1. ALERTALERT ! The Oxford ALERT Programme Siobhan Teasdale Clinical Educator AICU Outreach Team John Radcliffe Hospital September 2009

2. ALERTALERT ! ALERT in Oxford Started January 2002 15 courses 1 st June 2008-31 st 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

3. ALERTALERT ! ALERT in Oxford Became a Trainers centre January 2003 1 st June 2008- 31 st May 2009: 2 External Train the Trainers days [28 candidates] 1 Internal Train the Trainer day [7 candidates] Grand total approx 400 candidates per year

4. ALERTALERT ! Practicalities Resources: Clinical Educator Medical Director Independent Cost centre Support from Outreach and the AICU SPRS Secretary Laptop Kadoorie Centre

5. ALERTALERT ! Practicalities Currently 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.

6. ALERTALERT ! Practicalities Faculty encouragement -Constructive feedback on teaching techniques -Tea, coffee and doughnuts -Lunch vouchers -Honoraria

7. ALERTALERT ! Practicalities Number of faculty needed per course –2 throughout day –6 for scenarios Manuals –posted out to candidates –handouts at the end

8. ALERTALERT ! Practicalities Finances: -Medical school funds medical student places -ETTT days income generate -Surplus places sold to Private Sector -No charge to ORH nurses or physiotherapists

9. ALERTALERT ! 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, MCQs, simulation

10. ALERTALERT ! Oxford changes AGM Annual dinner Annual report Wandering Star

11. ALERTALERT ! 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

12. ALERTALERT ! Assessment Not included in Oxford ALERT Candidates successfully attend the complete course Links with RAID training Local view –Whats possible? –Whats helpful?

13. ALERTALERT ! The ALERT Five Minute Multiple Choice

14. ALERTALERT ! 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)

15. ALERTALERT ! The time it takes to give 250 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

16. ALERTALERT ! 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

17. ALERTALERT ! 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

18. ALERTALERT ! 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 ….

19. ALERTALERT ! 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

20. ALERTALERT ! 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

21. ALERTALERT ! Question Four The following drugs are often life saving for a patient with a low fluid output: Oxygen Frusemide Saline Viagra

22. ALERTALERT ! Question Four The following drugs are often life saving for a patient with a low fluid output: Oxygen Frusemide Saline Viagra

23. ALERTALERT ! Question Five True or False You should stop a patients oxygen before taking arterial blood gases in order to accurately assess their oxygen exchange

24. ALERTALERT ! Question Five True or False You should stop a patients oxygen before taking arterial blood gases in order to accurately assess their oxygen exchange FALSE

25. ALERTALERT ! Question Five True or False The respiratory rate is a useful observation for predicting patients deterioration

26. ALERTALERT ! Question Five True or False The respiratory rate is a useful observation for predicting patients deterioration TRUE

27. ALERTALERT ! Question Five True or False Patients rarely deteriorate suddenly. Usually doctors and nurses suddenly notice that a patient is ill!

28. ALERTALERT ! Question Five True or False Patients rarely deteriorate suddenly. Usually doctors and nurses suddenly notice that a patient is ill! TRUE

29. ALERTALERT ! Question Five True or False Diuretics such as Frusemide help prevent renal failure on the wards

30. ALERTALERT ! Question Five True or False Diuretics such as Frusemide help prevent renal failure on the wards FALSE

31. ALERTALERT ! Question Five True or False Shock can be present, even when the blood pressure is normal

32. ALERTALERT ! Question Five True or False Shock can be present, even when the blood pressure is normal TRUE

33. ALERTALERT ! Question Five True or False The ALERT course is a fun day out for the whole family

34. ALERTALERT ! Question Five True or False The ALERT course is a fun day out for the whole family ?

35. ALERTALERT ! Any questions?