PAEDIATRIC INTENSIVE CARE FOUNDATION COURSE

1 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016

PAEDIATRIC INTENSIVE CARE FOUNDATION COURSE

PORTFOLIO OF LEARNING

Name:..…………………………………… Cohort:…………………………………... Mentor: …………………………………. …………………………………. Support Group:………………………… Kingdom:………………………………..


Overview of your learning portfolio:

Welcome to our PICU Team. You are joining our PICU Foundation programme, we hope you will enjoy it and it be the basis of your PICU career. All the resources for this programme, including timetable changes can be found at www.bch.moodle.org. This is a brief overview of assessment tools that are used throughout the programme to help you, your mentor and the clinical skills facilitators to identify any outstanding training needs. The tools will also be reviewed by the PICU Education Team during your interviews to assess your progress. Support and Feedback will be given throughout and following the course via: Personal Development Interviews: You will have interviews during weeks 1, 4, 6, 8, 26 (6 months) and 36 (9 months) of the course. These will enable the Education Team to monitor your progress and to allow for additional support/learning on an individual need basis. You should also arrange to meet with your support group leader during the course for additional feedback. At 6 months if you are achieving your targets you will be permitted to work bank shifts. At 9 months you should arrange an appraisal with your support group leader. Once your appraisal is completed confirming your yearly targets are met and you have successfully completed the programme you will go through your Foundation gateway and receive your increment at one year. Using your completed competencies towards the appraisal process: Once you have completed the course you will have yearly reviews with your support group leader as part of the appraisal process. While the competences and learning outcomes of the foundation course outline the specific skills and knowledge required to work on the paediatric intensive care unit (PICU), the NHS appraisal is a broad and generic focusing on the application of your knowledge and skills. If you successfully complete the Foundation course you should meet all of the dimensions in the Band 5 staff nurse job outline. Further information about the appraisal process and what is expected from you can be obtained from your support group leader and the PICU Education team. For nurses joining PICU with previous experience you should keep your same appraisal date to ensure you get your increments. Please liaise with the PICU education team regarding who can do this for you.

http://www.bch.moodle.org/


Learning Outcomes

At the end of the course participants should be able to:

1. To be safe and competent in caring for a critically ill child.

2. Demonstrate knowledge of normal paediatric anatomy and physiology.

3. Be able to recognise abnormal physiology and link to clinical practice.

4. Demonstrate a sustained contribution to team work.

5. Demonstrate effective communication with the child and family on PICU.


Methods of Assessment

The course is summatively assessed via:

Multiple Choice Exam

Total Patient Assessment (clinical assessment) To assist your development and support you with the summative assessment, the following formative assessments are included within the course:

Skills Passport

Trust Requirements

Topic Teaching Tasks

Clinical Support Shifts Multiple Choice Exam: Questions devised directly from Topic Teaching Tasks. Therefore the Information Sheets which you have produced in the Topic Teaching Tasks and have been provided with by your peers should become your revision tools and resources for the exam.

You will be allowed 1 hour to complete the exam carried out in exam conditions.

There will be 50 questions with a choice of answers.

Questions may state that there are one or more correct answers.

You will have a question paper and an answer sheet.

Pass mark is 35/50. On passing the exam your mark will be calculated into a percentage out of 100% (pass mark as a percentage = 70%). You will be able to see your marked answer paper with correct answers indicated so you may review the question paper to increase your understanding and ask for clarification if needed from the education team. P. 30 Total Patient Assessment: To be undertaken at week 9-10. The aim of this assessment is to ensure you have gained the appropriate level of knowledge and skills to enable you to provide safe and effective care for the child and family requiring Level 2 PICU intervention. Pass/Fail P. 11 Skills Passport: The skills passport is a list of clinical skills that has been development to enable you to have a planned skill acquisition. It will also be used as a tool to enable mentors to monitor progress and individual learning needs. P. 21 Trust Requirements: There are mandatory trust clinical competencies and study requirements which require completion. A complete list of trust and PICU requirements is included to aid your completion.


P. 73 Topic Teaching Tasks: Within Action Learning Sets (ALS, groups within cohort) you will be given topics to; research, create information sheets and teach. You will then formatively assess your peer’s contribution to team work, clarity of communication and quality of feedback. These topics will align with the Multiple Choice Exam and the formative feedback on communication and team work will inform us of your development in these areas over the course duration. P. 35 Clinical Support Shifts: Members of the PICU Education Team will work with you clinically once a month until course completion. These will help inform you of your skills development and provide written feedback on performance utilising the shift reflections sheets. Your mentors and Clinical Skills Facilitators (CSF’s) will also complete these shift reflections if asked.


Guidelines for Sickness and Absence Reporting within PICU. Within PICU we have a strict sickness policy that all members of staff need to adhere to. Please make yourself familiar with the sickness policy but we have given an outline below. Please contact the band 7 nurse in charge on 0121 333 9653 when needing to phone in sick. It is every member of staff responsibility to contact the unit themselves to report sickness as soon as possible. Below are suggested times for contacting the unit to report sickness.

Early shift – Contact unit before 6am on day of shift

Late shift – Contact unit before 10am on day of shift

Night shift – Contact unit before 2pm on day of shift

Please give a reason for sickness and inform Nurse in charge of when you are next due on shift. For short term sickness, you must contact the unit on a daily basis to inform nurse in charge of your progress. On your first shift/study day back at work you must complete a yellow back to work form. These are located in the A/B side coffee room. Please complete the front of the form and attend the off duty clinic on that day to complete the rest of the form with the Band 7. Trigger Points. A stage one sickness review will be commenced if you have either of the following as sickness:

3 separate episodes in a continuous 6 month period

10 days in a continuous 12 month period.

Patterns of sickness will also be noted.

You are not able to do any bank shifts within the trust for 2 weeks following any single period of sickness and are unable to do bank for 3 months while on a stage 1 review. If you are absent for over 7 days you require a medical certificate from your GP. The certificate must be posted into the unit as soon as it has been issued and not kept until your return to work. Please address it to Yvonne Heward or Joanna Durham while on the foundation course. Please be aware that if you are off with Diarrhoea and vomiting you must still follow sickness policy but will be required to be absent for 48 hours from last symptom. The Band 7 remind you of this when you contact the unit.


Guidelines for signing Skills Passport for the PICU Foundation Programme

There have been recent changes to the PICU Foundation Programme. This document outlines the changes, which have been made as a result of feedback and evaluation. 1. Alteration to the supernumery structure.

Weeks 1-5: One to One supervision with an assigned mentor.

Weeks 6-10: Two to One supervision with Clinical Skills Facilitator (CSF).

The Skills Passport reflects these changes in supervision. The skills passport list is divided into completion dates of:

Before 6 weeks (supernumery period)

Before 10 weeks (CSF period)

Before 6 months

Before 9 months.

Assessment of skills

The list of skills is for your mentors, CSF’s or any staff nurse who has already

completed the foundation course to sign when you are competent.

This should allow you to prompt your mentors for learning opportunities if there

are skills that you have not yet experienced or feel competent in.

During your first 6 months of employment with the trust all new staff

members will undertake a probationary period. During this time we want to

ensure that you feel supported, listened to and developed at BCH. The

probationary period is a supportive process with a structured approach that

enable us to do this. It also ensures that you are clear about your role, what is

expected of you and your responsibilities. During the probationary period you

will be required to complete four weekly progress meetings. We will utilise

bedside shift reflections from your mentors along with 3 monthly reviews with

the education team. It is important that you complete the following review

points in order to comply with your contract. Your 6 and 10 week interviews

with your mentors and CSF’s will allow you to set and review learning

objectives as part of the review dates.

There are also shift reflections within this portfolio of learning so that you can

receive feedback on your performance each shift. It is an essential

requirement to complete the shift feedback after every supported shift. Both

the interviews and shift reflections will act as an aid to improve your learning

and development within PICU, by identifying together, areas for further


learning. Please present the interviews and shift reflections to mentors and

CSF’s to ensure they are completed.

Probationary Responsibilities.

KEY RESULT AREAS (breakdown further if necessary) to be achieved in the first 6 months

Performance of duties: Complete 10 week supernumery period and enter nursing numbers within the allocated timeframe. Successfully Pass Total Patient Assessment during allocated shift. Ensure all policies are adhered to and work within your own clinical capabilites. Complete all set moodle and clinical competancies in set timeframe.

Attitude/Behaviour: Please remember you are a representative of BCH and ensure professional behaviours and attitudes are maintained at all times. Ensure a positive attitude to learning is maintained throughout the Foundation programme.

Integration into ward/department: To work effectively within your Dizney team by ensureing you promote good teamworking attributes and skills.

Relationships with co-workers and manager: maintain good communication with mentors, CSF’s, Education team and Band 7 regarding progress, worries and anxieties.

Values/Standards: Ensure trust standards and values are maintained and promoted at all times. Demonstrate PICU values during all shifts


Students Interview / Learning Contract Mentor phase (week 1)

Initial interview: This interview is designed to focus both foundation member and mentor on the important learning objectives within the 1:1 supernumerary clinical environment. The PICU Education Team has the common learning outcome (below) as a requirement for everyone however there is space for you to add your own personalised ones as well after you have had a discussion with your mentor. Agreed Learning outcomes:

To achieve the skills in the section within the skills passport entitled, “complete before 6

weeks” (supernumerary period).

Complete BCH clinical competency – Administration of Medicines

Complete BCH clinical competency – Arterial/Central blood sampling

Complete Medical Gas Training on trust moodle. Date completed………………..

Complete Waste Management training on trust moodle. Date completed……………..

Complete PEWS training on trust moodle. Date completed……………….

Complete PEWS Neuro training on trust moodle. Date completed………………

Complete PEWS Recognition of the sick child on trust moodle. Date completed……,…

Mentor Comments:

Foundation Member Comments: Foundation Member: Mentor: Print name…………………………….. Print name…………………………….. Sign…………………………………..… Sign…………………………………….. Date…………………………………….. Date…………………………………..… Foundation Member: Print name………………………………………. Sign……………………………. Date………………


Students Interview / Performance Review Month 1 Mentor phase (week 4)

Week 4, Progress interview: The purpose is to review the progress of the foundation member so far and to recognise skills achieved, but more importantly those outstanding. Outstanding skills should then become a priority to learn in the final 1:1 mentor week, this list can be reviewed by the CSF’s so they can develop these skills further once they also start mentoring them. If you have concerns that there may be insufficient time to achieve these skills in the set time, please email the PICU Education Team ([email protected]) Agreed Learning outcomes:

Outstanding Skills from section entitled, “complete before 6 weeks” in skills passport. Mentor Comments: Is the Foundation member meeting everything set in probationary responsibilities? Yes No Please make any comments needed. Foundation Member Comments: Foundation Member: Mentor: Print name…………………………….. Print name…………………………….. Sign…………………………………..… Sign…………………………………….. Date…………………………………….. Date…………………………………..…


Interview / Learning Contract CSF phase (week 6)

Week 6, Initial Interview with CSF: The purpose of this interview is to review the progress and to review the skills passport achievements in the “complete before 6 weeks". Outstanding skills should become a priority in the CSF time. There are common learning outcome below, there is space for you to add your own personalised outcomes as well with discussion with your mentor. Agreed Learning outcomes:

To achieve any remaining skills in section within skills passport entitled, “complete before 6 weeks” in skills passport.

To achieve the skills in the section within the skills passport entitled, “Complete before 10 weeks” (CSF period).

Complete CAF training, link from our moodle page – Date completed……………….

Complete Health records training on trust moodle – Date completed……………….

Complete Child Protection Level 3 on trust moodle – Date completed……………….

Complete BCH clinical competency – Blood glucose

Complete BCH clinical competency – Capillary sampling

Complete BCH clinical competency – Transfusion sampling

Complete BCH - IV Moodle package – Date Completed………. Mentor Comments: Foundation Member Comments: Foundation Member: Mentor: Print name…………………………….. Print name…………………………….. Sign…………………………………..… Sign…………………………………….. Date…………………………………….. Date…………………………………..…


Interview / Performance Review Month 2. CSF phase (week 8)

Week 8, Progress so far interview: The purpose is to review progress of the skills achieved but more importantly those outstanding. Outstanding skills should be a priority to learn in the final CSF week. If you have concerns that there may be insufficient time to achieve these skills in remaining CSF time, please email the PICU Education Team ([email protected]) Outstanding Skills from section entitled, “complete before 10 weeks” in skills passport:

Outstanding Skills from section entitled, “complete before 10 weeks” in skills passport.

Complete Manual handling booklet by: Date …………………………………….. Date for completion: Mentor Comments: Is the Foundation member meeting everything set in probationary responsibilities? Yes No Please make any comments needed. Foundation Member Comments: Foundation Member: Mentor: Print name…………………………….. Print name…………………………….. Sign…………………………………..… Sign…………………………………….. Date…………………………………….. Date…………………………………..…


Performance Review meetings.

Perfomance Review Month 3 Date……………………

Preceptors Comments. Is foundation member achieving all probationary responsibilities? Yes No

Preceptees comments

Preceptors Signature……………………. Preceptee Signature………………..….



Preceptees comments




Preceptees comments





Preceptees comments




Preceptees comments



Skills Passport

Essential Skills

Complete before 6 weeks (supernumerary period)

Complete before 10 weeks (CSF period)

Complete before 6 months Complete before 9 months

Handover Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Notes made appropriately

Infusions cross checked and calculated

Further information asked for appropriately

IV lines secure

Effectively communicates during handover

Logical progression through handover (using the handover sheet)

Documentation

Nursing assessment form completed appropriately

Child and Family profile/ activity of daily living

Observations charted appropriately

Line and circuit changes form

Urine catheter form

Manual Handling form

Tissue Viability

Pain Standard

TISS from completed

All significant event’s / changes in condition & communication with families documented appropriately

Aware of Nursing Care Quality Indicators (NCQI’s) and able to list them


Essential Skills




Essential Patient Care Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Staff hand washing

Mouth care

Cleaning teeth

Eye care

Skin care & assessment

Catheter care

Use of hoist

Use of sliding sheets

Use of pat slide

Patient positioning

Prone positioning

ASEPTIC Non Touch Technique

Using the monitors & mini-me

Admitting and Discharging patient from monitor

Infection Control

Safe disposal of sharps & awareness of what to do following a needle stick injury

Identify the different colour codes used in relation to infection control

Isolation procedures – source/protective

Identify the personal protective equipment used

Respiratory

Able to assess airway

Able to assess breathing

Auscultation of chest

Can identify signs of respiratory distress


Essential Skills




Respiratory continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

PEWS

Completed pews online training, including:

Recognition of a sick child

O2 Therapy

Neurological assessment

Demonstrate correct use & ability to interpret PEWS chart

Knowledge of observation and monitoring policy

Resuscitation Trolley

Check resuscitation trolley

Assess and open airway

Size and insert OP/NP airway

Practice use of re-breath circuit

Effective use of ‘Rebreath’ circuit

Effective use of face mask and self inflating bag

Suction

Oropharangeal (OP)

Nasopharangeal (NP)

Nasopharangeal airway (NPA)/short tube (ST)

Endotraceheal tube (ETT)

Tracheostomy

Set up O2

Face mask emergency

Humid facemask / Trachy mask

Nasal specs

Head Box

Optiflow


Essential Skills




Respiratory continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Assisting with intubation

Awareness of drugs used

Equipment used

Servo I ventilation checks

Ventilator settings/alarm limits for children’s age

Set appropriate temperature for humidifier

Emptying water from tubing and traps

Knowledge and use of VAP Care bundle

High frequency oscillation

Ventilator settings/alarm limits for children’s age

Set appropriate temperature for humidifier

Emptying water from tubing and traps

Nebulizers

Face mask / Trachy mask

Bagging

Via Servoi

Cleaning and storage of pots

X-ray

Recognise endotracheal tube position on x-ray

Pulse Oximetry

Probe selection and placement

Setting alarm limit

Probe placement for pre and post ductal saturation monitoring

Blood gases

Identify normal values

Interpretation


Essential Skills




Cardiovascular Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Able to assess circulation

Correct placement of ECG / respiratory leads

Identify Sinus Rhythm

Feeling Pulses

Capillary Refill time

Identify ectopic beats

NIBP

Perform blood pressure measurement

Select correct cuff size

Select and review time intervals

Setting alarm limits

Invasive Monitoring

Zeroing transducers

Setting up flush system and transducer set

Troubleshooting

Change scales, labels & alarm limits

Temperature Monitoring - Select, apply and safely use appropriate heating/cooling

device

Axilla (Neonatal)

Rectal

Skin / Toe

Sure Temp

Chest Drains

Preparation/Setting up for insertion of a drain /setting up bottle

Assist with insertion of chest drain

Changing bottle


Essential Skills




Chest drains continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Use of clamps

Connecting suction

Observation of chest drain-bubbling, swinging, draining

Difference between mediastinal and pleural drains

Removal of chest drain

Defibrillator

Be able to switch on

Awareness of joules required

Ensure safety for staff and patients

Able to connect defib to monitor using interface cables

Able to change cables for internal or paddle cable

Demonstrates how to take off the test well, store it in the draw and connect pads

Pacing Box

Safely change the battery

Check the mode of pacing

Be able to locate spare batteries

Be able to locate the pacing box

Able to check the leads are securely attached to the box

Can identify which leads are which

Blood Sampling (MPP)

From an arterial line

From a venous line

Taking blood cultures

Administer blood products (MPP) under supervision

Setting up (rate, choosing appropriate giving set and filters


Essential Skills




Blood continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Warming blood

Checking procedure

Documentation & audit trail (sign form & return tag)

Safe disposal

Correct storage (signing in & out of fridge)

Collection & transport of blood products

Cardiovascular Continued

IV drug administration (MPP) Under supervision

of IV assessed person

Care & removal of peripheral intravenous (IV) lines

Care and removal of central venous catheters

Safe administration of bolus drugs under supervision

Use of Central line care bundle

Fluids & Nutrition

Calculate fluid requirements/output

Check fluid balance is accurate regularly

Placement of enteral feeding tube:

Awareness of when to use an oral tube

Nasogastric (NG)

Administration of enteral feeds via NG, oral, NJ & Gastrostomy

Testing ph paper

Care of gastrostomy site and


tube

Essential Skills




Feed continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Use of feed pump

Administration of medicines Trust competency documentation completed

Gastro Intestinal Care

Bowel assessment

Stoma Care

Giving suppositories and enemas

Renal

Change & Connect urine drainage bags

Able to check catheter patency

Collect urine samples for analysis

Perform, record and interpret urinalysis

Safely remove urethral catheter

Peritoneal Dialysis (PD)

Care of PD catheter site under supervision

Prepare and set up dialysis fluid bags

Safely interpret prescription

Safely change dialysate bag

Safely take PD fluid sample

Safe dismantling of system to leave PD drain

Assist with removal of PD catheter

Neurological Care

Use and interpret AVPU

Use and interpret Modified


Paediatric Coma Scale

Essential Skills




Neurology continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Assisting in insertion of bolt

Set up Camino monitor, interface with monitor

Assist with bolt removal

Be able to safely participate in log rolling

Demonstrate and interpret limb observations following spinal injury and traumatic injury

Care of EVD

I V Assessment

Safe discontinuation of infusions

Safely changing infusions

Have knowledge of safely changing inotropes and vasoactive agents

Complete Stage 1

Demonstrates knowledge of extravasation policy

Heating and cooling devices – set up and safe use:

Cooling mattress

Bear Hugger blanket

Over head radiant heater (burns)

Neonatal

Care of new mother – referral to midwife

Assist and encourage new mothers to breastfeed/express

Knowledge of breastfeeding equipment and know where its located


Neonatal positioning

Essential Skills




Neonates continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date

Care of neonates under phototherapy lights

Temperature control

Set up & safe use of an incubator

Minimal handling

Care of a silo bag

You will attend an IV SD as part of the Foundation Course and once completed you can work towards become Stage 1 IV Assessed. Until that time you will be expected to prepare and administer drugs under direct supervision of an IV assessed nurse. It is your responsibility to inform the 2nd nurse that you are not IV assessed


Requirements for first year on PICU to pass through your gateway

Achievements by 6 weeks:

A

chievAc Achievements by 9 weeks:

Required Study Date Completed Handed in to PICU Education (Yes)

Blood Glucose competency

Transfusion sampling competency

Newly qualified Nurse (NQN) Maths Test

Moodle mandatory training: Core Mandatory training courses

Health Safety and Clinical risk

Information Governance

Local induction

Manual Handling Awareness Role essential Mandatory training courses

Blood transfusion (needs to be completed prior to blood study day)

Child protection level 3 Role essential training courses

Healthcare records

Safe clinical Handover

Capillary Blood sampling competency

ICE training

Manual Handling Workbook (complete moodle or paper copy prior to manual handling study day and submit to Manual Handling Team 1 week prior to study day)


Administration of Medicines competency

Arterial and Venous sampling competency

Medical Gas Training Moodle Package

Waste Management Training Moodle Package

Basic Life Support

PEWS online Trust Moodle training (Recognizing sick children, O2 Therapy and Neurological assessment) Password - PEWS

Child Protection Level 3 Moodle package (New Staff) – Complete within 2 weeks

Administering IV Therapy on Moodle before IV study day Password – IV2014


Achievements by 20 weeks (4.5months):

Achievements by 36 weeks (9 months):


Stage 1 IV Assessed

Manual Handling Study Day

Conflict Resolution Teaching (timetabled)


Blood Study Day

Blood Collection competency

Stage 2 IV Assessed

6 month appraisal

Medical Devices + online medical device declaration


Alternative Learning Experiences

During your supernumery time, you will be allocated to work a shift with a Band 7 Clinical Co-ordinator who will hopefully also be your support group leader. This will provide you with an opportunity to better understand the demands of PICU and the role of the Band 7 whilst also meeting another person responsible for your professional development.

You will also be allocated a shift with the Health Care Assistant’s to enable you to gain knowledge of where things are stored, bed space preparation and understand their role on PICU more fully.

We have provided a band 7 learning sheet below which you should complete when with them in order to guide your learning. Please use this worksheet and question the Band 7’s, as this will help you to appreciate why certain actions and decisions are made.

We will attempt for you to go to theatre for one shift to follow a cardiac surgical patient journey. This cannot be guaranteed, dependant on service demand.


GUIDED LEARNING FOR WORKING WITH BAND 7

Working with the band 7 co-ordinator during this shift is to help you appreciate their role, and have a better understanding of management of PICU; and its part of being a Regional referral centre. 1. During the handover, try and answer the following: a) Who is present and what are their roles?

b) For what reasons are patients admitted to PICU?

2. During the 8.20am meeting, what is discussed and might this be important to communicate? 3. a) During the Dr’s Huddle in morning and afternoon, who is present? b) What is discussed?


c) Write down any conditions that you do not understand? d) Why do you think this handover is important?

4. What other tasks does the Band 7 have to perform and why are these

important?

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Short reflection of your shift with the Band 7

Description:

Key Learning points:

Evaluation:

How will what you have learned influence your future practice?

Date Band 7 Signature

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GUIDED LEARNING FOR WORKING WITH HCA

Working with the Health care Assistant’s (HCA’s) during this shift is to help you

appreciate their role and have a better understanding of the roles and

responsibilities of the HCA’s and how this influences the unit on a shift by shift basis.

1. During handover from outgoing HCA to start of new shift, what is discussed?

2. During 8.20am meeting, what information is important for the HCA’s to be

aware of?

3. HCA’s set up bed spaces for elective admissions to the unit.

What equipment is set up at these bed spaces and why?

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4. Why is it important for HCA’s and team leaders/resource nurses to have good

communication throughout the shift?

5. What tasks do the HCA’s do throughout the day which improves the day to day

running of PICU?

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6. As a staff nurse, how can you help the HCA’s during busy shifts?

7. How does a HCA role differ from the other band 1-4 roles on PICU?


Short reflection of your shift with the HCA’s

Description:

Key Learning points:

Evaluation:

How will what you have learned influence your future practice?

Date: HCA Signature:

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Total Patient Assessment

The aim of this assessment is to ensure you have gained the appropriate level of knowledge and skills to enable you to provide safe and effective care for the child and family requiring Level 2 PICU intervention. This assessment should take place on a level 2 ventilated patient, which will be identified by the clinical educators prior to your shift. This assessment has been designed to meet learning outcomes 1, 2 and 4. Whilst working with a member of the education team or clinical skills facilitator to complete this assessment there may be aspects of your clinical skills list and / or competencies that may be met. You will receive verbal feedback directly after your shift.

Guidance on Assessing Total Patient Assessment

In order to complete a Total Patient Assessment (TPA) with Foundation course members, the patient allocated must meet the following criteria:

Level 2 patient

Intubated and Ventilated

Stable, at the beginning of the shift

When undertaking the TPA, the assessor will be an education team member or clinical skills facilitator.

They will work with the foundation programme member in a one to one capacity and is allowed to

assist in bedside activities such as suctioning and care provision when asked for by the foundation

course member or if an emergency situation occurs.

The assessor will observe the patient assessment and care.

If at any time during the TPA the patient deteriorates and therefore moves outside of the patient

criteria for the TPA (as above) then the assessment should stop and recommence later that shift or be

re-scheduled.


Total Patient Care Assessment (To be undertaken between weeks 9 and 14)

Patient Handover:

Wash Hands using the 6 step technique & apply an apron

Yes No

Notes made appropriately Yes No

Infusions cross checked and calculated Yes No

Further information asked for appropriately Yes No N/A

IV lines secure Yes No

Participates in the IPASS Yes No

Immediate Checks:

Summary of overall appearance / identifies any immediate concerns.

Yes No

Assess the security of the airway Yes No

Is able to correctly identify the type of airway in situ & check the size & length of the tube are documented correctly

Yes No

Emergency Equipment: - Anaesthetic bag & Oxygen - Bag valve mask (self-inflating) - Masks - Airways (Measure with the flange at the centre of the incisors, then curve around the face to reach the angle of the mandible – APLS guidelines) - Working suction at an appropriate pressure - Yanker sucker & Correctly sized catheters

Yes No

Alarm Limits appropriately set - Patient Parameters

Yes No

Check that a name band is in situ & apply if not already in place

Yes No

Check patient drug calculator Yes No

Check red bag Yes No

Respiratory: Observed bilateral chest movement Yes No

Observed chest for signs of respiratory distress Yes No

Observation of colour Yes No

Assessment of SpO2 Yes No

Chest auscultated Yes No

Ventilation Mode - ability to explain

Yes No

Set Rate Yes No N/A

Spontaneous rate / respiratory rate Yes No N/A

Tidal volumes identify and correct for child’s wt (ability to identify any leak)

Yes No

Airway pressures Yes No

Ventilator alarms checked Yes No

Fio2 Yes No

Check cuff pressure. Deflate and re-inflate Yes No N/A

Appropriate assessment of last blood gas analysis (referring to normal range reference guide) & identification of when to repeat

Yes No


Cardiovascular: Heart rate (cross check pulse with monitor for 1 min) Rhythm

Yes No Yes No

Blood Pressure Invasive- Appropriate trace Re-levelled & re-zero’d (gloves worn, new bung) Non-invasive- Appropriate intervals (minimum of 1hrly)

Yes No N/A Yes No N/A

CVP Appropriate trace Re-levelled & re-zero’d (gloves worn, new bung)

Yes No N/A

Capillary refill time assessed (centrally, press for 5 secs)

Yes No

Temperature Appropriate management of temperature if outside normal parameters

Yes No Yes No N/A

Appropriate assessment of chest drain losses (type & quantity of losses)

Yes No N/A

Neurological / Pain Assessment:

Pupil’s assessed Yes No

Spontaneous movements / Response to intervention assessed

Yes No

Identification of pain / sedation score Yes No

Appropriate management /evaluation of pain Yes No N/A

Appropriate management /evaluation of sedation Yes No

AVPU / Glasgow coma score (GCS) score as appropriate

Yes No

Fluid balance: Correct calculation of fluid allowance Yes No

Correct calculation of fluid being administered Adjustments made accordingly

Yes No Yes No N/A

Identification of oedema / can describe the signs Yes No

Assessment of urine output (mls/kg/hr) Appropriate management of reduced urine output (< 1ml/kg/hr in a baby / small child)

Yes No Yes No N/A

Maintain an accurate fluid balance Identification of signs of dehydration / oedema and / or an inappropriate balance (+’ve or –‘ve)

Yes No Yes No N/A

Nutrition:

Document the length / mark the length of the gastric tube (NG or OG)

Yes No N/A

Aspirates the gastric tube appropriately: (Before administering medication or feed & at least 4hly during continuous feeds or when nil by mouth) Assessment of pH (can describe normal range – pH1-5) If pH >5 takes appropriate action (look at the length of the tube, is it taped appropriately? Has it migrated out? Has there been a recent chest x-ray which may confirm the position?, Discuss with the team leader, Does the child require an x-ray )

Yes No Yes No

Correct calculation of feeds Yes No N/A


General Patient care:

Eye care undertaken appropriately Yes No

Mouth care undertaken appropriately (teeth brushed in older children where appropriate)

Yes No

Moving & Handling risk assessment checked / completed

Yes No

Completion of tissue viability risk assessment Yes No

Identification of any pressure area’s Yes No N/A

Appropriate management of: - Known pressure area’s - Potential pressure points

Yes No N/A Yes No N/A

Patient re-positioned at appropriate intervals Yes No

Appropriate assessment of wounds / CVL sites: - Is the correct dressing in situ - When does the dressing need to be

changed? - Dressings changed appropriately - Identify any signs of infection - Swab sent if indicated

(Guidelines available for sternotomy wounds & CVL sites, there may also be information in the notes form the tissue viability team)

Yes No N/A

ET Suctioning: Need for suctioning identified appropriately Yes No

Suctioning given as indicated by patient condition - in a timely manner - as required - routinely with care / re-positioning if the patient is paralysed / heavily sedated

Yes No

Pre-oxygenation given where appropriate Yes No N/A

Appropriate sized catheter used Yes No

Correct suctioning technique used Yes No

Accurate description of secretions documented Standard descriptions 1-Minimal, 2-Moderate, 3-copious M-Mucoid, M P-Muco-purulent, B-Bloody

Yes No

Appropriate use of personal protective equipment Yes No

Administration of Medicines:

Patient chart reviewed for allergies Yes No

Right patient (check name band) Right drug Right time Right Dose Right Route

Yes No

Observes for signs of extravasation during administration of IV medication (If there are no signs of extravasation can describe the signs that would indicate an extravasation injury)

Yes No

Ongoing communication:

Any concerns reported appropriately to the team leader / nurse in charge and / or medical team.

Yes No

Appropriate communication with the child & family ie. Keep them updated with care / progress

Yes No

Bedside Handover:

Effectively communicates during handover Yes No

Logical progression through handover (using the handover sheet)

Yes No


Evidence for completion:

o Direct observation o Discussion of appropriateness of assessment / intervention o Accurate completion of the assessment form o Accurate completion of the observation chart

Documentation:

Nursing assessment form completed appropriately Observations charted appropriately Line and circuit changes form

Yes No Yes No Yes No

Urine catheter form TISS from completed Nappy rash care plan

Yes No N/A Yes No Yes No

All significant event’s / changes in condition & communication with families documented appropriately

Yes No

Assessors Comments: Pass Refer

Action Plan (if applicable)

Nurse Comments:


Shift Reflections

To be completed by your mentors, the CSF’s or the Education

Team at the end of any support shift and during your first nine

weeks. Additional pages are available to print off on Moodle.

Please keep this document with you at all times, so you can get

it completed when you are at work as you go.

This is your responsibility and failure to bring this document will

result in no written feedback.


FOUNDATION COURSE SHIFT EVALAUATION SHEETS

Please identify and weaknesses/ learning needs

DATE TYPE OF PATIENT Supervisor Name: Signature:

Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment:

Clinical Skills :

Response to patient needs:

Organisation and prioritisation:

Observation and paperwork:

Communication:

Other:

LEARNING NEEDS



Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS


DATE TYPE OF PATIENT Mentor/CSF/ Education Team












DATE TYPE OF PATIENT Supervisor Name: Signature: Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS


DATE TYPE OF PATIENT

Supervisor Name: Signature:




Self Assessment

Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
















































































DATE TYPE OF PATIENT

Supervisor Name: Signature:






Notes.

Documents

PAEDIATRIC INTENSIVE CARE FOUNDATION COURSE