Platform 6: Improving Safety and Quality of Care

Scope and weight

Ten questions at 1.5 minutes is about 15 minutes. The block is large in content and small in marks, so efficiency matters. The material splits into two halves: infection prevention and control, which is procedural and rule-based, and safety culture, which is principle-based. The first half is a memory task; the second half is a judgement task about candour, reporting and speaking up.

What is tested

• Patient safety events. Incident reporting, Never Events and learning from patient safety events under the national framework (PSIRF).
• Standard infection control. Hand hygiene using the WHO five moments, PPE selection, donning and doffing, and ANTT.
• Transmission-based precautions. Contact, droplet and airborne precautions and isolation nursing.
• Specific organisms. MRSA, C. difficile, norovirus and CPE control.
• Sharps. Safe handling and management of needlestick injury.
• Medication safety. The six rights, near misses and errors.
• Prevention bundles. Falls and pressure ulcer bundles, VTE prevention, patient identification, wristbands and the WHO surgical safety checklist.
• Workplace law and regulation. RIDDOR, COSHH, manual handling and fire safety, and CQC fundamental standards.
• Human factors and restraint. Safety culture, speaking up, least restrictive practice and safe holding.
• Safeguarding and equipment. Recognising and reporting abuse and neglect, sepsis and deterioration as safety priorities, and decontamination of equipment.

Local points to anchor your answers

• Hand hygiene. The WHO five moments: before touching a patient, before a clean or aseptic procedure, after body-fluid exposure risk, after touching a patient and after touching patient surroundings. Confirm at source.
• C. difficile. Wash with soap and water because alcohol gel does not kill spores, and nurse the patient in a side room with contact precautions. Confirm at source.
• Sharps injury. Encourage bleeding, wash with soap and running water, do not suck, report immediately to occupational health and seek urgent advice on post-exposure prophylaxis. Confirm at source.
• RIDDOR. Employers report specified work-related injuries, diseases and dangerous occurrences to the Health and Safety Executive. Confirm at source.
• Never Events. Serious, largely preventable incidents such as wrong-site surgery, a retained foreign object or misplaced NG tube feeding. Confirm at source.
• Candour. Code 14 applies when things go wrong: act to put things right, explain, apologise, document and escalate.
• Restraint. Use the least restrictive option and follow policy and the Mental Capacity Act, with proportionate, time-limited measures.

Three typical traps

1. Using alcohol gel for C. difficile. It is a classic infection control distractor. Soap and water is the answer where spores are involved.
2. Blaming instead of reporting. After a medication error, the best option makes the patient safe, informs the appropriate people, reports the incident and is open with the patient. Hiding it, or reprimanding the person involved first, is wrong.
3. Isolation by label, not by route. Contact, droplet and airborne precautions differ in the PPE and room needed. Match the precaution to how the organism spreads and read the stem for the clinical detail.

How the questions are framed

Platform 6 stems put you in a moment where something is about to go wrong or has just gone wrong. A patient with diarrhoea has just tested positive for C. difficile, a nurse has a needlestick injury, a drug was given to the wrong patient, a fall has occurred overnight, a Never Event has been identified, or a colleague is working without the right protective equipment. The task is to take the right action in the right order and to report it.

What the exam asks about each group

• Infection prevention. Choose the correct hand hygiene method, PPE and room. Match contact, droplet and airborne precautions to the route of spread.
• Organism-specific control. Know how MRSA, C. difficile, norovirus and CPE differ in screening, isolation and cleaning.
• Sharps. Immediate first aid, then report and seek advice on post-exposure prophylaxis. Never recap a used needle by hand.
• Incident management. Make safe, report, be open with the patient, learn. Know that the national approach emphasises learning, not blame.
• Prevention bundles. Falls, pressure ulcers and VTE prevention are measures applied to every at-risk patient, not only to those already harmed.
• Identification and checklists. Wristbands and the WHO surgical safety checklist reduce wrong-patient and wrong-site errors.
• Legal duties. RIDDOR covers reportable workplace injuries and dangerous occurrences, COSHH covers hazardous substances, and CQC fundamental standards set the minimum for regulated care.
• Restraint and safeguarding. Use the least restrictive approach and report concerns about abuse or neglect promptly through the local route.

In infection control stems, find the organism or route first. Most wrong options are correct for a different organism.

How to revise it

1. Make an organism table with columns for route of spread, precaution, hand hygiene method and room.
2. Rehearse the incident sequence: make safe, escalate, report, be open, record, learn.
3. Walk through PPE order for donning and doffing out loud until it is automatic.
4. Revise the legal names in one line each: RIDDOR, COSHH, CQC fundamental standards, PSIRF.
5. Link to the care bundles for falls, pressure ulcers and VTE, which also feature in Platform 3.

Related pages: Platform 1 for candour and whistleblowing, and Annexe B for aseptic technique.