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CCOrCCCOrC©©
Critical Care Outreach Critical Care Outreach CourseCourse
Lesley Durham NoECCN: Manager, Lead Nurse, Service Improvement Lead
Chair NOrF
North East & Cumbria Critical Care Network
What I am going to talk about !What I am going to talk about !
• Describe Critical Care Outreach (UK)• Our course!• Background and evolution• Structure and delivery methods• Teaching and learning strategies• Evaluation• The valuable contribution of Critical Care
Networks• Future plans
Critical Care Outreach: Described• Outreach is “an
organisational approach to ensure equity of care for all critically ill patients, irrespective of their location”
• CCOR Should be a collaboration & partnership between the ICU & ward based teams (ICS 2002)
Global Models• Critical Care Outreach Teams (CCOT) UK,
Canada• Patient at Risk Teams (PART) UK• Rapid Response Teams (RRT) US, Europe,
Wales• Medical Emergency Teams (MET) Aus
Also: PERT, ERT, CCOS, ACOT’s, AIT’s& HAN , NNP’s, Hybrids: Combo’s: Acute
pain, Resus
Comprehensive Outreach (is good for patients)!
Designated Lead‘Enough’ Wte Band 7Consultant SupervisionPhysio input24/7/365 Hospital WideComprehensive Model
Track and TriggerRapid ResponseEducationFollow-upAudit(+ / - Transfers)
‘Pre-emptive physiological preservation’
A little bit about us…A little bit about us…
• NoECCN• 3 Million population• 17 Acute Hospitals• 252 Critical Care Beds• Approx 50:50 L2 / L3• 14 CCOT’s• 6 = 24/7• Approx 60 staff
Background and evolutionBackground and evolution2004: In the UK…..• No standardised approach to education• Course / competencies- ‘fit for purpose’• Funding – little or none!• Concept origin - Emilio Garcia & Isabel Gonzalez • Recruited (hoodwinked) colleagues to write manual,
form faculty & become supervisors!• Myself & Louise Burn – ‘Credit Equivalence’
process with Northumbria University• NE&CCCN & TV&SDCCN financial / administrative
support
Course MaterialsCourse Materials• Manual• CD• Handbook• Competencies• Learning Outcomes• Educational
Supervisor• Learning Contract(Reference books)
Programme StructureProgramme StructureCCOrC©- part time practice focused;
work based educational framework and competency package…
...delivery 1 or 2 per year
..can be undertaken at three levels and links with the established Continuing Inter-Professional development (CiPD) framework at Northumbria University. Successful course participants may apply to undertake the Accreditation of Prior Learning (APL) process to obtain 40 CAT points at level 6 (degree) or 7(masters)…
..Consultant Intensivist supervisors…
ConsultantIntensivists
Consultant Nurses
Specialist Outreach Practitioners
Academic Staff
Teaching and Learning StrategiesTeaching and Learning Strategies
Series of …• Seminars, workshops, and
lectures… • …the learning outcomes,
clinical competencies & procedures; assessment strategy…
• …guidance on attainment of academic levels, reflective thinking, practice portfolio development, MCQ, OSCE and ‘test scenario’ preparation
Notional Workload = 400 hrs
Teaching and Learning StrategiesTeaching and Learning Strategies
‘Outreached focused’…• Clinical Competencies• Clinical skills• Clinical procedures• Case studies• Learning Outcomes
Portfolio DevelopmentPortfolio DevelopmentSupplementary evidence to demonstrate achievement of
learning outcomesHours with supervisor/CCOTHours in ‘learning zones’ e.g.) CCU, CDUHistories ( x 6 per system)Physical assessments – findings (Clinical signs)Log of Outreach consultationsDivide your portfolio into learning outcomesAnalysis of critical incidentsReflective journalMeetings / action plans etc
Assessment StrategyAssessment Strategy2 Day continuous assessment programme•Interactive workshops•MCQ’s •OSCE’s•Clinical scenario•Completed Competencies•Completed Portfolio•Written Assignment (L6&L7)
All elements need to be met!
Critical Care Outreach Course
This is to certify that
Has successfully completed “CCORC” at Level……
in June 2006 inclusive of –
• Achievement of all the clinical competencies
• Achievement of 3 day assessment
•Achievement of Portfolio
_____________Emilio Garcia Lesley Durham
EvaluationEvaluationElectronic survey…• 27 Completed CCOrC©
• Response rate – 67%• 2 ‘extensions’• 2 deferred• Attrition ‘low’ – 4• Cohort 10 currently• Further 12 Oct 2009
Total candidates = 27
9
18
Answ ersurveyNo answ er
6.12 7.897.12 8.94
7.88 8.947.00 8.61
5.00 7.564.82 7.44
8.47 9.336.94 8.28
8.59 9.226.76 8.11
7.658.568.59 9.228.71 9.22
8.358.89
6.94 8.567.35 8.56
6.888.44
0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00
Medical know ledge of common diseases
Assessment of critically ill patients
Interpretation of ABG’s
Interpretation of FBC and U&E’s
Interpretation of ECGs
Interpretation of CxR
Interpretation of MEWS charts
Understanding of medical treatments
Monitoring of invasive lines
Confidence prescribing/suggesting treatment
Confidence communicating w ith doctors
Confidence communicating w ith nurses
Confidence communicating w ith relatives
Confidence in the transfer and monitoring of the critically ill patient
Understanding of ethical and medicolegal aspects of the outreach service.
Confidence w orking alone
Ability to develop your personal development portfolio
AFTER CCOrC
BEFORE CCOrC
EvaluationEvaluation
Expertise greater than 7.63 (range 0 – 10)
EvaluationEvaluation
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
Med
ical k
nowl
edge
of c
omm
on di
seas
es
Asse
ssmen
t of c
ritica
lly ill
patie
nts
Inter
pret
ation
of AB
G’s
Inter
pret
ation
of FB
C and
U&a
mp;E’
s
Inter
pret
ation
of EC
Gs
Inter
pret
ation
of Cx
R
Inter
pret
ation
of M
EWS c
harts
Unde
rstan
ding o
f med
ical t
reatm
ents
Mon
itorin
g of in
vasiv
e line
s
Conf
idenc
e pre
scrib
ing/su
gges
ting t
reat
ment
Conf
idenc
e com
mun
icatin
g with
docto
rs
Conf
idenc
e com
mun
icatin
g with
nurse
s
Conf
idenc
e com
mun
icatin
g with
relat
ives
Conf
idenc
e in t
he tr
ansfe
r and
mon
itorin
g of t
he cr
iticall
y ill p
atien
t
Unde
rstan
ding o
f eth
ical a
nd m
edico
legal
aspe
cts of
the o
utre
ach s
ervic
e.
Conf
idenc
e wor
king a
lone
Abilit
y to d
evelo
p you
r per
sona
l dev
elopm
ent p
ortfo
lio
BEFORE CCOrC
AFTER CCOrC
Level at which candidates took CCOrC
32%
32%
36%
MASTER LEVEL
DEGREE LEVEL
OTHER
INTENTION TO PROGRESS TO ADVANCE CRITICAL CARE NURSE PRACTITIONER
20%
50%
30%
YES
NO
I DON'T KNOW
EvaluationEvaluation“All aspects of the course were very
beneficial and have enabled me to use valuable skills in my
every day working practices”
"It was good to discuss practice with other Outreach
Practitioners and this enabled us to share best practice”
"..... feel great because the course is Outreach specific and I felt
that it really was Outreach orientated”
"..... a fantastic learning experience“
‘CONFIDENCE’
Would you recommend the CCOrC to a colleague?
6%
94%
Yes
No
Key PointsKey Points• Programme flexibility, peer support and
collaborative learning provide excellent opportunities for individual and team development.
• Standardised approach facilitates the acquisition of standards of knowledge and competence which is transferable across the Northern Region.
• Critical Care Networks can significantly contribute to the development of structured regional educational programmes
ConclusionConclusion• CCOrC©
has proven to be a successful
innovative and cost effective approach to the provision of an approved standardised programme of education across the Northern Region providing practitioners with the essential knowledge, skills and competence to safely and effectively function as independent Outreach practitioners
Future Plans…Future Plans…• Minimum standard
(NE&CCCN already )• Interface with Advanced
Critical Care Practitioner (ACCP) programme
• 2nd Edition• Further additions:
– Independent Px– Advanced practical
procedures• ‘Copy share’
Big thanks to….Big thanks to….
Emilio Garcia Isabel Gonzalez Louise Burn Diane Monkhouse
Phil Cudworth Mark Carpenter Steve Chay
..and authors…and many many more…!!!
IntroductionCritical Care Outreach (UK) is described as “an organisational approach to ensure equity of care for all critically ill patients, irrespective of their location” (National Outreach Forum 2003).A need for an approved standardised programme of education across the Northern Region providing practitioners with the essential knowledge, skills and competence to effectively function as independent Outreach practitioners was identified.
Key Points•CCORC provides a structured approach to the training of members of Critical Care Outreach teams•Combination of seminars, portfolio development and simulation have proven to be a successful approach
Critical Care Outreach UK: A Regional Approach to Education and CompetenceCritical Care Outreach Course© (CCOrC©)
North East & Cumbria and Tees Valley and South Durham Critical Care NetworksGonzalez I, Garcia E and Durham L 2009
References 1.DoH (2008) The National Education and Competence Framework for Advanced Critical Care Practitioners2.National Outreach Forum 2003 Critical Care Outreach 2003: Progress in Developing Services NHS Modernisation Agency3.ICS 2002, Guidelines for the Introduction of Outreach Service
Results
Programme StructureCCOrC© is a part time practice focused, work based educational framework and competency package. The programme can be undertaken at three levels and links with the established Continuing Inter-Professional Development (CiPD) framework at Northumbria University. Successful course participants may apply to undertake the Accreditation of Prior Learning (APL) process to obtain 40 CAT points at level 6 (degree) or 7 (masters).
Teaching and Learning StrategiesThere are a series of half-day workshops, seminars and lectures covering: the learning outcomes, clinical competencies, assessment strategy, and guidance on attainment of academic levels, reflective thinking, practice portfolio development, MCQ, OSCE and ‘test scenario’ preparation.
Evaluation
Preliminary evaluation via electronic survey demonstrates extremely positive outcomes in terms of knowledge, skills, competence and confidence in practice, with all participants grading their expertise greater than 7.63 (range 0 – 10) in all areas following course completion. In particular the opportunity to network and share practice experiences with other Outreach colleagues through the process of collaborative reflection was reported to be one of the key benefits of undertaking the course.
Clinical Skills Framework Competency AssessmentThe themes of the outreach practice based competencies/clinical skills framework to be demonstrated prior to the 3-day final assessment programme are:•History taking & rapid assessment of the acutely ill patient•Clinical assessment of the respiratory system•Clinical assessment of the cardiovascular system•Clinical assessment of the gastrointestinal system•Clinical assessment of the nervous system•Clinical assessment of the renal system•Clinical assessment of sepsis•Risk management & legal issues•Research & audit•Education & training•Leadership & multi-professional working
Overview of Course Structure and Process•Successful application•Receipt of course material•Identification of ‘Level’ of study•Formal introduction to the course and induction day•Agree and sign leaning contract with educational supervisor•Minimum of 3 months practice focused learning incorporating structured programme of lectures, seminars, workshops and tutorials •Practice Portfolio development•Summative written assignment (Level 6 and 7)•Facilitated clinical placements across the region
Clinical Skills Competencies
• CxR interpretation• Arterial blood gas
interpretation• ECG interpretation• Blood results
interpretation
Clinical Procedures• Administer oxygen
therapy• Administer CPAP • Administer NIV• Perform
venepuncture• Perform ABG’s
stab• Assist with CVP
insertion
[email protected] [email protected]
North East & Cumbria Critical Care Network
ConclusionsCCOrC©has proven to be a successful innovative and cost effective approach to the provision of an approved standardised programme of education across the Northern Region providing practitioners with the essential knowledge, skills and competence to safely and effectively function as independent Outreach practitioners.
Quote“All aspects of the course were very
beneficial and have enabled me to use valuable skills in my every day working
practices”
“Critical Care Outreach and the Acute Care Interface: New advances in approaches and
Practices”
www.norf.org.uk
NOrF Autumn National Meeting & 4th AGMOctober 1st & 2nd
2009
The NEC Birmingham
Learning Outcomes Learning Outcomes Level 7 By the end of the programme participants will be able to;
• 1. Demonstrate competence in the assessment and management of the acutely ill patient including history taking, physical examination and evaluation skills in both clinical practice and classroom based assessment scenarios :
• 2. Articulate and debate the ethics and medico- legal aspects of outreach practice drawing upon a range of relevant theories.
• 3 Identify and implement the strategies necessary for the evaluation of Outreach Services and the audit of patient outcomes in order to lead practice & service development.
• 4. Apply practice based and theoretical knowledge to the care of the critically ill patient demonstrated by effective clinical reasoning and decision-making.
• 5 Critically reflect on their own practice and the practice of others in order to enhance patient outcomes and individual development as an autonomous practitioner.
• 6 Evaluate the leadership skills necessary to develop and sustain collaborative partnerships and strategic alliances in the workplace
• 7 Reflect upon and analyse communication strategies required to develop and sustain effective working relationships
• Critically analyse and lead strategies to facilitate learning in the work place