ALERT™ AWARE™ & BEACH™ Network Day

Tuesday 21st October 2014Holiday Inn, Birmingham

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Introduction• The Team• Fire procedures• Parking• Facilities• Mobiles• Manuals • Evaluation Forms• Slides will be on the website

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Morning Programme

10.00-10.15 Welcome & Introduction

10.15-11.00 Official launch of BEACH™ V2

11.00-11.15 ALERT™ in the pre-registration nursing curriculum at Bucks New

University

11.15-11.30 Coffee/Tea – Lancaster 1 Foyer

11.30-12.15 Official launch of Obstetric ALERT™

12.15–12.30 AWARE™ – 1 year on 3

Afternoon Programme 12.30-13.15 Lunch & Networking – Lancaster 1 Foyer

13.15-14.15 ALERT™ Education Outcomes and Impact on Clinical Practice

14.15-14.30 Developing ALERT™ Faculty (with working tea/coffee)

14.30-14.45 Looking forward to 2015

14.45-15.00 Final ‘open’ discussion and themes for next year’s Network Day

15.00-15.10 Evaluation & Close 4

Any Questions?

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Obstetric ALERT™ Course

Nicky SayerALERT™ Course Lead

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Overview

• Separate course which follows the ALERT principles

• Pilot stage• Manual, Programme and Teaching

materials• Next steps

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Manual

• Familiar but distinctly different

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Manual – Inside the cover

• Pages 1-2• Pages 31-32• Pages 37-39• Page 48• Pages 103-111• Pages 139-140

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Programme09.00-09.45

Introduction & Case Discussion

09.45-10.30

The ALERTTM System of Assessment

10.30-10.45

 COFFEE

10.45-11.00

Faculty Demonstration of The ALERTTM System of Assessment

11.00-11.15 Immediate Assessment and Management of Airway

11.15-12.00

Immediate Assessment and Management of Breathing

12.00-12.30  

Immediate Assessment and Management of Circulation

12.30-12.40 The Oliguric Patient 10

Programme13.15-13.35

The Patient with a Disordered Conscious Level

13.35-14.00

Sepsis

14.00-14.35

Communication and the Deteriorating Patient

14.35-14.50

 TEA

14.50-15.1015.10-15.3015.30-15.5015.50-16.10

Scenarios (4 x 20mins)

16.10-16.20

Evaluation & Close 

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Teaching Materials

• Key changes are:Obstetric based Case DiscussionBreathless Patient workshopSepsis lecture/workshop addedObstetric based scenarios

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Case DiscussionPage 7 in manual

Case Discussion

Key points to note:• SIRS and new infection on Day 1• Delayed referral for senior Obstetric

and ICU review • Poor documentation – e.g. “Full

bloods” what was sent?• Poor recognition of sepsis by all

clinicians including GP, ED and Obstetric staff

• Sepsis 6 not done

What would make a difference

• Sepsis Pathway• Use of MEOWS and escalation

protocols• Sepsis awareness and management

education • Improved documentation standards

Teaching Materials

• The Breathless Patient is group work using a hand out from the CD

Let’s have a go

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The Breathless Patient

Cases Patient History Clinical Findings

1 22yr old 24/40. Has a Salbutamol Inhaler. She has had a 3 day history of a cough, increased shortness of breath and wheeze

↑Resp Rate ↓SpO2 Wide spread wheeze ↑Pulse Rate Anxious

2 28yr old 28/40 with a one week history of a cough. She has seen the GP and been prescribed antibiotics

↑Resp Rate ↓SpO2 ↓Air Entry right base ↑Temp ↑Pulse Rate

3 34yr old 34/40 ↑BMI presents complaining of chest pain and increased shortness of breath

↑Resp Rate ↓SpO2 ↓Air Entry right base ↑Temp ↑Pulse Rate

4 Severe pre-eclampsia. Post-natally has had ↓urine output despite increased fluid input

↑Resp Rate ↓SpO2 despite increased FiO2 ↑Pulse Rate

The Breathless Patient

Case Diagnosis Treatment and

InvestigationsComplications

1 Asthma OxygenNebulisersHumidified Oxygen to target SpO2SteroidsConsider antibiotics if infective causeCXRABG

PneumothoraxSevere respiratory failure

The Breathless Patient

Case Diagnosis Treatment and

InvestigationsComplications

2 Pneumonia Oxygen to target SpO2IV AntibioticsCXRABGPhysiotherapy

Sepsis Respiratory failure

The Breathless Patient

Case Diagnosis Treatment and Investigations

Complications

3 Pulmonary Embolism

Oxygen to target SpO2CXRECGAnticoagulation

Profound hypoxia (refractory to oxygen therapy)Heart failure

The Breathless Patient

Case Diagnosis Treatment and Investigations

Complications

4 Pulmonary Oedema

Oxygen to target SpO2Seek expert help

Profound hypoxia

Sepsis LectureLearning Objectives

• Understand the aetiology of sepsis

• How to recognise sepsis

• Understand the initial management of sepsis including the sepsis six

•Understand the importance of early senior involvement

Teaching MaterialsScenarios are:•Hypovolaemia due to Hyperemesis Gravidarum (Faculty Demo) •Eclampsia•Hypoglycaemia•Sepsis•MOH•Pulmonary Embolism

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Scenario’s

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Personnel: Candidate, Patient, Narrator, Midwife/Assistant (Narrator may act as Midwife) Patient brief Patient is in a room on the labour ward lying on the bed she is blue and fitting. This resolves once the candidate approaches the bed. They remain unresponsive and need their airway maintained in a head tilt chin lift position. If this is not done, the patient will snore. Documents available Obstetric notes Brief to candidate It is 08:30 and you are asked to see a 20 year old woman who is 34 weeks pregnant. She has recently been brought into the labour ward by ambulance in an agitated and distressed state. As you approach the woman you notice she is fitting. Brief to midwife/assistant You should be supportive and helpful but no prompting. Brief to narrator The patient has just been bought in by ambulance in an agitated and distressed state. She has abdominal pain and may be in labour. The obstetric notes indicate poor attendance for antenatal care. The candidate is called to see the women and on approaching her finds her blue and fitting. The fit quickly stops and leaves the woman unconscious. The patient needs airway support using a head tilt, chin lift manoeuvre. If this is not maintained the patient should start snoring. The patient’s conscious level improves over time such that patient responds to verbal stimuli.

SCENARIO A

Scenario A Eclampsia and airway compromise

Personnel: Candidate, Patient, Narrator, Midwife/Assistant (Narrator may act as Midwife) Patient brief Patient is in a room on the labour ward lying on the bed she is blue and fitting. This resolves once the candidate approaches the bed. They remain unresponsive and need their airway maintained in a head tilt chin lift position. If this is not done, the patient will snore. Documents available Obstetric notes Brief to candidate It is 08:30 and you are asked to see a 20 year old woman who is 34 weeks pregnant. She has recently been brought into the labour ward by ambulance in an agitated and distressed state. As you approach the woman you notice she is fitting. Brief to midwife/assistant You should be supportive and helpful but no prompting. Brief to narrator The patient has just been bought in by ambulance in an agitated and distressed state. She has abdominal pain and may be in labour. The obstetric notes indicate poor attendance for antenatal care. The candidate is called to see the women and on approaching her finds her blue and fitting. The fit quickly stops and leaves the woman unconscious. The patient needs airway support using a head tilt, chin lift manoeuvre. If this is not maintained the patient should start snoring. The patient’s conscious level improves over time such that patient responds to verbal stimuli.

The candidate should assess the patient and find / institute: Immediate Assessment, Monitoring and Treatment AIRWAY: There are signs of an airway obstruction and the woman is blue and snoring. The woman’s airway requires opening using the head tilt, chin lift manoeuvre, so the airway is maintained. If this is not manually maintained by the candidate or assistant the airway closes again and the woman starts snoring. Oxygen administration should be commenced using a mask with reservoir or variable performance mask at 15 litres per min. They should request that a pulse oximeter is attached, before the airway is opened the SpO2 is 82%, if oxygen is attached after airway manoeuvres, the SpO2 is 97%. The candidate should also initiate manoeuvring the women into a lateral position or tilted to relieve aortocaval compression. The candidate should summon help using the local emergency number such as ‘2222’ for the obstetric emergency team as urgent assistance is required from an airway and obstetric perspective as the patient is ‘U’ on AVPU. BREATHING: Once the airway has been opened, the patient’s colour improves rapidly. The respiratory rate is 15 per minute and, once correct airway manoeuvres are instituted, the chest

Next steps

• Get the feedback from the pilot centres

• Revise course materials if necessary• Roll out Obstetric ALERT Course to all

centres

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Any Questions?

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Summary

• Obstetric ALERT™ Course is an exciting addition to the ALERT™ suite of courses

• Email alert.course@porthosp.nhs.uk for more information

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Developing ALERT™ Faculty

Nicky SayerALERT™ Course Lead

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Overview

• Applicable to all courses• What faculty is needed• Who to target• Train the Trainer Course versus

developing your own faculty

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What faculty is needed

• A Course Facilitator - ALERT™ Train the Trainer Course or

- a Resuscitation Council Instructor or - a senior clinician with a recognised

teaching qualification• A Course Administrator

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What faculty is needed

• Core faculty to deliver sessions, participate in the demo and scenario’s

• Core Faculty must:– be credible educators with acute clinical

experience – have skills in delivering lectures, facilitating

workshops and running scenarios

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Who to target to teach

• Critical Care Outreach clinicians with known teaching experience

• Experienced healthcare professionals from an acute background with known teaching experience

• Practice Educators

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Who to target to teach

• Resuscitation Officers• Resuscitation Council (UK)

ALS/ILS/GIC Instructors

• ALERT™ candidates who have attended an ALERT™ Train the Trainer Course

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Train the Trainer Course

• Updated in February 2013• Aimed at ALERT™ candidates who do

not have experience of teaching or a teaching qualification

• Two centers Portsmouth and North Lincolnshire

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Train the Trainer Course Programme

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ALERTTM Train the Trainers Course Programme (Date)

(Venue)

* Bullock et al (ed.) (2008). Pocket Guide to Teaching for Medical Instructors (2nd edn). Oxford: Blackwell Publishing

Page in Pre-Course Reading *

Time Time Allocated

Faculty Allocation

08.45-09.00

15mins Registration Faculty Meeting

09.00-09.15

15mins Introduction to the day and meet your mentors

Pgs. 1-13 09.15-10.15

60mins Lecture: Adult Learning Styles

10.15-10.30

15mins COFFEE

Pgs. 14-24 10.30-11.00

30mins Faculty Demonstration: Lecture (5min section only) Followed by a discussion of key lecture techniques

Pgs. 14-24 11.00-12.30

90mins Skills Practice: Delivering an ALERTTM / AWARETM / BEACHTM Lecture

12.30-13.15

45mins LUNCH (not provided)

13.15-13.30

15mins Mentor Meeting

Pgs. 57-68 13.30-14.00

30mins Lecture : Giving Feedback

Pgs. 31-37 Pgs. 51-56

14.00-14.30

30mins Faculty Demonstration: Facilitating an ALERTTM Scenario or AWARETM / BEACHTM Workshop and Giving Feedback, Followed by a Discussion on the Principles of Continual Assessment

14.30-14.45

15mins TEA

14.45-16.15

90mins Skills Practice: Facilitating an ALERTTM Scenario or AWARETM / BEACHTM Workshop

16.15 – 16.25

10mins Next step your ALERTTM / AWARETM / BEACHTM Course Journey Any Questions

16.25-16.30

5 mins Evaluation & Close

Developing faculty who don’t need ALERT™ TTT Course

• Attend or observe an ALERT™ Course• Ensure they have a manual and access

to the teaching materials pre-course• Support from the Course Facilitator for

teaching experience as required• Feedback using the Lecture and

Scenario Evaluation forms from Train the Trainer Course

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ALERT™ Lecture and Scenario Evaluation Forms

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  Needs further development

Effective and competent

SET [includes environment]

1. Checks and adjusts layout and equipment    

1. Has prepared appropriately to deliver the lecture/workshop and is

2. familiar with the content, case studies and teaching materials

   

1. Introductions    

1. Establishes usefulness and clearly states learning outcomes    

DIALOGUE

1. Uses visual aids and teaching materials appropriately    

1. Uses voice and eye contact appropriately    

Developing your own faculty

• Enter them onto the ALERT Local Faculty Database

• Will get a certificate • Transferable between Trusts• This evidence can be used for annual

appraisals

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Any Questions?

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Summary

• Sustainability is based on developing your own faculty or utilising the Train the Trainer Course

• Using credible educators with acute clinical experience will ensure your course maintains it’s integrity

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Looking forward to 2015

Nicky SayerALERT™ Course Lead

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Introduction

• ALERT V4 will be the focus• Manual will be updated• Comprehensive review of teaching

materials• Group work from Network Days will

guide developments• Network Day in October 2015

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Ideas to be explored

• Pre & Post Course MCQ • Video option for the Faculty Demo• Less lectures and develop the sessions

to be more workshop and scenario based

• Increased options for introducing local policies, documents, case studies etc.

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Ideas to be explored

• Sepsis• Airway as a skill station• More scenarios - basic in the morning

and more advanced in the afternoon• More scenarios to chose from (AAA,

Tracheostomy, HAP, Chest Pain)

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Ideas to be explored

• Able to tailor-make scenarios to candidates role/speciality

• More complex scenarios for medical staff

• Acute Kidney Injury• More Human Factors

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Ideas to be explored

• Assessment scenario with MCQ so Pass/Fail option for centres

• Teaching materials on the website• Recert Course option – half day

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Any Questions?

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Summary

• ALERT V4 will be the focus• Manual will be updated• Comprehensive review of teaching

materials• Network Day in October 2015 will be

arranged

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