looking back to move forward - train the trainer study day for nivas

VeinTrain/NIVAS Study Day

What Works and What does not in healthcare training

Sarah Phillips: Author, MA, BA, Dip NMD and Organisation Consultant – Systems Psychoanalytic

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Who We Are and What We Do?

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In a world where reality is not as simply Packaged ……..

…As it would first appear

VeinTrain keeps learners

focussed on Vascular Access

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Joining the dots

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Published in 2011 UK and

Indonesia 2014

Book signing due in Bali by 2016

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2001 Sarah introduced Compulsory Annual smiling

Training for 240 Imperial College Medical Students

9

Training for competency before and

after at Chelsea and Westminster

41%

43%

16%

Competent Not Comp Left

98%

2% 0%

Competent Not Comp Left

BEFOREAFTER

Training of all 500 nurses in 2000

10

Supervision was key

Supervised Practice3%

24%

73%

Essesntial

Helpful

Not Needed

“ made me feel

confident”

“Would not have done

skills without supervisor”

“Difficult sometimes,

needed more time”

“Motivated you to do the

skill”

Collins et al (2006)

11

Benefits of Training for patients

36%

4%

57%

1%

Venepuncture Reasons n= 242

Routine

Patient

Pre-Tx

Pre Dx

FastingBloods

23%

19%57%

1%

Cannulation Reasonsn = 163

Routine

Re-Siting

AwaitingTreatment


She was my

allocated patient

Post-operative bloods to

allow the patient

to be discharged on time.’

Patient went home

earlier as doctors

busy and had missed

the phlebotomy round.

Team in theatre. Cross

match not taken before

theatre. Able to oblige.

Team in theatre. Cross

match not taken before

theatre. Able to oblige.’

Patient relieved and

appreciated the

technique adopted for

her, that is, butterfly

Needle phobic – knows

me. Sat with patient

and explained

necessity for blood test.

Rapid results of

cardiac markers

ensures correct

treatment.


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Anyone who came in the

skills lab had to learn

these skills!

I managed gloves, a

sharps bin in view and got

a smile and compliment. I

gave him ‘confidence’

apparently. His photo

helped me with my sharps

management work.

No Escape!

Sir Nigel Crisp, CEO of the NHS 2004

Common Skill

Over 60% of admitted patients will need

intravenous therapy

15 million patients are admitted in UK

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“The wide variety of clinicians offering these skills to their

patients is welcome and makes the most of the talent in the

NHS, while offering patients choice and an efficient service.

However, such diversity risks different types of practices

evolving.”

Lord Darzi PC, KBE, FMedSci, HonFREng

(In Phillips et al Venepuncture and Cannulation. 2011)

Standardising in Complex Healthcare

Lots of small measures

make a big difference

particularly with these

common skills

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Standardised

assessment

70,000

NHS/Private

3rd Edition

Est.14.5 Million

patient outcomes

per year!

(based on 4 cannula a week on 70 000

staff

A Structured

Learning Programme

ABSTRACT – Updated 2012

This project has been developed by a group of Intravenous Therapy Nurses and

Trainers. The group (Vascular Access Network) continued to work sharing

educational and audit material and experience to produce this standardised learning

and assessment tool for Venepuncture and Cannulation. This innovative booklet is a

high quality yet economical tool that enables learning while working and facilitates

competency achievement. It is now in its 3rd Edition with 50000 copies in

circulation/ The whole of South Central SHA has adopted it as have many NHS Trust,

two medical schools as well as private sector uptake. The current aim is to ensure

sustainability and continue encouraging uptake across the UK. It is a project for

patients, not for profit.

The book leads the learner and assessor through a structured yet simple process that

considers the core elements of professional understanding, theoretical knowledge

and practical skills and assessment. The book is aimed at a multidisciplinary

workforce, as part of inter professional learning and development. It can also be

adapted to encompass competency achievement within specialised care areas such as

paediatrics and neonates. Once completed it provides evidence of a solid

foundation of knowledge and a record of personal achievement.

Objectives• Equip practitioner with relevant expertise to deliver high quality of care.• Standardised and simplified training programme to enable competency

achievement.• A flexible approach to education and training to promote high quality

learning that is also value for money.• Improve skills transference between organisations/departments and limit

the need for unnecessary re-training.• Reduce printing costs and re-inventing the wheel by

fellow trainers.• Encourage fair, valid and reliable assessments.• Adapt this successful framework for future

intravenous skills standardisation.

VisionStandardise training and assessment for venepuncture and cannulation across the UK inorder to improve the experience for the patient receiving these procedures and thelearner acquiring them.

PhilosophyFostering strong working relationships and shared learning between organisationsthrough collaborative work to create the best way forward for the patient, practitionerand organisation.

Authors: Mary Collins, Sarah Phillips, Lisa Dougherty, & Annie de Verteuil.

COPIES FROM www.Veintrain.co.uk

http://www.veintrain.co.uk/

REFERENCES:

Bloomfield, J. Pegram, A and Jones, C. (2010) How to pass your OSCE:

A guide to success in Nursing and Midwifery. Harlow, Pearson

Education Ltd.

GMC (2015)Promoting excellence: standards for medical education and

training http://www.gmc-uk.org/education {accessed 3rd September

2015}

Health and care professions Council (2014) Standards of education and

training guidance. http://www.hcpc-

uk.org/assets/documents/10001A9DStandardsofeducationandtraininggu

idanceforeducationproviders.pdf {accessed 3rd September 2015}

Hughes, S.J. & Quinn, F.M. (2013) Quinn’s principles and practice of

nurse education. 6th ed. U.K. Cengage learning.

NMC(2015) The Code: Professional standards of practice and behaviour

for nurses and midwives

http://www.nmc.org.uk/globalassets/sitedocuments/nmc-

publications/revised-new-nmc-code.pdf {accessed 3rd September 2015}

Skills for Care and Skills for Health (2013) Code of Conduct for

Healthcare Support Workers and Adult Social Care Workers in England

(2013) http://www.skillsforhealth.org.uk/images/services/code-of-

conduct/Code%20of%20Conduct%20Healthcare%20Support.pdf

{accessed 3rd September 2015}

INTRODUCTION: Learning the skill of venepuncture and/or cannulation requires

effective supervision and assessment. The direct link to safeguarding the health and well being of the public warrants that

high priority is given to supervision and assessment of these skills. Effective and

well-supported supervision is key to ensuring that the Health Care professional

learning the skill/s of venepuncture and/or cannulation are fit for purpose upon

completion of the Structured Learning programme.

WHO IS THE ASSESSOR?

An expert with the required qualification who makes the final judgement

to determine the learner has achieved the knowledge, skills and

competence required to safely perform the skill/s being assessed. They

will have undertaken a relevant teaching qualification to develop the skills

in assessing the learners proficiency and remain accountable for their

decision

MEETING PROFESSIONAL REQUIREMENTS:

Allied Health Professional Council (2014) “Learning, teaching and

supervision must encourage safe and effective practice, independent

learning and professional conduct”.

General Medical Council (2015) “Supervisors must determine a learner’s

level of competence, confidence and experience”.

Nursing and Midwifery Council (2015) “support any staff you may be

responsible for to follow the Code at all times. They must have the

knowledge, skills and competence for safe practice”.

Skills for Care and Skills for Health (2013) “Strive to improve the quality of

healthcare, care and support through continuing professional development “.

The supervisor and assessor must maintain the professionalism and

reputation of their profession when assessing the learner. They must

have:

•Clinical currency and capability in the skill for which the learner is being

assessed

•A working knowledge of the Venepuncture and Cannulation Structured

learning programme

•An understanding of the regulator requirements for the individual learner

and the contribution they make to meet these requirements.

Supervisors must also have:

•Time to supervise, reflect and give feedback to the learner.

•Assessed the student on more than one occasion to see if competence

has been achieved and sustained; to ensure reliability.

Assessors must also have:

•Met their professional/organisational requirements to be an assessor.

•An in-depth understanding of their accountability to their profession and

organisation for the decision they make to pass or fail a learner when

assessing proficiency requirements at the final assessment.

WHO IS THE SUPERVISOR?

A supervisor is defined as someone who enables the professional and

personal growth of the learner. The have the clinical expertise in

venepuncture/cannulation to oversee the performance of the skill by the

learner. They must be currently practicing the skill on a weekly basis.

Core objectives achievable using the V&C programme to supervise and

assess learners are:

•Improve patient care

•Reduce risks to patients and staff

•Improve the patient journey and reduce waiting times

•Encourage access to training by making it flexible, appropriate and safe

The supervised practice assessments offer a holistic and integrated

approach to facilitate the learner to achieve core knowledge for the skills

they are working towards accomplishing. It enables the learner with an

opportunity to learn while working with direct access to patients and

supervisor/assessor.

A standardised approach to assessment reduces variations in

practice among supervisors and assessors. This standardisation aims to

provide transferable evidence for practitioners competence to perform

independently should they move to another healthcare organisation.

Using a Structured Learning programme to supervise and

assess skills of Venepuncture and Cannulation

Enabling

supervisor

Competency pathway

Expert assessor

Safe Practitioner

Mary Collins, Senior Lecturer - Mentorship

and Practice Education, Kingston and St

George’s Joint Faculty

OSCE as an assessment tool for supervisors and assessors:

Bloomfield et al (2010) point out that an assessment using OSCE assesses

performance relating to the following:

Knowledge: a student’s knowledge and understanding of a particular skill

Motor: the motor or technical aspects of a skill

Attitude: the affective aspect or attitude associated with the performance of a

skill

Structure: how a student approaches a skill in terms of a systematic, logical

and organisational approach.

OSCE is a recognised assessment tool across all fields of healthcare. It offers

an important advantage to the supervisor and assessor to engage with the

student during the acquisition and assessment of skill/s and is a valid

examination for the formative and summative assessment (Hughes and

Quinn, 2013).

How To Use

the Structured

Learning

Programme

Collins 2015

http://www.gmc-uk.org/education

http://www.hcpc-uk.org/assets/documents/10001A9DStandardsofeducationandtrainingguidanceforeducationproviders.pdf

http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf

http://www.skillsforhealth.org.uk/images/services/code-of-conduct/Code of Conduct Healthcare Support.pdf

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Clinicians first

responsibility

and personal

expectation

‘First do no

harm’

22

The public are worried

Dramatic but still current

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Dynamic arena - Technologies

that look odd but work well!

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VeinTrain 2014 highlight – Back to London!

Invited to Guys’ and St Thomas’ NHS Foundation

Trust (GSTT) for a large project that would benefit

from external resourcing

GSTT – Where the Intravenous Therapy was already outstanding

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VeinTrain was immediately aware we

would be working in historically steeped

organisation with dynamic origins.

Where

History is

rightly

respected

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Where nursing

leadership is

strong, and

acknowledged

by the Nation

Chief Nurse,

Guys’ and St Thomas’s

NHS Foundation Trust

Dame Eilieen Sills,DBE

Where we were reminded how

much practice changes

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Visiting the Wards at St Thomas’s revealed lots of

implementation of best practice and high calibre professionals

Clearly still dynamic and leading edge

32

VeinTrain clinical walk around at

St Thomas’s Hospital, London

Which hosts students from the

UK/World Top University

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Guy’s and St Thomas’s, 2015

160 Nursing Students VeinTrained

1st for the UK

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Guy’s And St Thomas’s

160 Nursing Students

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Large Event lecture with high

trainer ratio workshops

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High trainer:learner ratios

And minimum of two limbs per trainer

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Time, space and equipment

management in any venue

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Nursing

Student

Feedback

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Comments

from Nursing

Students

Before we VeinTrain

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VeinTrain National

courses attract

delegates

from all clinical

backgrounds. This

can be difficult to

pitch, but

fascinating.

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• Webinars - Live

Training

• Instant referencing

• Communications

• Apps!

• Images

• Patient Information

Tapping into our

‘connected’ world

Locally, nationally,

globally

Reason for continuing to

challenge practice decades onProfessional Issues Continue

• Research – we still have issues

• It is simple to improve, albeit a challenge

Personal:

• “no we have not been trained but we will

have a go” GP receptionist at Sarah’s children annual blood

tests

• “you will not believe this…..” Photo messages from

friends

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Work is fascinating and essential

Studied an MA in Organisations

We spend a lot of time at work!

Out of 77 years of Life

Red is sleep! Pink, just behind, is work

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• Expertise and drive to improve

these skills

• Unmet need identified while in NHS

• Sole provider for the family

• Business qualification but remain

vocational

• Role model for clever young ladies.

Two diplomas, Two degrees and a

profession = ‘working’ mum!

MD Reason for working

on VeinTrain

Royal College of Surgeons, London,

where once women were not

permitted to be surgeons.

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:

Flexible Working hours

with occasional trips in to

‘help’ and boost morale.

“I can work 24 hours a

day, as long as I am not

late in the morning!”

The children like it and

small amounts of inclusion

is supported in

pyschoanalytic thinking for

secure attachment.

Benefits of building a

business for a family

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• Training in hospital could lead

to cancelled courses due to

rooms and staffing.

• As a company we are set up

not to need one individual.

• VeinTrain has never

cancelled a course on

trainer/service issues.

• Vein breaks are mandatoryfor all the team, including the MD

Reliable Service