Innovations in Innovations in Precepting:Precepting:

Electronic TrackingElectronic Tracking

Kent Brown ACP Program Coordinator

City of Winnipeg

Fire Paramedic Service

Today’s PathToday’s Path

Evolution The Program Evaluation Relevance The Platform Costing Strengths Weaknesses Opportunities

EvolutionEvolution

The Past– Slow and time

consuming– Subjective– Searchability– Storage

The PresentThe Present

PortableInterface friendlyUser friendlyMulti-functional

ImpetusImpetus

National Occupational Competency ProfileInternal technology advances.Internal database advances.Wired network throughout City of

Winnipeg Fire Paramedic Service.

Impetus – cont.Impetus – cont.

“The accreditation process expects programs to design evaluation tools that ensure that the student's performance of each C and P Specific Competency is evaluated against clear competency criteria ….”

“ …that the evaluation is recorded and signed….”

“… that there will be documented evidence that the student has demonstrated these competencies in the required setting …”

The PathThe Path

Phase I – Internal - vision– Introduce– Analyze

Phase II – outsourced - reality– Alter – Analyze

Phase III – looking forward– Build upon

Phase IPhase I

iPAQ purchasesInternally developed programInitial trialFeedback

– Lengthy– Collation– Intuitiveness– Analysis

““The Tyranny of the OR”The Tyranny of the OR”

Good Fast

Cheap

Please Pick Two

StuffStuff

Hardware– iPAQ– Desktop PC– Database Server

Software– Mobile VB + Add ons– DB2

Internally Developed - contracted– Precepting program

(collection)– Syncing program– Analysis program

CostingCosting

Hardware– Database – on site– Desktops – on site– iPAQ’s $1000

including software

Software– $10000 contract with

Lynx Software

Old process

-Manuals $6.35/student

Current CostingCurrent Costing

iPAQ’s now ~ $500Cost recovery at $6.35 per manual

– 500/6.35 = 79 students– Storage savings– Search time

Phase II - The ProgramPhase II - The Program

Please excuse our spelling.

Several courses 20 + students per

course

ProcessProcess

The student is observed at the call.

Data is entered into the handheld as soon as possible after the call.

The preceptor goes over the data with the student citing any insufficiencies that is being entered.

Both sign off on comments.

RecordingRecording

Competence involves the demonstration of skills, Competence involves the demonstration of skills, knowledge and abilities in accordance with the knowledge and abilities in accordance with the

following principles: following principles:

consistency (the ability to repeat practice techniques and outcomes)

independence (the ability to practice without assistance from others)

timeliness (the ability to practice in a time frame that enhances patient safety)

accuracy (the ability to practice utilizing correct techniques and to achieve the intended outcomes)

appropriateness (the ability to practice in accordance with clinical standards and protocols outlined within the practice jurisdiction)

1 – Student had the opportunity, but did not demonstrate any of the critical behaviours of the specific competency.

2 – Student demonstrates some or all of the critical behaviours with prompting or assistance from the instructor

3 – The student performs safe, medically appropriate patient care, demonstrating all critical behaviours of the relevant patient care protocol or procedure. The provision of care by the student is organized, accurate and timely without prompting or assistance of the instructor.

End of the shift the data is downloaded electronically at the station and is stored in an electronic database

ProcessProcess

Consistency – Internally Defined.– Program analyzes database to ensure

consecutive 3’s– Automatically updates student profile.– Shares with all iPAQs in system

iPAQ 1

iPAQ 2

iPAQ 3

Desktop PC

Site 1

Desktop PC

Site 2

Database

Collection and Analysis

Data Analysis – Student Data Analysis – Student PerspectivePerspective

iPAQ recognizes display of consistency of competence – deletes competency from student record.

Desktop updates at database – to collate data from all iPAQs

Data Analysis – Program Data Analysis – Program PerspectivePerspective

Link to other databases (runsheet)Searchability for:

– Exposures/likelihoods– Preceptor participation– Themes/trends– Site specifics

Results have lead to core preceptorship program changes.

StorageStorage

CD – To student RecordProgram Files– Master Student DiscBacked up on WFPS City Server

ExpansionExpansion

Initial development for Phase 2 – approximately 2-4 months.

Adding additional educational programs, with different competencies, would now require one month as platform is in place.

StrengthsStrengths

Perception of increased objectivity.Standardization for “sign off”TrackabilitySearchability.ImmediacyIntuitivenessStorage

WeaknessesWeaknesses

Inservicing/IT/ResistanceGlitches/IT dependencePower supplyUpload timingOutliersFirewallsQueries – not intuitive

OpportunitiesOpportunities

Other clinical sitesDatabase linkagesField Quality AssuranceOperational DocumentsExtension Programs – Central Database

ThreatsThreats

AcknowledgementsAcknowledgements

Nathan Wiebe – Software Solution Developer, Lynx Graphics

Ltd.

Deputy Chief Jim Brennan – WFPSDoug Major – QI Officer (ret) - WFPSRoss Bale – LIIA Paramedic WFPS