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BACCN Conference

Workshops

Workshops W01 - W10

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HOW TO DO A SYSTEMATIC REVIEWDr. Bronagh Blackwood,Queen’s University Belfastb.blackwood@qub.ac.uk

IntroductionOver the past 30-years there has been a huge growth in scientific research and evidence-based literature that has contributed significantly to modern healthcare practice. As a result, the expansion in the quantity of scientific literature has created a state of information overload and placed extra demands on the skills of healthcare practitioners. The increasing number of studies, often with conflicting findings, has generated a requirement for skills in critical appraisal, critical analysis, synthesis and review. Systematic reviews are designed to do just that. They are concise summaries of the best available evidence that address sharply focused clinical questions.

AimThe aim of this master class is to outline the process involved in generating a systematic review and impart an appreciation of the potential use of systematic reviews in critical care practice.

DiscussionSystematic reviews differ from other types of review in that they adhere to a strict scientific design in order to make them more comprehensive, to minimize the chance of bias, and so ensure their reliability. Rather than reflecting the views of the authors or being based on only a (possibly biased) selection of the published literature, they contain a comprehensive summary of the available evidence.

The techniques used to ensure the reliability of the review results will be outlined particularly in relation to the question to be addressed; the methods by which potential studies are identified; the criteria by which studies are selected; the scales or checklist by which they are subsequently appraised; and the techniques of synthesis or analysis by which they are presented.

The master class will conclude with a brief look at reviews that have provided important answers for critical care practice.

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02BLOOD RESULTS FOR BEGINNERSPhilip Woodrow, East Kent Hospitals University NHSFoundation TrustPhilip.Woodrow@ekht.nhs.uk

BackgroundBlood tests are widely used in healthcare, with frequency of tests usually increasing in sicker patients. Advances in information technology means that nurses are often the first clinical staff to view results. With nurses taking increasingly proactive roles in healthcare treatments (DOH, 2000), knowing normal ranges and likely causes of abnormalities with more commonly encountered diseases enables earlier intervention.

AimWhile there are a number of texts (such as Higgins, 2007) which provide authoritative information, these are more likely to be used for occasional reference rather than everyday practice. This workshop aims to provide staff new to critical and high dependency care (level 2 + 3 patients) with the skills to interpret key blood results of patients for whom they will be caring..

MethodThe session will begin by over viewing causes of abnormalities, which will then be applied through work-shopping scenarios. Participants will be encouraged to interpret causes, significance, and likely treatments of results. This workshop format will be based on one used by the presenter for courses. Examples will be structures so that further information can then be developed about key biochemistry, haematology and other results.

DOH. 2000. The NHS Plan. London. Department of Health.

Higgins, C. 2007. Understanding Laboratory Investigations. 2nd edition. London. Blackwell Publishing.

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CARDIAC MONITORING AND RHYTHM RECOGNITIONBilliejoan Rice, Queen’s University Belfastb.j.rice@qub.ac.uk

AimAt the end of the session students will understand basic principles of cardiac monitoring and how to read a rhythm strip.

ObjectivesOutline the indications and techniques for ECG monitoring Revise basic electrocardiography and the conducting systemExplore the six step approach to reading a rhythm stripIdentify cardiac arrest rhythmsIdentify peri-arrest rhythms and discuss

MethodsPower point presentationDiscussion with groupUse of flip chartDistribute rhythm strips for students to identify, using six step approachUse of manikin and correct positioning of ECG leads, and monitoring leadsGroup workDiscussion

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“CRITICALITY” AN INTERACTIVE LEARNING TOOL TO FORMATIVELY ASSESS PRACTITIONERS UNDERTAKING CRITICAL CARE EDUCATIONMargaret Douglas, Newcastle upon Tyne Hospitals NHS Trust

Vanessa Gibson, Northumbria Universitymargaret.douglas@nuth.nhs.uk

AimIn this workshop the authors aim to share their experiences of developing an interactive learning tool/board game and for the audience to participate in playing the game.

Background and Implications The use of games as educational tools are widely used throughout higher education (Bochennek et al. 2007, Duffin 2003). The aim of the Foundations in Critical Care Module at Northumbria University is to increase the knowledge base of qualified practitioners.

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The assessment strategy for the module is an exam and it was envisaged that participating in the game would enable students to integrate knowledge from all the sessions in the module and to identify subjects for revision prior to their exam. The authors first had the idea for the game following a BACCN conference where Toby Edwards and Agi Holland presented their game entitled “Neuropoly”.

During “Criticality “ students are required to work in teams and compete against each other by asking and answering questions relevant to the module content. Players have one hour to “save” their patient. Within the hour they must collect a series of interventions required by the patient.

ResultsThe evaluation has exceeded our expectations with comments such as;

“the game was a fun way to learn without making you feel stupid if you got the question wrong”“ the questions prompted you to think what you had learnt over the last 10 weeks”

Delegates attending the workshop will be asked to form teams and actually play the game. Come along it’s great fun and you never know you may be part of the winning team!

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ASSESSMENT / MANAGEMENT OF THE ACUTELY ILL PATIENT AND CARDIAC ARREST DUE TO ELECTROLYTE DISORDERAidín McKinney, Billiejoan Rice & Patrick Gallagher, Queen’s University Belfasta.mckinney@qub.ac.uk

AimTo enable participants/delegates to review their ability to assess and manage the care of a patient who has become acutely ill.

Learning outcomes To revise the ABCDE method of assessment.To review the key management issues to consider when a patient becomes acutely unwell, including the management of patients with electrolyte disorders, breathing difficulties, chest pain, hypovolaemic shock and deteriorating Glasgow coma scale .

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To highlight the importance of the SBAR method of communication when calling for help.To revisit the management of cardiac arrest.

Teaching delivery methodForm of simulated learning using case scenarios and manikin.

Cardiac Arrest due to electrolyte disorder

Key teaching ObjectivesBy the end of this session the student will:

Have a systematic approach to assess and treat the patient with electrolyte disorders

ObjectivesRevise a normal urea and electrolyte result and normal valuesExplain the role of each electrolyte and their effects on organ functioningExplain the effects of a deranged U&E result on cardiac function and how this will present on an ECGDiscuss the signs of hyperkalaemia/ hypokalaemiaDiscuss the treatment for hyperkalaemia and hypokalaemia.

Teaching MethodsThis session could be led as either: A case based discussion using visual aidsA scenario based workshop+/- manikin.

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Case Based scenarioA 60 year old man presents to A&E with a 2 day history of severe diarrhoea and vomiting. His medications include frusemide and an ACE inhibitor. On arrival:A ClearB RR 20C P130 min, BP 80/50, CRT 5 secondsD Patient is weak and lethargic. Responds to voiceE No rashes, looks pale

What is your initial treatment? What investigations will you request? A 12 lead ECG would be presented showing, flat, absent T waves, Wide QRS complexes, tall T waves, ST depression,. This would be explained to students...

Treatment of hyperkalaemia would be discussed as group work and rationales.

Treatment of hypokalaemia would be discussed as group work with rationales also.

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NEUROLOGICAL ASSESSMENTMargaret Douglas, Newcastle upon Tyne Hospitals NHS Trustmargaret.douglas@nuth.nhs.uk

Presenter detailsMargaret Douglas, Senior Lecturer/Practitioner Newcastle upon Tyne Hospitals NHS Foundation Trust and the School of Health, Community and Education Studies, Northumbria University.

BiographyMargaret’s clinical background is in neurosciences where she has enjoyed a variety of senior clinical roles. More recently she has returned to a more educationally focused role leading the Critical Care Education Team within the Trust and working within the University contributing to the critical care modules.

Subject AreaClinical Practice/Education

Abstract: Looking beyond the glasgow coma scale!

The end of the 20th century and the beginning of the 21st century has seen a dramatic expansion in the development of the roles of critical

care practitioners, roles such as consultant nurses and outreach practitioners. This has necessitated practitioners gaining new skills in physical assessment. However, it is not just critical care practitioners who require these skills but practitioners working in the acute wards and emergency admission departments (DoH 2000). The key tool associated with neurological assessment is the Glasgow Coma Scale (GCS) however particularly within critical care this tool is often limited in its application and there is greater emphasis placed upon patients localising and clinical signs.

The aim of the workshop would be to provide an insight into the process of neurological assessment.

Objectives:The delegates would:

Identify the differences between consciousness and altered consciousnessDiscuss the relationship of the contents of the skull in relation to intracranial causes of altered consciousnessDebate the usefulness of the GCS for the critically illIdentify other observations which will inform the practitioner regarding the broader neurological status of the patientDiscuss how the neurologically compromised patient could present when developing RICP

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The maximum number of delegates would be 20. Ideally the minimum time in which this workshop could be delivered would be 1.5 hours.

ReferencesDoH (2000) Comprehensive Critical Care: A Review of Critical Care Services. DoH. LondonMcLeod, A (2004) Intra and extracranial causes of alteration in levels of consciousness. British Journal of Nursing, Vol.13. No. 7. 354-361

PATIENT HANDOVER: THE PROCESS OF COMMUNICATION WHEN TRANSFERRING PATIENTS IN AND OUT OF ICUBrian McFetridge & Mark Gillespie, Western Health and Social Care Trustdbmcfetridge@btinternet.com

Patient Handover: the process of communication when transferring patients in and out of ICU

BackgroundWhen a patient is transferred in or out of a critical care setting, it is vital that the communication process occurring during the patient handover is effective to facilitate safe and seamless care delivery. Patient handover is integral to this process and in maintaining the continuity of holistic patient care. However, when a critically ill patient is being transferred, it is often the physical needs of the patient that become the focus of the nurse and other healthcare staff. Patient handover requires a structure to ensure that all vital patient details are handed over to the receiving nurse in a clear and structured manner.

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Critically ill patients are vulnerable and rely upon healthcare professionals to provide safe and effective care at all stages of the journey through critical illness. This care is informed by the verbal and written information provided at patient handover.

Nursing staff are the gatekeepers of information pertaining to the critically ill patients and need to be able to effectively share this detail with other nursing and healthcare staff.

The objectives of this workshop are:To examine the rationale for patient handover. To explore the challenges faced by nursing staff when giving and receiving a patient handover and suggest possible ways of overcoming these challenges. To analyse approaches to providing patient handover and consider the different phases of the handover process To demonstrate and analyse various approaches to patient handover and consider the contribution of patient records to the process.

This workshop is based upon findings from a study funded by a BACCN Research Award (McFetridge et al 2007) and will facilitate an interactive examination and consideration of the communication processes involved with patient handover.

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The workshop is suitable for any nurse who receives or provides handover when a patient is transferred in or out of a critical care setting.

ReferenceMcFetridge, B., Gillespie, M., Goode, D., Melby, V. (2007) An exploration of the handover process of critically ill patients between nursing staff from the Emergency Department and the Intensive Care Unit. Nursing in Critical Care, 12(6): 261-269.

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PATIENT SAFETY IN PRACTICE: MATCHING MICHIGAN & UNDERSTANDING THE SCIENCE OF SAFETY Chris Goeschel, Johns Hopkins School of Medicine

Annette Richardson, Newcatle upon Tyne Hospitals NHS Foundation Trustannette.richardson@nuth.nhs.uk

AimIncrease awareness of the emerging science of patient safety and the critical role of nurses in identifying and mitigating safety issues. Objectives1. Provide “take away” didactic on the emerging science of patient safety2. Provide a review of the NPSA ‘Matching Michigan’ project3. Review The Comprehensive Unit Safety Program “CUSP” as a method to enhance the context for safe care4. Test some of the tools used within CUSP, including the Learning from a Defect Tool, the Daily Goals form, and the unit safety survey

Short content summaryThis 60 minute session will involve both presentation and group exercises designed to explain and then “test” methods to improve patient safety. Method of deliveryPresentation, short video clips (2) and interactive exercises

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PHYSICAL ASSESSMENT (RESPIRATORY SYSTEM)Julie Irwin & David Waters, Buckinghamshire New UniversityJulie.Irwin@bucks.ac.uk

BackgroundThe acquisition of physical assessment skills has becoming increasingly necessary within nursing. These skills have been especially prevalent in Advanced Practice (RCN 2008). Use of more advanced physical assessment skills in practice has clear benefits in patient care, such as more effective and timely decision making and interventions.

AimThe aim of this session is to give practitioners the opportunity to begin to develop physical assessment skills and gain an understanding of the pathophysiology that underpins it. The session will be presented as a workshop and will look at the physical assessment of the respiratory system. It will take the form of a demonstration and then supervised practice in small groups.

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