes, all staff involved in transferring patients from critical to general care must:

Question 3

Memo

To: Hospital staff
Re: Nutrition screening

This is to remind staff of the importance of nutrition screening to identify problems which may go unrecognised and, therefore, remain untreated during the patient’s hospital stay. Nutrition screening should occur on admission and then weekly during the patient’s episode of care; at least monthly in slower stream facilities; or if the patient’s clinical condition changes.
All patients should have their weight and height documented on admission, and weight should continue to be recorded at least weekly. Patients whose score is ‘at risk’ on a validated screening tool or whose clinical condition is such that their treating team identifies them as at risk of malnutrition should be referred to a dietitian for a full nutrition assessment and nutrition support as appropriate.

The memo says failure to screen a patient for malnutrition may result in

Question 4

Stock requisitioning

If stock levels of a medicine are low, the nurse should firstly liaise directly with their ward-based team to arrange urgent stock replenishment. If the ward-based team is unavailable, the nurse should complete a request form online and email it to the pharmacy stores. Paper-based ordering systems are available (e.g. the ward medicines requisition book); however these should not be relied on if ward stock is urgently needed.
“At risk medicines” – Diazepam/Codeine Phosphate/Co-codamol – may only be ordered for stock when a paper requisition is written. Paper-based requisitions should be complete, legible and signed, and then sent to the pharmacy department. Wards/clinical areas using Mediwell 365 cabinets will have orders transmitted automatically to Pharmacy on a daily basis, as stock is used.

This policy document states that nurses

Question 5

6.2 Intensive Care Unit (ICU)

6.2.1 Unplanned admissions to the ICU need a referral at consultant level. In exceptional circumstances, referrals will be discussed with the Ward Registrar looking after the patient if a delay in referral to ICU would lead to the rapid deterioration of a patient.
6.2.2 All patients discussed with the ICU staff but not admitted remain under the care of the primary team and as such they remain responsible for reviewing and escalating care should deterioration occur.
6.2.3 We encourage collaborative patient-centred care. However the ICU is defined as a closed unit. This means that when patients are admitted into the ICU, they are under the care of the ICU team. It is expected that members of the primary referring team will liaise daily with the ICU team to discuss the patient’s management. However, it is up to the ICU team to make final decisions.

The extract from the guidelines states that

Question 6

Patient Safety Incidents

Information about a patient safety incident must be given to patients and/or their carers in a truthful and open manner by an appropriately nominated person. Patients want a step-by-step explanation of what happened that considers their individual needs and is delivered openly. Communication must also be timely – patients and/or carers should be provided with information about what happened as soon as practicable. It is also essential that any information given is based solely on the facts known at the time. Healthcare staff should explain that new information may emerge as an incident investigation is undertaken, and patients and/or their carers will be kept up-to-date with the progress of an investigation. The Duty of Candour Regulations require that information be given as soon as is reasonably practicable and be given in writing no later than 10 days after the incident was reported through the local systems.

When dealing with patients following a safety incident, staff must avoid