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A Blended Learning Approach to Acute Care Training (ACT)

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Presentation on theme: "A Blended Learning Approach to Acute Care Training (ACT)"— Presentation transcript:

1 A Blended Learning Approach to Acute Care Training (ACT)
Miranda Verswijvelen - Senior instructional designer Sonya English - Clinical Nurse Specialist Critical Care Outreach

2 Imagine You have just been told your loved one is gravely ill in intensive care. Despite your concerns over the last 6 hours junior healthcare staff did not respond to the early signs of deterioration.

3 The deteriorating patient
Failure to recognise the deteriorating patient and communication errors have been widely identified as the most common cause of errors in healthcare. HDC cases worldwide 2006 we set up a critical care outreach service that used EWS based on pt. Vital signs to flag sick ward pts.

4 Quality Care Structured frameworks to support: effective assessment,
intervention escalation of care to senior medical staff. It is internationally recognised that structured frameworks are successful in supporting effective assessment, intervention and escalation of care to senior medical staff. In New Zealand these frameworks are supported by the NZRC & NZ HQSC. You will of heard of the ABCDE approach to a patient in cardiac arrest/ collapse….This allows the healthcare worker to utilise a systematic pathway of care that is both safe and provides a logical approach to the deterioating patient. In New Zealand structured algorithms of acute care are supported by the NZRC and HSQC.

5 The ACT Simulation Course
Basic acute physiology and simulation practice of principles revised. 50% Lectures 50% Simulation In 2006 a team of critical care specialists got together to design a practical course based around frameworks of acute care. The 1 day course consisted of lectures in the morning and simulation scenarios in the afternoon.

6 The Theory to Practice Gap
Time taken to practice and combine clinical decision making skills with knowledge is fundamental. Our hope: participants attend with a refreshed knowledge of basic physiology and the frameworks for the acutely unwell patient. For many healthcare staff their training has not equipped them fully with the knowledge and skills for independent practice. Talk about confidence.

7 The ACT Course Monthly ACT Faculty - specialist clinicians
> 2000 participants June present Two sites at WDHB - NSH/ Waitakere Faculty - senior physio, anaesthetic tech, critical care nurses and educator and Intensivists all clinical active.

8 The Challenge :: 30 participants per course Junior Doctors Nurses
Physiotherapists Participants from different backgrounds disciplines and levels of academic acumen as well as clinical experience. Aim to come with a certain amount of presumed knowledge. Build on this and reflect on what can be improved in the acute care setting.

9 The Book Acute Care Training
ACT effectively ACT Rapidly ACT Right At each course the participant received a book with readings on each of the physiological systems they were required to revise in advance. The book became a logistic challenge due to the nature of healthcare, participants often swapped with colleagues or dint turn up, or forget their books on the day of the course. We resorted to giving them the book on the day of the course.

10 Goal Refresh physiological knowledge and learn anticipatory skills.
Blended solution? ACT team ‘wishlist’ for a blended solution revise basics revise frameworks detect their own skill and knowledge gaps In a blended solution, the act team wished for participants to come into the simulation day with refreshed knowledge of the bascis and the frameworks. This would provided them with a better view on their own skills, and knowledge gaps before starting. The aim was to reduce lecture time and spend more time on practice. Goal Refresh physiological knowledge and learn anticipatory skills.

11 The question from ACT team
Provide the book online as pre-reading. Add a quiz. The ACT team came to us and explained their ideas. Their first wish was to put the book online, as pre-reading, and accompany it by a quiz. This would ensure that participants came with refreshed knowledge of the basics. The quiz results would provide some insight in knowledge gaps to be adressed in the lectures.

12 We can do more... The e-learning team agreed to to look at this solution, but discussed with them that we could do so much more. So we sat down to uncover the real training needs for the online part of the course. As part of our e-learning strategy at the DHB we work with the action mapping model of Cathy Moore, which puts actions rather than information at the forefront of traning needs analysis - starting from a measurable goal. Not explain model now. ©Cathy Moore

13 Action map In a long meeting we unraveled all aspects of the training, using the action mapping model. This revealed the real needs to make the online solution an actual fit in the whole package that was offered: the student needed to arrive on simulation day with a firm grasp on the application of the frameworks, and a refreshed knowledge of decision-making around the physiology behind them so lecture time could be drastically cut. The measurable goal actually worked towards the training day, rather than towards goals on the floor. Which made it fit into the full program

14 Behaviours required Prompt escalation to the right person
Recognition without testing Prompt escalation to the right person Better communication Care appropriate to whanau and patient orders When do I call for help? How do I call for help? We identified a number of behaviours that we need to practice in the online learning module. Explain what is on screen What am I ALREADY doing to help?

15 ABCDE A irway, with oxygen administration B reathing, is it adequate?
DRS A irway, with oxygen administration B reathing, is it adequate? C irculation and treatment D isability, neurological assessment E xpose and examine patient The concept of the ABCDE structured approach is recognised by resuscitation councils worldwide to identify and rule out critical conditions that can then be treated rapidly and effectively along with prompt escalation to specialists i.e. critical care. It relies on the skills of the practitioner however is a good foundation to build skills and confidence. The director Intensivist in our critical care has always maintained…….

16 Scenario-based The e-learning team started from the idea of a strong focus on the frameworks. We needed to ‘drill’ the frameworks, while solving realistic clinical scenarios. Four realistic scenarios (real patients and experiences) were drawn up by the SME, covering all aspects of the ABCDE framework, we will explain further. Initial idea was to have five full scenarios that would cover A B C D E fully - but we quickly realised that would nake the modules very complicated and long. So we decided to concentrate each one on one of the letters, and have the other ‘letters’ happen ‘magically’ - not handled by the learner, but another character in the module.

17 Drill ABCDE We designed a gamified approach to the actual drills - explain how the game works. Why a drill: sonya

18 Drill ABCDE We designed a gamified approach to the actual drills of the ABCDE framework. With less and less time to solve the drill throughout the module.

19 Scenarios Each scenario would start with interactive options for patient observation - visual, communication with the patient, to for a first impression

20 Scenarios The learner could at all times look at the patient's paperwork, just like in real life. In some cases, specific tests would only be available after the learner had selected the correct actions in the scenario. Their own actions would reveal more information to better treat the patient.

21 Guide on the side Following the learning theory behind the action mapping model, the course concentrates on the actiual behaviour changes that were required, and the learner is provided with the necessary information for those on an ‘as needed’ basis. Pull vs. push. There is NO frontloading at all.

22 Scenarios Step by step the learner is guided through the scnario and has to make decisions, based on their observations and following the ABCDE framework

23 Checklists Sonya talks about how they do this is real life.

24 ISBAR ISBAR was first utilized by the United States Navy to ensure the accurate transfer of important information. Then used in the 1990s by medical emergency teams. It was also used in the airline industry as part of a crew resource management (CRM) safety package . Health care institutions started using ISBAR as part of their safe communication strategy from the late 1990s. Regular use of SBAR is an important part of any organization's Crew Resource Management (CRM) family of skills; helping caregivers function as effective team members while establishing a culture of quality, patient safety and high reliability. Was introduced to nursing and medical teams in the late 1900’s, in the US in Colorado 2002 it was used for MET team handover. HQSC project looking the deteriorating pat I - IDENTIFY: Yourself, Name, Position, Location Receiver: Confirm who you are talking to. Patient: name, age, sex, location S - SITUATION: If urgent SAY SO make it clear from the start State purpose “the reason why I am calling is…” B - BACKGROUND: Tell the story Relevant information only: History, Examination, Test results, Management A - ASSESSMENT: State what you think is going on. Use the ABCDE approach. R - RECOMMENDATION: What do you want from them – BE CLEAR State your request or requirement.

25 ISBAR ‘choices’ About complicated branched scenarios - to get a number of conversation options with consequences

26 ISBAR ‘choices’ Converstaion options

27 ISBAR ‘choices’ Some humour added to consequences.

28 Evaluate and iterate Launch at 80% and iterate
Multidisciplinary/ ACT faculty Feedback online and face to face Feedback on scenarios so they reflect real life - where patient safety happens Complex program, hard to review all options and paths by dev team alone. Decided to launch when ‘play-ready’ and iterate on all feedback coming in. Sonya tells how she gathered feedback from everywhere

29 Problems Glitches due to complexity of programme
Matching guide to scenarios Technical issues due to outdated browser in hospital Checklists - literal vs interpretation Fear of failure and reputation (not marked)

30 User feedback “Reminded me to use ABCDE, ISBAR, systematically and effectively” The scenarios in e-Learning were relevant to everyday nursing on ward” “Great e-Learning rehighlighted ISBAR” “‘Very thorough” “It really helped to get to know the basics rather than coming with a blank mind” “Realistic scenarios about deteriorating patients. Enjoyed working through them” Talk about how feedback matches the goals we set out through the action mapping model: refreshing basics, training on frameworks,...

31 Changes to f2f part Positive programme changes
More time for hands-on learning 20% Lectures 80% Simulation The blended approach has allowed the participants to have more hands on time in the simulation lab. Since the outset of the e-learning - the whole program has change. No more lectures - we stand around bedside and do practical sessions on ABCDE, look more at equipment, preferment expressed by people who have done both courses

32 Success outside of the course
Application in other areas: debriefing tool after a ‘situation’ CNM’s use it as a compulsory learning tool Sonya - give example of debreifing recent case.

33 Success - now the future
Director of Nursing at WDHB has suggested to make the ACT e- learning compulsory Working on DHB-wide programme to use ISBAR Aim to translate experience of e-learning into nurse portfolio goals (after identifying insecurities or gaps)

34 Engagement of Clinical Staff
“We have two jobs: to do our job, and to improve.” Dr David Galler Intensive Care Specialist, 2016 After 9 years of doing the course successfully we felt that it was time to find a better way of having participants come in 2016 book Written by ICU Specialist David Galler ‘things that matter’.

35 Q&A

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