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CCOrC CCOrC © © Critical Care Outreach Critical Care Outreach Course Course Lesley Durham NoECCN: Manager, Lead Nurse, Service Improvement Lead Chair NOrF North East & Cumbria Critical Care Network

North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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Page 1: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 2: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 3: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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)

Page 4: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 5: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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’

Page 6: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 7: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 8: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

Course MaterialsCourse Materials• Manual• CD• Handbook• Competencies• Learning Outcomes• Educational

Supervisor• Learning Contract(Reference books)

Page 9: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 10: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 11: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

Teaching and Learning StrategiesTeaching and Learning Strategies

‘Outreached focused’…• Clinical Competencies• Clinical skills• Clinical procedures• Case studies• Learning Outcomes

Page 12: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 13: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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!

Page 14: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 15: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 16: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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)

Page 17: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 18: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 19: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 20: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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

Page 21: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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’

Page 22: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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…!!!

Page 23: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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] [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”

Page 24: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

[email protected]

Thank you for your kind attention

Any Questions?

Page 25: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

“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

Page 26: North East & Cumbria Critical Care Networkrapidresponsesystems.org/downloads2009/CCORC_Durham.pdf · CCOrC© Critical Care Outreach Course Lesley Durham NoECCN: Manager, Lead Nurse,

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