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The Oxford ALERT

Programme

• Siobhan Teasdale• Clinical Educator AICU Outreach Team• John Radcliffe Hospital• September 2009

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ALERT in Oxford

Started January 2002 15 courses 1st June 2008-31st May

2009– Up to 25 candidates per course– Roughly half nurses, half medical

students/doctors, 2 physiotherapists per course plus observers

– Compulsory for medical students– Approx 360 candidates a year

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ALERT in OxfordBecame a Trainer’s centre January 2003

1st June 2008- 31st May 2009:

• 2 External Train the Trainer’s days [28 candidates]

• 1 Internal Train the Trainer day [7 candidates]• Grand total approx 400 candidates per year

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PracticalitiesResources:

• Clinical Educator • Medical Director • Independent Cost centre• Support from Outreach and the AICU SPR’S• Secretary• Laptop• Kadoorie Centre

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PracticalitiesCurrently 42 ‘active’ members of faculty, half nurses, half doctors, 3 physiotherapists

Criteria:• Minimum SPR, Senior Staff Nurse or Senior

Physiotherapist. • Recommended • Clinically credible • Good at teaching. • Teach at least twice a year.

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PracticalitiesFaculty ‘encouragement’

- Constructive feedback on teaching techniques

- Tea, coffee and doughnuts- Lunch vouchers- Honoraria

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Practicalities Number of faculty needed

per course– 2 throughout day– 6 for scenarios

Manuals– posted out to candidates– handouts at the end

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PracticalitiesFinances:

- Medical school funds medical student places

- ETTT days income generate- Surplus places sold to Private Sector

- No charge to ORH nurses or physiotherapists

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Oxford “changes” Changing round the program

– Communication earlier– Maintain ABC lecture order– Move demo back– Increased numbers to 25 per

course– Other teaching techniques:

group work, videos, MCQ’s, simulation

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Oxford ‘changes’•AGM

•Annual dinner

•Annual report

•Wandering Star

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Feedback

Verbal feedback is positive• Direct and indirect• Medical, nursing, physio, management

Compulsory feedback form• Enjoyable and Valuable• Used to improve the course

Arrest rate / ICU admissions rate

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Assessment Not included in Oxford ALERT Candidates successfully

attend the complete course Links with ‘RAID’ training Local view

– What’s possible?– What’s helpful?

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The ALERTFive Minute

Multiple Choice

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Question One Below are several forms of intravenous

access. Rank them according to how quickly 250 mls

of Gelofusine can be administered through them, with the fastest first (1 = fastest; 5 = slowest)

A Pink (20G) Cannulae (Venflon) using a pressure bag

A triple lumen central line A PICC line (Peripherally Inserted Central

Catheter) A Grey (16G) Cannula (Venflon) A Green (18G) Cannula (Venflon)

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The time it takes to give250 mls of Gelofusine

A Grey (16G) Venflon– 1 minutes 20 seconds

A Pink (20G) Venflon with a pressure bag (with 300mmHg pressure)– 2 minutes (pressure at least halves the

time) A Green (18G) Venflon

– 3 minutes A triple lumen central line

– 3 minutes 30 seconds (on largest lumen) A PICC line (Peripherally Inserted

Central Catheter)– Too slow to bother timing!

FAST

SLOW

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Question Two A patient on your ward is breathing

inadequately with a respiratory rate of 4 per minute. Their airway is patent and the crash team is on its way. You should …

Give oxygen and observe for a respiratory arrest

Attempt bag mask ventilation with maximum oxygen flow

Intubate the patient with an endotracheal tube or laryngeal mask

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Question Two A patient on your ward is breathing

inadequately with a respiratory rate of 4 per minute. Their airway is patent and the crash team is on its way. You should …

Give oxygen and observe for a respiratory arrest

Attempt bag mask ventilation with maximum oxygen flow

Intubate the patient with an endotracheal tube or laryngeal mask

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Question Three A patient on your ward has a

tracheostomy. They are cyanosed and having trouble breathing. Help is on its way but you want to give oxygen at as high a concentration as possible.

The safest set up for delivering Oxygen acutely is ….

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Question Three A partial rebreath mask (mask with reservoir

bag) held over the mouth and nose

A partial rebreath mask (mask with reservoir bag) held over the tracheostomy

28% humidified oxygen through a “tracheostomy mask” over the tracheostomy

A partial rebreath mask (mask with reservoir bag) held over the tracheostomy and another mask held over the face

Pushing green oxygen tubing down the tracheostomy and turning the flow on the wall as high a possible

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Question Three A partial rebreath mask (mask with reservoir

bag) held over the mouth and nose

A partial rebreath mask (mask with reservoir bag) held over the tracheostomy

28% humidified oxygen through a “tracheostomy mask” over the tracheostomy

A partial rebreath mask (mask with reservoir bag) held over the tracheostomy and another mask held over the face

Pushing green oxygen tubing down the tracheostomy and turning the flow on the wall as high a possible

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Question Four The following drugs are often life

saving for a patient with a low fluid output:

Oxygen

Frusemide

Saline

Viagra

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Question Four The following drugs are often life

saving for a patient with a low fluid output:

Oxygen

Frusemide

Saline

Viagra

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Question FiveTrue or False

“You should stop a patients oxygen before taking arterial blood gases in order to accurately assess their oxygen exchange”

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Question FiveTrue or False

“You should stop a patients oxygen before taking arterial blood gases in order to accurately assess their oxygen exchange”

FALSE

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Question FiveTrue or False

“The respiratory rate is a useful observation for predicting patients’ deterioration”

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Question FiveTrue or False

“The respiratory rate is a useful observation for predicting patients’ deterioration”

TRUE

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Question FiveTrue or False

“Patients rarely deteriorate suddenly. Usually doctors and nurses suddenly notice that a patient is ill!”

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Question FiveTrue or False

“Patients rarely deteriorate suddenly. Usually doctors and nurses suddenly notice that a patient is ill!”

TRUE

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Question FiveTrue or False

“Diuretics such as Frusemide help prevent renal failure on the wards”

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Question FiveTrue or False

“Diuretics such as Frusemide help prevent renal failure on the wards”

FALSE

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Question FiveTrue or False

“Shock can be present, even when the blood pressure is normal”

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Question FiveTrue or False

“Shock can be present, even when the blood pressure is normal”

TRUE

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Question FiveTrue or False

“The ALERT course is a fun day out for the whole family”

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Question FiveTrue or False

“The ALERT course is a fun day out for the whole family”

?

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Any questions?