Evaluation of the Pilot Mobile Clinical Skills Unit
CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Evaluation of the Pilot of the Mobile Clinical Skills Unit Clinical Skills Managed Educational Network
1 January 2009 to 31 December 2010 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
The CS MEN team at the launch of the mobile unit. From left to right: Janet Skinner, Regional Champion for the South and East Regions; Jeanette Stevenson, Educational Projects Manager; Felicity Garvie, Project Administrator; Jean Ker, Clinical Lead; Anna O’Neill, Regional Champion for the West, and Jerry Morse, Regional Champion for the North. The team was joined by Sarah Race, Project Officer on 1 June 2009.
Credits The evaluation of the mobile unit was conducted, and this report compiled, by the core staff of the Clinical Skills Managed Educational Network based at the University of Dundee. The team is: Andrea Baker, Educational Resource Developer Felicity Garvie, Project Administrator Sarah Race, Project Officer - Mobile Unit Jeanette Stevenson, Educational Projects Manager and is led by Professor Jean Ker, Clinical Lead.
Design and artwork by The Malting House Graphic Design Studio Printed by Winters & Simpson Ltd
Hosted by the University of Dundee A Scottish Registered Charity - No SC015096
2 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Foreword from the Minister for Public Health
I was delighted, just over two years ago, to launch a remarkable vehicle which has since travelled the length and breadth of Scotland, bringing clinical skills education to hundreds of healthcare practitioners in remote and rural areas. This vehicle is the Mobile Clinical Skills Unit which NHS Education for Scotland has funded and the Clinical Skills Managed Educational Network commissioned, built and deployed for a two-year pilot that ended on 31 December 2010.
The mobile unit, or “skills bus” as it is affectionately known, provides state of the art simulation equipment, including very realistic interactive manikins, and a flexible space to allow a broad range of clinical skills education to be delivered. This fulfils a key objective of the Scottish Clinical Skills Strategy in addressing the inequity of access to high-quality multi-professional education, at the same time increasing staff confidence and patient safety in rural areas, where up to one in five people live, depending on the definition used.
Those of us who have been lucky enough to see the mobile unit at first hand cannot fail to be impressed with its facilities and the pioneering vision that put it on the road. But don’t take my word for it – this report provides the statistical evidence as well as case studies from different health professionals all over Scotland which illustrate best practice. I would like to congratulate everyone who has helped to make this great project happen.
The unit has made a fantastic start – and I am confident that with ongoing funding from NHS Education for Scotland it will continue to be seen on Scotland’s rural roads for a long time to come. Shona Robison MSP
The Mobile Clinical Skills Unit was launched on Friday 21 November 2008 by Ms Shona Robison MSP, Minister for Public Health, during the Scottish Clinical Skills Alliance conference, and has been on the road since January 2009.
3 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Contents
Foreword...... 3 5. Results: Design and Planning Phase of the Mobile Unit ...... 13 1. Executive Summary...... 6 5.1 What type of unit? ...... 13 2. Introduction...... 7 5.2 Equipment requirements ...... 13 2.1 Background...... 7 5.3 Identification of venues and hosts...... 15 2.2 Purpose of this report...... 7 5.3.1 Determination of venues...... 15
3. Methods of Evaluation...... 8 5.3.2 Development of hosts...... 15 5.4 Development of training programme...... 16 4. Methods of Evaluation: Design and 5.5 Logistics and consumables ...... 16 Planning Phase of the Mobile Unit...... 9 5.5.1 Logistics...... 16 4.1 What type of unit?...... 9 5.5.2 Consumables...... 17 4.1.1 Literature review...... 9 5.6 Organisational and management structure.... 17 4.1.2 Stakeholder consultation process...... 9 5.7 Publicity ...... 18 4.1.3 Review of mobile units in other public sectors...... 9 6. Methods: Implementation Phase 4.1.4 Review of potential transport needs...... 9 of the Mobile Unit ...... 19 4.2 Equipment requirements...... 9 6.1 Faculty development...... 19 4.2.1 Online survey...... 9 6.1.1 Identifying course provider...... 19 4.2.2 Consultation with expert groups...... 9 6.1.2 Constraints in training local faculty...... 19 4.3 Identification of venues and hosts...... 10 6.1.3 National courses...... 19 4.3.1 Determination of venues...... 10 6.1.4 Dissemination of training expertise...... 19 4.3.2 Development of hosts...... 10 6.2 Evaluation of venues...... 19 4.4 Development of training programme ...... 10 6.3 Evaluation by participants...... 19 4.5 Logistics and consumables ...... 11 6.3.1 Immediate evaluation ...... 20 4.5.1 Logistics...... 11 6.3.2 Follow-up evaluation ...... 20 4.5.2 Consumables ...... 11 6.3.3 Practitioner stories...... 20 4.6 Organisational and management structure.... 12 6.3.4 Case studies...... 20 4.7 Publicity ...... 12 6.4 Resources and programmes...... 21
6.5 Value for money...... 21
4 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
7. Results: Implementation List of Figures Phase of the Mobile Unit...... 22 Figure 1. Faculty who completed the Faculty 7.1 Faculty development...... 22 Development Course at the Scottish 7.1.1 Identifying course provider...... 22 Clinical Simulation Centre by health board...... 23 7.1.2 Constraints in training local faculty...... 22 Figure 2. Faculty who completed the Faculty 7.1.3 National courses...... 24 Development Course at the Scottish 7.1.4 Dissemination of training expertise...... 25 Clinical Simulation Centre by 7.2 Evaluation of venues...... 28 professional group...... 23 7.3 Evaluation by participants...... 28 Figure 3. Breakdown by professional group of faculty who used the unit in the 7.3.1 Immediate evaluation ...... 28 pilot period...... 24 7.3.2 Follow-up evaluation...... 33 Figure 4. Trainers’ time at local venues 7.3.3 Practitioner stories...... 36 (excluding national programmes) 7.3.4 Case studies...... 40 for the pilot period...... 25
7.4 Resources and programmes...... 48 Figure 5. Breakdown by professional group 7.5 Value for money...... 51 of participants who attended educational sessions in the pilot period...... 29 7.5.1 Revenue...... 51 Figure 6. Participants’ rating of the unit 7.5.2 Summary of capital costs...... 51 from the pilot period...... 31
8. Summary and Recommendations ...... 52 Figure 7. Breakdown by professional group of participants in educational sessions on Appendices...... 54 the mobile unit in the Shetland Isles in the pilot period...... 41 Appendix 1 Breakdown by profession of people who attended educational sessions Figure 8. Venues of Paediatric Retrieval Outreach on the unit...... 54 study days in the pilot period...... 43
Appendix 2 Faculty Development Figure 9. Breakdown by role of participants in Course Descriptor...... 56 Paediatric Retrieval Outreach study day Appendix 3a Evaluation form for participants...... 58 for the pilot period...... 44 Appendix 3b Evaluation form for trainers...... 59 Figure 10. Participants’ rating of the Paediatric Retrieval Outreach study day: quality Appendix 3c Follow-up survey...... 60 of tutors for the pilot period...... 44 Appendix 4 Pack development process...... 61 Figure 11. Beakdown by professional group of SAS Acknowledgements...... 62 staff who participated in educational sessions on the mobile unit in the pilot period...... 46
Figure 12. Breakdown by venue of SAS staff who participated in educational sessions on the mobile unit in the pilot period...... 46
5 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
1. Executive Summary
The unit visited 26 venues for between one and three weeks throughout the two-year pilot, providing 227 courses to over 1700 healthcare practitioners, and was utilised 60% of the time. Approximately 100 trainers have been trained through the development of a customised national training programme or through on-site training days. It has also been showcased in urban areas and at a number of conferences.
The skills education programmes delivered were identified as a result of a training needs analysis carried out in association with the Remote & Rural Healthcare Educational Alliance (RRHEAL), British Association for Immediate Care Scotland (BASICS) and the NES Clinical Skills Programme Board. This report by the Clinical Skills Managed They have included national skills courses linked Educational Network highlights the results of to health service priorities as well as enabling the the pilot evaluation of the mobile clinical skills rehearsal of multi-agency emergency scenarios. unit carried out between January 2009 and The unit has also provided individual practitioners December 2010. with both the facilities and standardised evidence- The mobile clinical skills unit was designed and based resources to enhance their skill portfolios. operationalised by the Clinical Skills Managed The evaluation by participants has been Educational Network as part of the Scottish Clinical overwhelmingly positive both in relation to the unit Skills Strategy. Clinical skills education priorities facilities and their own learning. There are several are closely aligned to the Scottish Government’s practitioner stories related to change in behaviour Quality Strategy in relation to the delivery of safe in practice which has resulted in better patient and effective person-centred care. The unit, as a outcomes. There have been several instances unique innovation, was evaluated from a number where the unit has been used to deliver specialised of different perspectives, using both quantitative services and these case studies provide a further and qualitative methodologies. perspective. There have been logistical challenges, For its successful implementation, it required but the appointment of a dedicated Project Officer a collaborative organisational and management has enabled these to be addressed in a timely and infrastructure and the expertise to purchase efficient way with minimal disruption to the venue specialised equipment and develop support systems programme. for both host venues and skills educators.
6 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
2. Introduction
The aspirations of the Scottish Government’s 1. The provision of standard clinical skills learning Quality Strategy launched in 2010 are to implement resources (KSF-matched) changes in NHS Scotland that improve the safety 2. The implementation of a national quality and effectiveness of care, with the patient at the assurance system for clinical skills education centre of the process. 3. The development of a network of clinical From the patient’s perspective, the greatest skills educators determinant of their experience and quality of 4. The delivery of better value for money healthcare are the clinical skills of the staff caring for in clinical skills education. them – the ‘touch point’ of the NHS with members One of the most visible and successful outcomes of the public. Clinical skills education is therefore has been the establishment of the mobile clinical core to the success of each health board’s delivery skills unit, dedicated to delivering education of the Quality Strategy and its performance in terms to healthcare practitioners in remote and rural of the standards of care delivered consistently to Scotland to reduce inequalities of access and every patient every time. contribute to a sustainable healthcare system in A mobile clinical skills unit can ensure healthcare these areas. The following were the identified practitioners are able to deliver high standards of outcomes for the mobile unit: skills to patients whoever they are and wherever 1. To link to the overall outcomes of the CS MEN they are practising. It can have a clear role in 2. To provide national standards of clinical skills enabling practitioners to access quality-assured skills education to remote and rural practitioners education with minimum disruption to the service. 3. To provide quality-assured clinical skills education 2.1 Background 4. To provide standard clinical skills facilities As part of the implementation of the Scottish 5. To provide value for money. Clinical Skills Strategy in 2007 a mobile clinical The mobile clinical skills unit has also had the skills unit was designed and operationalised by opportunity to support the educational network the Clinical Skills Managed Educational Network development of RRHEAL, BASICS and the Scottish (CS MEN). The two-year pilot (2009-2010) was Multiprofessional Maternity Development funded by NHS Education for Scotland (NES). Programme (SMMDP). The CS MEN was established to enable the delivery of clinical skills education throughout NHS Scotland 2.2 Purpose of this report by providing clinical leadership, common quality This report has been compiled to focus on the standards, increased skills education provision and key findings related to both the process and coordination of research and development priorities outcomes of the evaluation and to make some in skills and simulation linked to the Patient Safety recommendations. It may be useful to read it in Programme. Successful outcomes from the CS MEN conjunction with the Report and Recommendations in the last three years include: to Health Boards on Clinical Skills Education by the Clinical Skills Managed Educational Network (March 2011). This is available to download from the CS MEN website: www.csmen.ac.uk
7 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
3. Methods of Evaluation
There are many approaches to evaluating an In order to learn maximally from this intervention, intervention. These should relate to the purpose we needed to identify different sources of evidence of the intervention and the learning from it, at different times of the pilot. both in terms of its impact and in relation to the There were two main phases to evaluate, the design implementation processes. This is an internal and planning of the mobile unit and the evaluation by the team who implemented and implementation: managed the mobile unit during the pilot. 1. Design and planning phase of the mobile unit There are opportunities and constraints with both external and internal evaluations; external • What type of mobile unit? evaluators can bring a new perspective and add • Equipment requirements value from previous experiences but can be costly. • Identification of venues and hosts Internal evaluators are aware of all the difficulties • Development of skills training programmes that arise during a project and bring important • Logistics and consumables knowledge of the organisation, networks and stakeholders but may lack the specialised • Organisational and management structure expertise and experience of evaluating. • Publicity.
In the case of the mobile unit where it is a unique 2. The implementation phase of the mobile unit intervention for NHS Scotland, it is important to • Faculty development evaluate whether it provided remote and rural • Evaluation of venues areas with access to the specialised facilities and • Evaluation by participants. continuing skills development. Evidence was collected both qualitatively and quantitatively using a variety of methods including semi-structured interviews, surveys and written reflective accounts.
8 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
4. Methods of Evaluation: Design and Planning Phase of the Mobile Unit
4.1 What type of mobile unit? 4.2 Equipment requirements Several methods were used to identify what type 4.2.1 Online survey of mobile unit would be appropriate to provide In spring 2008 the CS MEN surveyed remote and access to skills education throughout remote rural practitioners through RRHEAL, BASICS and and rural Scotland. the Scottish Clinical Skills Network and received 4.1.1 Literature review 143 responses. The results were used to determine a list of specialised equipment to be available on A review of the literature indicated that where the unit and to source and/or develop appropriate a mobile clinical skills unit had been introduced, quality-assured skills packs for use on the unit for it had been designed either to take specialist priority skills. The full analysis of this questionnaire equipment from venue to venue or to provide is available from the CS MEN office. an education venue. 4.2.2 Consultation with expert groups 4.1.2 Stakeholder A comprehensive list of simulators was refined consultation process through further discussions with expert educators During the stakeholder meetings in developing from static clinical skills centres and medical the Scottish Clinical Skills Strategy, practitioners and nursing practitioners. It was important to in remote and rural Scotland identified the need understand from the practitioners the training for skills education facilities to be part of any mobile they would like to undergo onboard the mobile unit. Meanwhile skills education experts in the unit and what equipment was necessary for this to fixed skills centres identified the need to ensure happen. We also needed to take into account the the facilities were of the same standard in a mobile storage space available on the unit, as each piece of unit so that educational programmes could be equipment would stay on the unit permanently and standardised and quality-assured. These facilities required a safe and suitable space. would require a video feedback system.
4.1.3 Review of mobile units in other public sectors Other education service providers were reviewed and during the planning stage the team visited a customised mobile unit for the fire services which was designed and provided by the coachbuilders Cebotec Ltd.
4.1.4 Review of potential transport needs Potential venues for the mobile unit to visit included the Western Isles and the Orkney and Shetland Islands, so any mobile facility had to be able to travel on all the island ferries.
9 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
4.3 Identification of venues 4.4 Development of training and hosts programme 4.3.1 Determination of venues A broad range of skills education was developed to The success of the project would depend heavily be delivered through the unit, in sessions ranging on individuals and teams at the local venues. Initial from two hours (self-revision skills stations) to three venues were identified to allow all healthcare days (as a station on ALS courses). We used three practitioners on mainland Scotland and some of different methods to research the range of skills that the islands to be within two hours’ driving time of could be offered on the unit. These were as follows: either the mobile unit or a quality fixed clinical skills a) Survey with practitioners education centre. During the later stages of the The remote & rural training needs analysis identified pilot we also visited some smaller venues with low a selection of skills education including emergency population bases who had fewer opportunities for care (adult, child and maternity), generic skills, local skills education and whose need for the unit communication skills, clinical assessment, patient was therefore greater. management and procedural skills as a priority when developing a programme. 4.3.2 Development of hosts b) Interviews with faculty The CS MEN required each new venue to nominate After developing and sourcing a range of materials three people to defined roles: one local host and and equipment to enable the delivery of skills two educators from the start of planning, all to be education for the prioritised skills and making them identified by the local health board. The role of the available on the unit, the CS MEN interviewed host would be essential for a successful visit; their faculty and staff to identify their needs and to responsibilities would start six to twelve months in determine which of the skills would be delivered advance of a visit and continue until after the unit at each venue. As the local faculty was to lead the departs. The host would be supported throughout development of a programme of education for by CS MEN. their venue, it was important that the educational Expectations about the project, both in terms programme met the learning requirements of their of CS MEN’s expectations about the local venues’ healthcare professionals. All education should meet role and the local venues’ expectations about the minimum standards identified for the delivery of CS MEN’s role have been remotely managed with quality simulated practice sessions (the CS MEN has transparency. There are many responsibilities for the a self-assessment questionnaire to assist with this host and educators, and the creation of supporting that can be downloaded from the website: documents detailing their roles and responsibilities www.csmen.ac.uk). would be essential to ensure successful visits. c) Direction from national education initiatives Discussions with national education initiatives underpinning the Paediatric Retrieval Service, the Emergency Medical Retrieval Service, SMMDP and Heartstart education programme also took place during the development of the mobile unit. All services were keen to be involved in the project and continue to deliver their outreach programmes on the mobile unit. They felt the level of training they offered would be enhanced by the high-quality simulation and debriefing equipment.
10 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
4.5 Logistics and consumables 4.5.1 Logistics The size and weight of the mobile unit requires it to be driven by a Class 2 licence holder and in compliance with the Vehicle & Operator Services Agency drivers’ hours and tachograph guidelines. It was therefore important to find a sustainable solution regarding the deployment of the unit; in addition to driving skills, such a specialised vehicle required the knowledge of how to set up the external sections and connect the electrical supply.
One option was to use fully qualified agency drivers to deliver and collect the unit at each venue, but they would not provide any additional on-site support to the venues on arrival; for example, assisting with the internal set-up and troubleshooting the AV and computer equipment. It was also unlikely that there would be continuity with agency drivers as this would depend on their 4.5.2 Consumables availability and the unit’s location. A number of options regarding consumables were discussed during the initial development Another option researched was to second a Scottish meetings, including the possibility of charging Ambulance Paramedic/Technician for the two-year a nominal fee to health boards to cover the costs. pilot period to deploy the unit and in addition, It was decided it might be difficult to obtain provide on-site support during the first few days at payment for consumables used during a visit each location. It could also provide the Paramedic/ because of the pressure on local budget-holders. Technician with an opportunity for personal development, for example, leading educational sessions at each venue.
Both options would require several training sessions for the drivers on how to deploy the unit, connect the electrical supply and fix the unit for travelling on ferries.
11 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
4.6 Organisational and 4.7 Publicity management structure The mobile clinical skills unit would be officially The organisation of the mobile clinical skills unit launched prior to its first visit, giving those involved as part of the CS MEN required a group to take in developing the unit and educators throughout forward both its direction and implementation. Scotland the opportunity to see the finished customised vehicle. There were several incentives for developing the Mobile Unit Steering Group which included the The unit required to be publicised through many need to: different media channels, including print, radio, television and internet. A central role was identified 1. disseminate the role of the mobile unit to for the CS MEN’s website and quarterly newsletter health boards in enhancing its use. The CS MEN also coordinated 2. link faculty development with the with NES and the University of Dundee regarding educational programmes publicity through their media channels, and a 3. liaise with other remote and rural initiatives, promotional DVD (pictured below) about the vision, e.g. BASICS and RRHEAL genesis and deployment of the unit was produced 4. provide a gateway for practitioners to using funds provided by NES and disseminated develop new skills sessions for the unit. throughout the network. If the schedule allowed and opportunities became available, the unit would The need for a mobile unit Project Officer to also attend conferences, to showcase its facilities. enhance the system of communication, support learning between venue and programmes, and Each venue could decide to promote the unit to ensure there was a system for reporting back staff and members of the public through local through the CS MEN to the NES Clinical Skills media when it visited their region. Programme Board was identified in the planning phase. This was undertaken as part of a task analysis by the CS MEN team. A main responsibility for the Project Officer would be the operational logistics, ensuring that travel plans were developed in line with the driver’s working hours regulations whilst supporting him during travel and set-up. Supporting the hosts and educators during the pilot would also be a priority.
12 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
5. Results: Design and Planning Phase of the Mobile Unit
The following are the results from the design and planning phase of the mobile clinical skills unit.
5.1 What type of unit? In partnership with Cebotec Ltd, whose core activity is the manufacture and conversion of non-standard and specialist commercial vehicles, the mobile clinical skills unit was designed in consultation with the lead clinician and experts in remote and rural education.
The unit is essentially a lorry with pods on each side that open out to create a classroom when it is parked at a venue. It is 10 metres long to enable it to fit on the ferries to some of the smaller islands; this allows a classroom space of approximately 25 sq m, suitable for groups up to 16 people, 5.2 Equipment requirements depending on the activity. The unit is equipped The mobile unit is a multi-professional resource with the normal items that would be expected in designed to be used for training and updating skills a classroom, such as a screen for using PowerPoint/ of all healthcare professionals in the primary and watching videos. secondary care sector. As a result of the consultation To enable video recording and debriefing, and survey, a wide selection of part-task trainers and the Scotia Medical Observation and Training a diverse assortment of skills kits are available on (smots™) audio-visual system was installed. the unit, plus a comprehensive range of simulation Three smots™ cameras are fixed in the unit, and equipment, including SimMan, SimBaby and a a fourth mobile camera is also available to allow Child Crisis Manikin. recording in real healthcare situations. The unit can Each piece of equipment has a dedicated cupboard then be used to debrief from the mobile camera. and detailed guides are kept onboard the unit A control room is separated from the main enabling staff to find each item quickly. We rely classroom area by a one-way window, in front on every venue to return each piece of equipment of which rises the plasma screen for delivering to the correct location before the unit departs. presentations/video and houses the computer This ensures the equipment is safely stored, equipment to run scenarios. minimising potential damage during travel.
13 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Building the mobile unit August to November 2008
14 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
5.3 Identification of venues and hosts 5.3.1 Determination of venues Throughout 2009 all venues including Fort William, Wick, Oban, Shetland and Stranraer had large numbers of staff and were approximately two hours or more from a fixed clinical skills facility. In 2010, as well as repeat visits the unit also visited smaller islands, offering those staff the same access to education and development. 5.3.2 Development of hosts As this was a new project, none of the local hosts or educators had the time and resources required to organise and support the visit in their work plans. We capitalised on a great deal of goodwill created by the CS MEN and stakeholder meetings, recognising that the necessary planning was largely Their responsibilities continue during the visit done in people’s free time. The full-time role of host ensuring each session has the consumables has varied between venues and has been taken required, and that the unit is kept clean, tidy and on for example by a Staff Nurse, GP and a Senior secure when not in use. After the last session the Resuscitation Officer. host should ensure the equipment is cleaned and The first task for the host is to establish a location stowed away correctly; that feedback is given to and power supply for the unit; all hosts are supplied CS MEN on the number of participants and any with documentation detailing the dimensions and other aspects of the visit that worked or didn’t power supply required. The second is to develop work well. the training programme for the duration of the visit, A standard ‘Guide for hosts’ and a ‘Guide for liaising with educators and staff to ensure the right trainers’ were developed and circulated to the host education sessions are being offered. and educators in the initial stages of the planning for every visit. These are read by the hosts and educators and discussed with CS MEN afterwards to make sure all concerned were clear about their roles. The duties and responsibilities of each role are clearly communicated in the guides, and this has generally worked well throughout the pilot. These guides are available from the CS MEN office.
15 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
5.4 Development of training programme A broad range of skills education has been delivered through the unit, in sessions ranging from two hours (self-revision skills stations) to three days (as a station on ALS courses).
A typical programme for a two-week visit is:
Week Monday Tuesday Wednesday Thursday Friday Saturday Commencing
12 Oct 9am-5pm 9am-12pm 9am-12pm 9am-12pm 9am-12pm 10am-12pm Paediatric Retrieval Anaphylactic Shock Male Catheterisation Adult BLS with IO Access Heartstart Outreach Study Day Training Training airway adjuncts Course
1pm-5pm 1pm-5pm 1pm-3pm 1pm-5pm Adult BLS/AED Venepuncture and Minor Injury Central Venous Paediatric BLS Cannulation Training including suturing Access Insertion
6pm-7pm 4pm-6pm Guides/Scouts BLS Self-learning Sessions
19 Oct 9.30am-4.30pm 9am-5pm 10am-12pm 9am-5pm 10am-4.30pm Immediate Life Maternity/ Chest Drains Self-learning Management of Support Neonatal Training Sessions a trauma patient 1pm-3pm 6pm-8pm Airway Management Examples: Dental Nurse BLS Venepuncture 4pm-6pm Male Catheterisation Self-learning ABG Gases Sessions Suturing Cannulation
5.5 Logistics and consumables 5.5.1 Logistics Investigations were carried out into all the options The agreed solution was to use a driver offered for a driver to deploy the unit and after careful by Cebotec Ltd, the company who built the unit. consideration from the Scottish Ambulance Service He is fully qualified and was involved in the building (SAS), it was decided that they were not able to process and therefore had specialist knowledge and release staff to deploy the mobile unit. CS MEN has experience. Cebotec Ltd also has a proven record continued discussions with the SAS throughout the when it comes to service and maintenance of large pilot period and we are pleased that four members mobile units and their current customers include of staff were trained in 2010 to deploy it. Scottish Police Forces, Fire and Rescue Services and Government departments. The unit is stored with It was also important to have some continuity Cebotec Ltd at Falkirk when it is not being used. of driver for the mobile unit due to the specialised nature of the vehicle and the set-up required. This could not be achieved by using agency drivers for the full pilot period.
16 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
5.5.2 Consumables As an overall solution it was decided at the start The Project Officer is the single point of contact of the pilot period that a stock of consumables for all venue hosts and education providers would be placed onboard the unit to complement whilst building relationships with project partners the equipment and skills that would be practised. and stakeholders. Throughout the pilot she has After each visit CS MEN would complete a stock developed good working relationships with all check to ensure supplies were kept at appropriate hosts and educators. Attending conferences levels. and educational days with the mobile unit has enhanced links with new partners to secure During the first few visits however, it became future visits. apparent that the venues were using their own consumables as these were the specific items used A Mobile Unit Steering Group was set up at the in their hospital, and it is important for health beginning of 2010, with the following remit: practitioners to have consistency. As a result, 1. To support the mobile clinical skills unit project only a few items such as handtowels, handwash and its engagement with stakeholders to ensure and gloves are now supplied with the unit and maximum and optimal use of the unit for all each venue is responsible for providing their professional groups in all locations own consumables. 2. To advise on the education to be delivered through the unit, both national and local 5.6 Organisational and programmes management structure 3. To advise on the best use of the unit within In 2009 a Project Officer was recruited to a professional area coordinate all aspects of the mobile unit. 4. To read and reflect on the report from the first six Her main responsibilities include development months of the pilot period, to build on previous and coordination of the schedule; administrative use and suggest how challenges can be met tasks to support the mobile unit; data collection, 5. To develop the unit on a national, sustainable entry and analysis; and responding to problems basis, linking into other national and local skills encountered by users of the unit as and when education they arise. The coordination of the schedule and 6. To facilitate engagement with the project by the travel plans to each venue require careful strategic decision-makers from key stakeholder construction in keeping with drivers’ working groups. hours regulations, the Working Time Directive and allowing for contingency time. This ensures The chair appointed was the Chief Executive each venue has the maximum amount of time of a NHS health board and representatives from for educational sessions. NES, Scottish Ambulance Service, Workforce Planning, Scottish Resus Group/Resus Council, Scottish Association of Community Hospitals, RRHEAL, Scottish Clinical Simulation Centre, BASICS, CS MEN and representatives of Allied Health Professionals were invited to be part of the group.
17 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
5.7 Publicity During many visits the hosting NHS board has National Association of Medical Simulation, Manchester, issued press releases to their local media and we November 2009 are aware of coverage in the following: Association for the Study of Medical Education, July 2009 2nd International Paediatric Symposium and Workshop, Print: Florence, Italy, April 2009 Lochaber News The Oban Times The Shetland Times The Courier (Dundee) 5th Out of Hours/Unscheduled Care Annual Conference, The Orcadian (Orkney) The Scotsman Dunblane, March 2009 Ileach (Isle of Islay) Scottish Intensive Care Society (SICS) Annual Scientific Meeting, Cumbernauld, January 2009 Radio: BBC Radio Shetland Local radio at Kelso Poster presentations: Paediatric World Congress Conference, Sydney, Television: March 2011 ITV Borders (at Kelso) BBC Grampian (Aberdeen) Transfer and Retrieval Conference 2009, hosted by the Internet: Emergency Medical Retrieval Service, Glasgow, May 2009 Article on BBC website Shifting the Balance – New Roles and New Models of Article on ITV website Care, Annual Conference of NHS Highland and Launch of http://news.stv.tv/scotland/89123-new-education-tool ‘Delivering for Remote and Rural Healthcare’, May 2008 -for-health-practitioners-in-rural-scotland STV (Fort William pilots medical training scheme The mobile unit has been showcased at: 02/02/2009) The annual Kirkcaldy & Levenmouth CHP Conference, http://news.stv.tv/scotland/north/73483-fort-william- Kinghorn, Fife, November 2010 hospital-pilots-medical-training-scheme UK CEA Conference, St Andrews, September 2010 Article on University of Aberdeen website Article on University of Dundee website Association for Medical Education in Europe (AMEE) Article on University of Edinburgh website Conference, Glasgow, September 2010 Article for Business Gateway (on NEWS-scotsman.com SMMDP Conference, The Beardmore Hotel & Conference 17/04/2009) Centre, Clydebank, March 2010 http://news.scotsman.com/health/Manikins-set-to-hone- Scottish Paediatric Anaesthesia Network Annual Education rural.5179541.jp Day, November 2009 Other print: AHP Consensus Conference, Edinburgh, November 2009 NES Networking and Learning for GP Nurses Newsletter RCGP Annual National Care Conference, SECC, Laerdal magazine November 2009 Stirling Management Centre magazine Scottish Clinical Skills Network Annual Conference, ‘Slainte’ (Western Isles NHS staff magazine) Glasgow, September 2009 NES Focus magazine Royal Infirmary Edinburgh, August 2009 Promotional DVD: Scottish Association of Primary Care, St Andrews, Produced in 2009 for NES. July 2009 Oral presentations on the mobile unit: Ninewells Hospital and Medical School, Dundee, Abstract accepted for 4th International Clinical Skills June 2009 Conference, Prato, Italy, May 2011 Aberdeen Royal Infirmary, April 2009 Association for Medical Education in Europe (AMEE) 5th Out of Hours/Unscheduled Care Annual Conference, Conference, Glasgow, September 2010 Dunblane, March 2009 The 14th Ottawa Conference, Miami, Florida, May 2010
18 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
6. Methods: Implementation Phase of the Mobile Unit
This phase required CS MEN to contact several 6.2 Evaluation of venues groups of people to gather evidence for the CS MEN would manage the communication and evaluation of the unit. organisation for each venue remotely via telephone, 6.1 Faculty development email and videoconference conversations. Keeping a log of every phone call and correspondence 6.1.1 Identifying course provider would ensure all aspects of the visit were discussed. An important aspect of the pilot was the training As well as the host there may be additional contacts of educators at each venue in order to build local that need to be kept informed throughout, capacity in the use of simulation to nationally including local estates departments, educators and quality-assured standards. The aim of the course national education initiatives. CS MEN would liaise would be to prepare the participants for their role with all parties to ensure a seamless visit. as faculty to maximise the educational benefit to After each visit the host and educators would be their learners and increase their confidence using encouraged to feed back to CS MEN their thoughts mid-fidelity simulation equipment. on challenges and improvements for the future. CS MEN approached the Scottish Clinical Simulation These experiences would be essential for developing Centre (SCSC) to develop the course; it is the only repeat visits but would also provide CS MEN with high-fidelity simulation centre in Scotland and has knowledge they could pass to new venues the expertise in developing and facilitating courses throughout the pilot. with simulation equipment and ensuring the learning objectives are appropriate to the groups 6.3 Evaluation by participants that the course is designed for. To ensure maximum Each venue would be responsible for ensuring that learning for the participants, it was planned for every healthcare professional in their area would the mobile unit to attend each course and for the have access to the sessions onboard the unit. majority of education to take place on the unit. Once the training programme was confirmed, it 6.1.2 Constraints in training would be distributed throughout the area and staff local faculty would be able to sign up for sessions that they were In addition faculty training was identified at venues interested in. The unit and equipment was designed where circumstances meant it was not feasible for to be accessed by any healthcare professional and staff to travel to the national centre (SCSC). would also enable full team training including emergency scenarios, which are often difficult to 6.1.3 National courses run in the current climate due to the need for travel, For national courses, training by the teams was staffing levels and the costs for a whole team to be arranged specifically on the mobile unit. released to attend training at a fixed centre. 6.1.4 Dissemination of training expertise In order to disseminate and share experience amongst the trained faculty, options were explored to capture this.
19 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
6.3.2 Follow-up evaluation Approximately four to six months after each visit a follow-up evaluation would be sent to those who had provided personal information, including an email address. The follow-up evaluation aimed to measure a self-reported impact of the session. 6.3.3 Practitioner stories From the completed follow-up evaluations we also collected stories from practitioners who told us the education they had received on the mobile unit had made a direct impact on their delivery of patient care. CS MEN interviewed each practitioner to discover more about their learning on the mobile 6.3.1 Immediate evaluation unit and the resulting impact on patient care. The immediate evaluation would take place 6.3.4 Case studies directly after each course via paper evaluation forms Working with the Paediatric Retrieval Service, SAS provided by CS MEN (see Appendix 3a, 3b and and the Shetland health board, CS MEN developed 3c). It was developed by expert skills facilitators case studies on their use of the mobile unit during and contains both open questions and a Likert-type the pilot. They showed the impact the mobile unit scale for key statements related to the organisation had on their teaching and learning methods. of facilities and the quality of the course. Each These stories and case studies can be viewed educator and host would encourage as many from Pages 36 to 47. participants as possible to complete the forms and they would then be returned to the CS MEN office after each visit for data input and analysis.
20 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
6.4 Resources and programmes 6.5 Value for money Following an initial survey completed by 143 Throughout the two-year pilot, both direct and remote and rural practitioners; an analysis of critical indirect costings have been identified. The value/ incident data from all health boards; reference to cost of any intervention is complex and requires the Patient Safety agenda; and a scoping exercise a cost/consequence analysis, where the real cost to see what skills education was already established, of running the mobile unit has to be considered the CS MEN planned to develop a number of against the cost of not training remote and rural national, multi-professional, evidence-based practitioners to a recognised standard. resources for priority skills, all of which would be There are two aspects of efficiency to consider: matched against the KSF framework to ensure 1) the technical efficiency of providing the skills their relevance to all healthcare staff. training, and 2) the allocated resource efficiency, The resources could be used in combination with which is about the additional costs required to the mobile unit, offering pre-course learning and bring value to the quality of healthcare. practical sessions under supervision onboard the The actual direct capital and running costs of the unit. Alternatively the resources could be used mobile unit were identified and recorded during independently of the unit for continued learning the pilot. The mobile unit provided the opportunity throughout the year. to train teams on site, minimising the cost of A copy of the educational programme from each accommodation and travel to the service. This all venue would be essential for the evaluation of the needs to be considered as part of the evaluation pilot. This would help the CS MEN to ensure that of the unit. the correct equipment was onboard the unit for each session and assist other venues later in the pilot, by giving examples of what courses had been offered in other areas.
21 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
7. Results: Implementation Phase of the Mobile Unit
7.1 Faculty development 7.1.1 Identifying course provider 7.1.2 Constraints in training The Scottish Clinical Simulation Centre (SCSC) local faculty developed a two-day Faculty Development Course As a solution to these issues, the CS MEN’s specifically for the educators using the unit Regional Champion (RC) for the North of Scotland (see Appendix 2). The key components of the has delivered ‘Training the trainers’ courses at course include: the venues over the first two days of the visit, to 1. Identifying learning objectives for people who were already involved in education. scenario training This has helped partners to engage with the project and the RC’s support has given confidence to new 2. The use of SimMan to create realistic users of the unit. clinical scenarios 3. The use of audio-visual equipment to In the pilot period, 51 people from nine health assist debriefing boards and a variety of professional backgrounds have attended the Faculty Development Course, 4. Knowledge and application of facilitated and 49 trainers have been trained on site by the debriefing skills. RC for the North. A further eight people attended A major benefit of the course has been to increase in February 2011, and now that a stock of faculty the standards of education delivered in remote and from across the boards has been built, the course rural areas, and this reaches beyond the scope of will be run by the SCSC two or three times a year the mobile unit project. Due to local faculty gaining as part of its normal course portfolio. experience and confidence in using simulation on the unit, we are aware of at least two venues that “The Clinical Simulation Facilitator’s are planning to increase their use of simulation in course was extremely well run and made their own fixed centres. Perception of the quality excellent use of time to blend the right of tutors by those trained on the unit is high for levels of interaction, so that once key each venue, as evidenced by the ratings given for the trainers that the CS MEN routinely collects from concepts were introduced, we could participants. quickly gain experience and obtain feedback on how we were doing. At least two people from each venue were required to complete the course before receiving the unit, I’m convinced that this training will with decisions made by each venue regarding the be useful generically in other facilitating appropriate people to attend. roles. By the end of day one, I felt
For the first visits to more remote venues, a few reassured and competent; by the partners were either not willing to travel to Stirling end of day two I felt excited about for the course, or the SCSC did not have the how we could best use the Unit during capacity to run the course before the visit to its visit to us”. that partner. David Hogg, GP Rural Fellow, from Brodick Health Centre on the Isle of Arran, November 2010
22 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Figure 1. Faculty who completed the Faculty Development Course at the Scottish Clinical Simulation Centre by health board Total number of completed forms: 51
1 NES 5 NHS Ayrshire & Arran 3 NHS Borders 7 NHS Dumfries & Galloway 17 NHS Highland
4 NHS Lanarkshire 1 NHS Lothian 3 NHS Shetland 1 NHS Tayside 1 NHS Western Isles 8 Scottish Ambulance Service
Figure 2. Faculty who completed the Faculty Development Course at the Scottish Clinical Simulation Centre by professional group Total number of completed forms: 51
46% Medical & GP 24% Nursing & Midwifery 18% SAS 12% Other
“Thank you for the opportunity of spending two days at the Simulation Centre. [the course] was a real eye-opener and, despite having been on an ATLS Instructor Course, I found the opportunity for learning skills regarding the use of a simulator was extremely valuable.” David Sedgwick, Consultant Surgeon at the Belford Hospital, Fort William, January 2009
23 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
The majority of feedback CS MEN received about The figure below shows the breakdown, the Faculty Development Course was positive, by professional group, of all faculty who used but some participants did express that they had the unit and completed evaluation forms. found the course too advanced in terms of writing Not all faculty who used the unit completed the and running the scenarios focussing on medical Faculty Development Course at the SCSC. Some emergencies. It was felt that it may have been more were already experienced users of simulation in useful to explore the learning needs of their local education, some had done similar courses at the communities before they attended the course and SCSC previously, some were BASICS trainers, learn how to address these through the equipment/ some had done GICs and some intend to facilities supplied on the mobile unit. All participants register for a future course. agreed that the course did provide them with the opportunity to familiarise themselves with the unit prior to a visit.
Figure 3. Breakdown by professional group of faculty who used the unit in the pilot period Total number of completed forms: 55
27% Medical & GP 37% Nursing & Midwifery 31% Other 5% Information not completed
7.1.3 National courses In addition to building capacity for local faculty to from the Paediatric Retrieval Service at Edinburgh deliver education, the unit has also been used to and Glasgow to jointly deliver their education day deliver education by national initiatives including: for the stabilisation and transfer of the sick child. 1. the Paediatric Retrieval Service These days have been very successful as the team has been able to deliver the same course locally 2. the Emergency Medical Retrieval Service around Scotland, and has got to know the unit and 3. the Scottish Multiprofessional Maternity equipment well, enabling them to use it to its full Development Programme potential. An additional benefit of this is that the 4. the Heartstart education programme. local trainers have the opportunity to see the full The unit has also been used for one or two days potential of the equipment. The trainers’ time and at many of the venues by the outreach teams travel is funded by NHS NSS, to enable the delivery of education required to support the retrieval service.
24 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Figure 4. Trainers’ time at local venues (excluding national programmes) for the pilot period Total number of completed forms: 53
62% Part of your normal work (no backfill) 14% Part of your normal work (backfilled) 4% Annual Leave 6% Days Off 12% Other
2% Information not completed
Notes: Two people took half a session off normal work with no backfill ‘Other’ time was accounted for as follows: One person took half a session with backfill and half without One person was there as an instructor on RCUK ALS Course One person took half of the course as annual leave Three people used duty/study leave One person used days off but will get time back One person used their own time, and another half their own time (and half study leave)
7.1.4 Dissemination of training expertise Since the close of the pilot period, a ‘Shared Space’ has been created by CS MEN on the NHS Knowledge Network for the mobile clinical skills unit faculty, which is used for discussions, user guides for the equipment on the unit, sharing resources, information on Faculty Development Courses, and practical support for troubleshooting common problems users have come across.
The success of the pilot has been largely due to the dedication and enthusiasm of the trainers and their willingness to use their leave and days off to deliver education through the unit.
25 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Mobile Unit: Summary of Visits
ISLE OF LEWIS Number of courses: 10 Number of days on site: 7 KINLOCHBERVIE Number of hours of training: 34 Number of people trained: 33 Number of courses: 1 Number of days on site: 1 Number of hours of training: 8 Number of people trained: 10
ISLE OF BENBECULA X2 Number of courses: 23 Number of days on site: 24 Number of hours of training: 72.5 Number of people trained: 156
ISLE OF BARRA Number of courses: 9 Number of days on site: 5 Number of hours of training: 34.5 Number of people trained: 70 FORT WILLIAM Number of courses: 12 Number of days on site: 9 Number of hours of training: 52.5 ISLE OF TIREE Number of people trained: 66 Number of courses: 8 Number of days on site: 5 OBAN Number of hours of training: 25.5 Number of courses: 14 Number of people trained: 56* Number of days on site: 12 Number of hours of training: 70.75 ISLE OF MULL Number of people trained: 150 Number of courses: 6 Number of days on site: 5 LOCHGILPHEAD Number of hours of training: 27.5 Number of courses: 21 Number of people trained: 60* Number of days on site: 11 Number of hours of training: 76 ISLE OF ISLAY Number of people trained: 86 Number of courses: 16 Number of days on site: 10 DUNOON Number of hours of training: 66 Number of people trained: 122 Number of courses: 8 Number of days on site: 5 Number of hours of training: 28.5 Number of people trained: 74
*approximate PAISLEY Island Venues SAS Training Mainland Venues Conferences STRANRAER X2 & Showcases Number of courses: 5 Number of days on site: 22 Number of hours of training: 32 Number of people trained: 39 26 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
KIRKWALL X2 Number of courses: 27 Number of days on site: 25 Number of hours of training: 65 Number of people trained: 222
YELL & LERWICK X2 Number of courses: 26 Number of days on site: 35 Number of hours of training: 127 Number of people trained: 291
WICK X2 Number of courses: 12 Number of days on site: 10 Number of hours of training: 40 Number of people trained: 46
AVIEMORE Number of courses: 1 ABERDEEN Number of days on site: 1 Number of hours of training: 8 Showcase Number of people trained: 7 DUNDEE Showcase
ST ANDREWS UK CEA & SAPC Conferences
DUNBLANE OOHs Conference
STIRLING Launch & SPAN Conference KINCARDINE KINGHORN SAS Training Fife CHP Annual Primary Care Conference EDINBURGH SAS Training EDINBURGH Showcase & AHP Conference KELSO Number of courses: 16 MONKLANDS Number of days on site: 9 Number of hours of training: 62 Number of people trained: 140 BEARDMORE, CLYDEBANK SMMDP Conference MELROSE Number of courses: 12 GLASGOW Number of days on site: 10 Number of hours of training: 44 Showcase, AMEE & RCGP Conferences Number of people trained: 73
27 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
7.3 Evaluation by participants 7.3.1 Immediate evaluation All participants are requested to complete an evaluation form at the end of each session to gather their feedback about the session, and any areas for improvement. These questionnaires aim to measure Level 1 of Kirkpatrick’s model of evaluation.1 The evaluation form had six Likert-style questions and some semi-structured open questions; a limited amount of personal data (name, role, place of work and email) is also collected, though this section is optional for the participant to complete.
1741 healthcare practitioners attended an educational session on the unit during the two- year pilot and 844 participants completed the initial evaluation form. The hosts and educators 7.2 Evaluation of venues for each venue have tried to ensure as many forms In the follow-up open interviews with both host are completed as possible, and usually achieve and educators at each venue, nearly all felt that approximately 50% response rate, when the there were things they would do differently, and number of completed forms is measured against better, next time. Examples included: the host’s records of the number who actually • scheduling more educational sessions attended each session. Thirty-seven percent of utilising evening and weekend times respondents did not complete the optional section of the evaluation form that collected personal • finalising and disseminating the training information, but from the 63% who did complete programme to staff further in advance the information, we have evidence that the use • organising multi-professional scenario training. of the unit has been multi-professional. Here it is From the evaluation forms, participants generally assumed that the results are not statistically skewed rated the pre-event organisation lower than they by one particular professional group being more rated the unit itself, its facilities or the quality of reluctant to give personal information. trainers. We recognise that the logistics of hosting a visit for the first time are complex and that the expertise of both the venues and the support to them from the unit will develop over time and throughout subsequent visits.
Where the same core group of people has been involved in several visits to different venues, for example in Argyll and Bute CHP, they have been able to use the unit to meet a significant proportion of their training needs, and have planned ahead well, using the unit to develop the role of community nurses in particular.
1 Kirkpatrick, D. L. (1994). Evaluating training programs: the four levels. San Francisco: Berrett-Koehler
28 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
The figure below gives a summary of the professional groups of people rainedt on the unit, and a more detailed breakdown by professional group and venue is attached to this document as Appendix 1.
Figure 5. Breakdown by professional group of participants who attended educational sessions in the pilot period Total number of responses: 902
10% Emergency Services <1% Healthcare Science 1% Allied Health
5% Medical 6% General Practitioners 5% Community 43% Nursing & Midwifery 3% Dentistry 27% Information not completed
As the table below illustrates, substantial proportions of healthcare staff have attended educational sessions on the mobile unit in several boards, with levels of staff in NHS Orkney and NHS Shetland attending at least one session on the unit particularly high at 31% and 36% respectively.
Approximate numbers Size of NHS workforce Approximate % attending training* (Healthcare practitioners only) of workforce who Source: NHS NSS attended training on the unit
2009 2010 2009 2010 2009 2010 NHS Borders 140 73 2270 2228 6.2% 3.3%
NHS D&G 17 22 3199 3156 0.5% 0.7%
NHS Highland 246 424 6147 6182 4.0% 6.9%
NHS Orkney 100 122 397 393 25.2% 31.0%
NHS Shetland 160 131 443 420 36.1% 31.2%
NHS Western Isles 140 119 712 700 19.7% 17.0%
* (excluding SAS as workforce stats are given separately for the SAS Board)
29 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Sixty-nine percent of all respondents gave the unit an overall rating of ‘excellent’, and a further 25% rated it ‘good’. Only 3% rated it ‘satisfactory’, with the remainder not completing the question, as illustrated in Figure 6. Some teething problems were encountered by the first venues and there were issues with the unit leaking later in the first year, but these were resolved due to the positive ‘can-do’ attitudes of hosts and trainers. Therefore we would have expected fewer ‘excellent’ ratings of the unit than were actually given by users.
Local hosts have confirmed that the project has enabled many more staff to access education than would have been possible if they had had to travel further for it. The release of staff from clinical duties has still been a significant issue for managers, “We worked with colleagues [for scenarios]. but because the cost of the pilot was funded by Ambulance crews were ambulance crews, NES, quality education has been more affordable nurses were nurses, GP’s the same. and therefore opened up to greater numbers of [It was] great for team building.” healthcare practitioners. Staff Nurse, Isle of Islay Local hosts and participants have particularly “[The best part was] acting out scenarios. appreciated that the unit makes whole-team training possible, because it can be done on site, Got us thinking and working as part whereas it would never be possible for a whole of a multi-disciplinary team” team to be released at the same time to travel Staff Nurse, Orkney to central facilities. Comments on the evaluation “Excellent. Invaluable source of education and forms indicated that many users appreciated the emphasis being on multi-professional training communication, team building superb for the whole team. - need more and more, thank you” Staff Nurse, Isle of Islay “To see the way different people interact together” Operating Department Practitioner, Fort William
30 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Figure 6. Participants’ rating of the unit from the pilot period Total number of completed forms: 844
69% Excellent 25% Good 3% Satisfactory <1% Poor/na
3% Information not completed
In addition to data from the evaluation forms, education via the unit, which reinforces their feeling verbal feedback has again been that healthcare of being valued in the NHS workforce. The island practitioners have been delighted with the facility, workforces were extremely enthusiastic about the and are encouraged by the visible investment NHS unit, and very keen to see it return. Education for Scotland is making to their skills
31 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
A selection of participants’ comments from the on-the-day evaluation forms “Facility is excellent, roomy, “Excellent training facility.” non-claustrophobic, wouldn’t know Consultant Physician from you were in a van! So convenient.” Caithness General Hospital Dental Surgeon, Isle of Islay “It was an interesting experience in a way that technology has advanced “Fantastic facility, excellent quality of so much that you get engrossed in the tutors not normally accessible so closely.” teaching and manikin.” Midwife, Isle of Islay Ambulance Technician, Isle of Islay “I am very aware of how powerful “Good to have mobile unit & training simulation can be as a training tool - locally. Handouts very useful.” I accept I made mistakes but can
take it on the chin and move forward Midwife/Team Leader, Kinlochbervie with my practise - learning can “Very realistic, [good] quality be uncomfortable at times.” of mannequin & equipment.” Clinical Practice Facilitator, Borders Staff Nurse, Stranraer “Very helpful having fully equipped unit, “[The most useful aspect was] especially on Tiree where transporting Recap of ABCDE.” equipment not as easy.” Staff Nurse Bank, Lochgilphead Ambulance Provider, Isle of Tiree “Excellent programme. Scenarios kept “I found this really interesting, I’m pretty very realistic for us locally. Kept staff new to the job and was a bit nervous ‘on-a-level’ and reassured at what about attending this course but I was actions we would take.” put totally at ease.” Senior Charge Nurse, Isle of Islay Nursing Auxillary, Orkney
32 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
A selection of participants’ comments from the on-the-day 7.3.2 Follow-up evaluation evaluation forms Where participants had given their contact details on the immediate evaluation form, a follow-up survey was issued four to six months after the session was delivered, for sessions up to the end of August 2010, to ask them about the lasting impact, if any, that the education had on their clinical practice. Whilst recognising the limitations of self-reporting to measure impact, this seemed the best option available considering time and resource constraints, and aims to measure Levels 2 and 3, Learning and Behaviour, of Kirkpatrick’s model.
141 participants gave consent to be contacted with the follow-up survey and 41 completed surveys were received from these participants, a response “Working together in our multi-professional team rate of 29%. Respondents had taken part in a wide managing simulated emergencies was invaluable variety of skills sessions, and were from a range of experience during the unit’s visit to Yell. professional backgrounds and ages. This practice highlighted the need for The lasting impact of the education delivered further discussion and team development. through the unit included: We now regularly include discussions about 1. the acquisition of new skills for role development how we manage various emergency situations 2. the practice of infrequently-used skills to as part of our team meetings.” increase confidence and stay up-to-date Community Nurse/Midwife, Yell, Shetland 3. the updating of local skills education. “As a member of the local fire fighting service, Respondents appreciated the opportunity for we found training together on the unit a great team-building, networking with their ‘real’ team opportunity. Practicing our skills as a team with and others from different clinical areas, the unit and equipment being available in their own locality, Sim-man in action made the experience more the ‘safe environment’ created on the unit, the realistic by mimicking breathing and the heart video feedback and the opportunity to test restarting. Another benefit was being able to their individual skills. train alongside the ‘experts’, who were leading the sessions, and ask them questions - this really enhanced the whole experience. We would definitely use the unit if it came up to Yell again!” Fire Fighter, Yell, Shetland
33 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
The follow-up survey aimed to assess the long-term impact of the education offered on the unit. Respondents were asked about the changes in their practice after the course, about the most useful aspects of the mobile unit, and for any other comments. Responses include:
“I observed practical scenarios with insiteful feedback from experienced and knowledgeable tutors… Shared experiences of other staff working within the NHS and how we interact with each other” Paramedic, Western Isles (Paed. Retrieval Outreach)
“…mobile clinical skills unit was an unusually excellent result of practical thinking in action. We in the smaller islands often feel that we are left to the bottom of priority when it comes to regular update of skills and the learning of new skills. I cannot be too fulsome in my praise of the mobile clinical skills unit. It is ideal. Well done. I do hope this service is maintained.” Family Health Nurse and Anticipatory Care Nurse Specialist, Western Isles (BLS, Venepuncture & Cannulation)
“…maximum use for both hospital and community staff… knew of its availability well in advance, could do a number of updates if needed. People able to take everything on board because of group size and if there was a problem with technique… didn’t feel so vulnerable because of the set up of the mobile unit.” Senior Charge Nurse Community Uist & Benbecula, Western Isles (BLS)
“[The most useful aspects of the unit were] Being able to attend evening session meant not losing work time… convenience of not having to travel far. [Having the] expertise of tutors from busier centres on the mainland.” Salaried G.D.P, Western Isles (Anaphylaxis & BLS)
“The mobile unit was great as it came to Barra, travelling “I put one [a chest drain] in a patient to Uist takes a couple of hours, possibly an overnight stay approximately 6 hours after the making it a big undertaking when everyone has other work training so it was very useful in and home commitments. So far I have been unable to attend consolidating my practical skills” any courses run in Stornoway, the mobile unit is essential for GP ST1, Fort William remote communities with few specialist medical staff.” (Chest Drain Insertion) GP, Barra Medical Practice (Obstetric Emergencies) “Brilliant facility. Good to be able to access something like this without spending hours travelling!” Infection Control Nurse, Oban (Sepsis Course)
“Excellent clinical facilities and well thought out sessions. Giving me hands on experience in a non threatening environment Island Venues at a local location.” Nurse Practitioner, Oban (Cannulation) Mainland Venues “[The impact on my practice has been] limited, Conferences as it is such an infrequent occurrence... & Showcases but that is why we need the practice!” Consultant Anaesthetist, Stranraer (Paed. Retrieval Outreach)
34 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
“It allowed me to have a role when dealing with sick “[This has] updated my knowledge and given me more “Mobile skills unit [is] flexible children, rather than knowing very little about the confidence - recently had to deal with CVP line and could have been set up differences between child and adult anatomy and had not dealt with this before - training had given me anywhere.” resuscitation I was able to retain a lot of the information insight into both the theory and practical aspects of Community Nurse from the day and I have since used the paediatric this procedure so equipment was more familiar and Midwife, Kinlochbervie resuscitation on two occasions. The study day made not so frightening. Also as I work in the emergency (Emergency me aware of my weakness with drug calculations which ward it has refreshed my knowledge and skills and Obstetric Update led me to continue with self directed learning on drug am using this on a daily basis.” Course) calculations, completing a Charles Blue Training course Nurse Practitioner, Orkney on drug calculations a few months back.” (Medical Emergency Scenario Training) 3rd Year Student Nurse, Wick (Paed. Retrieval Outreach) “Fantastic to undertake the training with local colleagues and learn together… scenarios in the simulated setting of the Balfour Hospital and getting expert critique. It was excellent to run through the scenarios afterwards with the recordings.” GP WS1, Acute Medicine, Orkney (Paed. Retrieval Outreach)
“The mobile unit was excellent, a good “I had a good chat with an engaged couple during the clinical environment with being able to showcase at Aberdeen, they were both 4th year medical practice in a non threatening environment. students and considering R&R careers but concerned about Locally based training of this standard training opportunities, for example, if they went to Shetland, is hard to find, well done to every one so they were encouraged that this facility is now available... involved.” Nurse Practitioner, Oban, I think the project will help with recruitment to R&R pathways (Venepuncture, Cannulation in the longer term.” & Life Support) Project Manager, CS MEN
“[These] skills enabled me to work independently and to give better nursing care to my patients.” Staff Nurse, Dunoon (IV Cannulation, Venepuncture & Male Catheterisation)
“…mobile skills unit is fabulous resource and can’t say enough about the trainers who provided the scenarios/feedback and support. The computer feedback was really interesting too” “…training [I received on the unit Community Nurse, Shetland is now] used in everyday practice” (ALS, Airway Management & Use of AED) Staff Nurse, Borders (ILS Training) “Meeting with and working along with staff grades “Good combination of lectures and from Student nurses to Consultants. Very ‘open and practical sessions with a small group, easy relaxed’ learning despite the stress of the scenario, to learn and ask questions. [It was good to] greatly increased knowledge of both acute and learn from watching others in scenarios” chronic asthma…” ST4, Paediatrics, Borders Practice Nurse, Shetland (Critical Asthma Attack (Paediatric Resuscitation Skills) Management)
“[The most useful aspects of the unit were] Team building, learning as a team and how to work together, reflecting and critiquing our practice and sharing this with others throughout the Isles.” Hospital Children’s Nurse, Shetland (PLS course)
35 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
7.3.3 Practitioner stories Dr Charles Siderfin, GP, Orkney
The Orkney Islands are an archipelago in northern Scotland situated 16 kilometres north of the Caithness coast. Orkney comprises approximately 70 islands of which 20 are inhabited. The largest island, known as the “Mainland”, has an area of 202 sq miles, making it the sixth largest Scottish island. The total population of Orkney is just under 20,000 with most people living on the Mainland, comprising 75% of Orkney’s population. Kirkwall is the main town, with a population of 7,500. The Balfour Hospital is situated near the centre of
Bryan Leslie: The Orcadian, 25 June 2009 Bryan Leslie: The Orcadian, Kirkwall. It is a Rural General Hospital with 64 beds.
There are about 30 GPs working in Orkney - the highest number of GPs per head of population in any UK Health Authority. They provide services both in the community and the hospital. Dental services are also delivered locally. Primary Care services on four of Orkney’s smaller islands are provided by resident Nurse Practitioners and a further three inhabited islands have no resident medical cover. Three consultant surgeons provide general surgical services to the islands, in conjunction with three consultant anaesthetists, providing planned and emergency care.
My name is Charles Siderfin, I am a GP at Balfour Hospital providing acute medical services and have helped coordinate and deliver educational sessions onboard the mobile unit in 2009 and 2010. Both years I attended the Paediatric Retrieval Outreach Study Day delivered by the Scottish Paediatric Intensive Care Retrieval Service (SPICRS) from Yorkhill and Edinburgh Sick Kids. This is a course in the resuscitation and stabilisation of the sick or injured child until the Retrieval Team arrives, which for Orkney can take up to 12 hours. I attended this course because in Orkney we see an average of eight paediatric emergencies each year and as an individual I might see one or two, therefore it is very important for me to keep my skills up-to-date.
Approximately two weeks after the session onboard the mobile unit with the Paediatric Outreach team, I was working a regular weekend shift when two profoundly shocked patients arrived at Balfour Hospital within 30 minutes of each other. It is a very rare occurrence to be treating patients with similar problems in such a short space of time. The surgical team attended one patient, and myself, as the medical team, attended the other. A peripheral line was inserted into one patient but this wasn’t possible with the second patient, so having completed my session with the SPICRS a couple of weeks earlier I had the knowledge and skills to use the EZ-IO gun to insert an adult intra-osseous needle to begin fluid resuscitation until a venous cut-down was undertaken.
We purchased three EZ-IO guns after the initial visit of the mobile unit in 2009 but they had not been used prior to this incident. The second simulated practice session on the unit gave me the confidence to actually use it.
Having the mobile unit a second time allowed us to utilise it far more effectively as we knew what to expect. It is a fantastic resource. This year we decided to plan a two-week ‘Learning Festival’ around the mobile unit visit, 423 staff participated in 68 different courses over the period and 20 of those courses were delivered onboard the mobile unit with over 110 participants.
As a user of the mobile unit I feel it is a phenomenal resource - it has made a real difference in Orkney. SimMan and SimBaby are fantastic for scenario training and it has been a tremendous opportunity to deliver team training. We delivered several sessions this year, where at the start of the session the team was not working well together, but by the end of two hours there was a noticeable improvement in the way they were working as a team.
36 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Dr Joe Tangney, GP, Glen Mor Surgery, Fort William Health Centre
Dr Joe Tangney has been a GP at the Glen Mor Surgery in Fort William since 1995. The surgery moved to the purpose- built Fort William Health Centre in 2007. As a GP in a busy training practice of over 5300 patients he has to deal with many sick children. The nearest paediatrician to Fort William is in Inverness, which is 70 miles away via the A82 which is a difficult windy road. Also, while working in the Fort William “out of hours” services the local GPs cover a huge geographical area. Patients in Mallaig are almost an hour away, Fort Augustus is a 45-minute journey etc, so the GPs need to have paediatric resuscitation skills to be able to deal with a sick child in a remote/rural setting. Also in the Belford Hospital the GPs often help the very inexperienced junior doctors manage sick children. Sick children have to be stabilised in the Belford before transfer or the retrieval team arrives.
During the first visit of the mobile unit to Fort William in January 2009, Dr Tangney attended the outreach education day delivered by the Paediatric Retrieval Teams from Yorkhill and Edinburgh Sick Children’s Hospitals. Months later, Dr Tangney completed the follow-up survey designed to capture the impact of the day. In the survey, he noted that since the education day he has felt much more confident in managing acute asthma, insertion of intraosseous needles, bag/mask ventilation, use of fluids in shock, and has developed a clear approach to dealing with a sick child.
“I really enjoyed the training day taking away both theoretical and practical skills. Most important was now having the confidence to be able to manage a sick child”.
Since the skills day, the Glen Mor practice now has a dedicated paediatric resuscitation bag on site. Dr Tangney noted that he had gained practical experience and confidence in dealing with a sick child, which is frightening for non-specialist doctors.
Part of the skills day covered acute asthma, and Dr Tangney noted that since the day, he has given the asthma treatment plan used on the skills day to all his colleagues at work and they have used it successfully several times for children with acute asthma over the last year.
“It [the mobile unit] is innovative and has huge potential for training especially in remote and rural areas throughout Scotland”.
Since attending the training day Dr Tangney has used the skills and knowledge gained on the day to teach groups of visiting Aberdeen medical students and several GP Specialist Trainees groups. He has created a PowerPoint summary of the day and borrowed a paediatric manikin to help demonstrate the practical skills learned on the mobile skills unit.
In thinking about the three things that were most useful about the unit, Dr Tangney listed the value of getting practical experience in a realistic environment, the constructive use of video and verbal feedback, and the unit being on site thereby saving a drive of 70-100 miles to Inverness or Glasgow. He noted that the mobile skills unit is ideal for training medical personnel in remote and rural areas. It saves, say, at least ten people travelling long distances to get to a training venue, which is something that immediately reduces attendance.
“If the unit comes to us it is so much easier to attend. The long travelling time to courses is a real practical barrier for most people living in remote and rural areas. This is a big factor not really appreciated by colleagues in urban areas”.
Finally, Dr Tangney said he hopes the mobile unit could visit at least once or twice a year if possible, in order to allow many more people to attend and update particular skills such as paediatric skills.
37 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Emma-Jane Trayner, Resuscitation and Clinical Skills Facilitator, Western Isles Hospital, Stornoway
The Western Isles is an archipelago of 11 populated islands 40 miles off the North West coast of Scotland. In 2006 the resident population of the Western Isles was 26,350, with 18,565 living on the Isle of Lewis, and of those about 8,000 resident in or around Stornoway, the biggest town. The Western Isles has the largest proportion of any health board living in areas classified as very remote/rural (79% compared to 3% in Scotland as a whole) and the second highest proportion of people aged 65 years and over in Scotland.
The islands are served by three hospitals: the largest is the Western Isles Hospital, a Rural General Hospital located in Stornoway. The Uist & Barra Hospital is situated in Benbecula to serve the Southern Isles and St Brendan’s Hospital with five beds is in Castlebay on the Isle of Barra. There are 12 GP practices with approximately 35 GPs throughout the Western Isles providing primary care services to the community, and dental services are also delivered locally.
I am the Resuscitation and Clinical Skills Facilitator for NHS Western Isles and I’m responsible for the training of 1065 staff, 420 of them clinical and 645 non-clinical. I’ve coordinated two visits of the mobile skills unit to the Western Isles, first in 2009 and then again in 2010.
The staff who were able to train on the unit included public health nurses, paramedics (including winchmen from the local Coastguard station), staff nurses, student nurses, hospital-based physicians and anaesthetists, GPs, dentists and dental students, midwives, community health visitors and healthcare assistants. Sessions offered in 2009 covered adult BLS and advanced resuscitation updates; paediatric ILS, neonatal life support, IO needle insertion, respiratory and cardiovascular examination, trauma, anaphylaxis, medical clinical skills and a CHD day along with the NES programme for the emergency care of children and young people and the national paediatric outreach programme delivered by the teams from Edinburgh and Glasgow Sick Children’s Hospitals. The training focussed in particular on paediatric skills, because although there is a well-equipped clinical skills centre at the hospital in Stornoway, which has a SimMan, the unit presented a golden opportunity to practise and learn paediatric procedures on SimBaby and the paediatric part-task trainers.
On the first visit, 140 healthcare staff in Stornoway and Benbecula underwent training on the unit over a three-week period. When the unit returned in 2010, it went to Benbecula and Barra for one week each; the visit to Barra was in response to many requests for the unit to go there. 119 staff were trained in BLS, ILS, Suturing, Obstetric Emergencies, IV Drugs, Venepuncture & Cannulation, the national DNACPR policy, Male Catheterisation and Recognition & Management of the Sick Child.
Most of the staff trained on the unit were looking to refresh or update their skills and the message that was coming over loud and clear afterwards was that they felt much more confident now. The visits have benefited patients by ensuring staff maintain their skills and also by encouraging staff to undergo training sessions which can be tailored to their own environment. More staff are competent now in basic procedures such as Venepuncture and Cannulation. People responded positively to all aspects of the unit and thought it was an excellent opportunity to access a lot of things in one fell swoop.
“This has been “just what I needed”. Hope the facility will be available on on-going basis for annual updates” (Practice nurse)
Staff liked that training was multi-disciplinary: for example, practice nurses and hospital staff learning alongside ambulance staff and looking at various aspects of a patient case together. This was particularly relevant in paediatric emergencies which are often a difficult time as it may be necessary to care for a sick child for up to 3-4 hours or more before the emergency retrieval services are able to arrive to fly them off the island due to weather conditions. To have practised in a team with an extra skilled person there who can assist them during that time, from Scottish Ambulance, is very reassuring.
38 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
“With improved knowledge gives greater confidence dealing with children. I have dealt with a number of paediatric cases since the course. I am now more aware of the needs of the child, what to assess and how to utilise the information. Also, I am now better equipped to discuss a child’s condition with a doctor in order to deliver earlier treatments on scene” (Paramedic, six months after the 2009 visit)
We appreciated the best practice statements and nationally accredited packs that are available on the unit as these endorsed the training sessions and scenarios offered. Staff can get stuck in their way of doing things, so these were beneficial for work-returners and also just for staff who wouldn’t normally see certain patient conditions.
“Excellent facility, clean, bright & plenty of room” (staff nurse)
The economic benefits of the unit are not immediately obvious as I and other colleagues still had to travel from Stornoway to Barra and Benbecula to deliver the sessions on it. This is a practice that takes place anyway; however, after we’d crunched the numbers and looked at what the unit cost us over two weeks in 2010, we found that courses were delivered at a cost to the Board of £10 per person - an impressive amount! The unit did help solve other problems – I often have difficulty finding a venue as the hospital in Barra is very small and doesn’t have a high enough IT spec for some of the equipment I use. The unit on the other hand has the right IT spec, it means I don’t have to carry around so much equipment with me, and is the perfect size for the amount of staff I can train at one time. Many thought it was great that they could update their training without spending time away from home and work:
“Fabulous that [it] came to Barra. Lots of updates, convenient - takes so long to travel to events usually” (community nurse/midwife)
From my point of view the unit does necessitate a considerable amount of extra work for each visit; however this has to be counter-balanced by the obvious benefit to our staff’s training needs. We have had a couple of hiccups along the way such as a leakage on the unit after torrential downpours, but the advantages have proven to far outweigh the disadvantages. John (the driver) heading off to the ferry is a welcome sight at the end of each visit but I know when he comes back next year the health board will be getting value in terms of our staff’s professional development and the direct benefit that has for our patients!
39 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
7.3.4 Case studies A CS MEN Regional Champion’s perspective NHS Shetland: Jerry Morse, CS MEN RC for the North
During the pilot of the mobile unit, I visited the unit many times at lots of different sites and saw some really good examples of how local staff used it to great advantage. To illustrate this, I’ll focus here on Shetland, which the unit visited twice, first in April 2009 and then again in June 2010.
It was an exciting time for me, travelling out there, networking with the local people, helping make it happen and getting to know all the staff that had put so much hard work into making the most of the fantastic facility that is, more often than not, known as “the skills bus”.
In both 2009 and 2010 the mobile unit was stationed at Montfield Hospital in Lerwick for the bulk of the time and we didn’t initially have any local staff trained to use it, so my job on my first visit was to set the unit up and then spend two days holding “Train the Trainer” sessions for local staff, in particular Consultant Anaesthetist Catriona Barr and Resuscitation Training Officer Julie Redpath, who subsequently taught most of the training programme (Resuscitation Council UK courses such as ALS, ILS, BLS, PILS). In these sessions I covered all the information required by the trainers who would be using the mobile unit from both the technical and non-technical perspective. We also held open sessions demonstrating the facilities to the local press and members of the health board, and getting the educational message across that the mobile unit required local support not just through training, but also with releasing staff to attend training.
During my second visit, and once again while based in Lerwick, along with a small faculty of national instructors, I had the pleasure of delivering the most northerly Advanced Life Support course in the United Kingdom over a brilliant summer weekend in June 2010. The course was one of the most successful I have taught on for quite a while and ran very smoothly, thanks to Julie and Catriona’s excellent organisation. Julie had recently completed the mobile unit Faculty Development Course at the Scottish Clinical Simulation Centre in Stirling, along with Niall Bristow of Scottish Ambulance and Dr Mark Aquilina, a GP at Yell Health Centre.
Whilst in Shetland in 2009, the unit was driven to the island of Yell for two days by a local contracted driver, where it hosted a patient support group; but when it went back a year later for a longer visit, we had managed to find two local service staff, Jason Wallace, an Ambulance Care Assistant based at Lerwick station, and Gary McMillan who is a volunteer fireman and drives with the Fire and Rescue Service, and is also a community nurse. This saved money as both already had their LGV licence so were trained to make the unit operational by John, our regular driver who takes the unit from its base to and from the sites. Jason and Gary also drove it to Bixter, another first visit for Shetland! Whilst in Yell the second time, local GP Dr Mark Aquilina also conducted sessions and joint training was run with the Coastguard Service.
40 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
“Great to get to use SimBaby and learn how to use the Figure 7. Breakdown by professional group of participants in educational sessions on the mobile unit in the IT equipment really good for running scenarios - really Shetland Isles in the pilot period good for team building and getting everyone to work Total number of completed forms: 99 together. Watching the video footage was good for reflecting on and learning from too”. Hospital Children’s Nurse, Shetland (PLS course) “Given the advanced nature of the models and patient simulators, I found it useful practicing…[also, it was]… useful to teach school children and the opportunity to attempt to widen access towards medical education.” Medical Student, Shetland (assisted in facilitating a session with late secondary school/6th form students) “[It was useful] Mixing with other colleagues and using the equipment, not in a stressful scenario and being able to go through different scenarios was very useful.” 2% Emergency Services 10% Community Practice Nurse, Shetland (Paediatric & Adult Life Support Courses) 13% Medical 27% Nursing & Midwifery 5% General Practitioners 43% Information “[The most useful aspect was] using de-fib & not completed newer model of ‘annie’” Assistant Mechanic, RNLI - Shetland
Almost 300 staff attended the sessions over the two years and as indicated in the figure, they came from a wide range of healthcare backgrounds, including consultants from the hospitals, paramedic trainers, nurse educators and the Coastguard service. Approximately 36% of the board’s workforce took part in training on the unit in 2009, and 31% in 2010 (using workforce statistics from NHS NSS). Certainly the visits were a success as we managed to get healthcare providers from a remote setting not only talking but training and sharing the educational experience. One specific outcome to illustrate this was that the Coastguard Service which has a SimMan at their base suggested regular training with not only the hospital but also the Scottish Ambulance Service, Fire Brigade and other providers from Shetland – a great example of multi-professional, collaborative working that gets value from shared resources!
The Shetland team laid on very ambitious training programmes in both years, both with the training delivered by local staff, and delivery of courses by the Paediatric Retrieval Service who delivered their outreach training programme to help with skills for stabilisation of the critically ill or injured child, involving lectures and workstations for different skills, and I would like to thank the teams for delivering their course in Shetland.
As RC for the North I really appreciate the contribution of dedicated individuals in the Shetland Isles to the national strategy for clinical skills and I do understand that the staff leading the training programme are under very considerable pressure to make it work alongside their own full-time jobs and all the other demands on them. I would therefore like to record my particular thanks to the following colleagues, without whose enthusiasm and commitment the visits could not have happened: Catriona Barr, Consultant Anaesthetist and Julie Redpath, Resuscitation Training Officer, who bore the brunt of preparation and training for the visits; Rhona Cooper, Postgraduate Administrator and Andy Glen, Staff Development Manager; Mark Henry, Staff Development Administrator; Gordon McFarlane, Consultant Surgeon; Niall Bristow of Scottish Ambulance; Dr Mark Aquilina GP; Jason Wallace, Scottish Ambulance and Gary McMillan, Community Nurse.
41 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
National Paediatric Retrieval Service and the mobile unit
The role of the Scottish National Paediatric Retrieval Service is to facilitate the provision of high-quality seamless care for critically ill or injured children in Scotland. The Critical Care Network starts with the referring team at the local site, who call the retrieval team, who oversee the retrieval and safe transfer of the child to one of the two Scottish Paediatric Intensive Care Units (PICU) in Edinburgh or Glasgow, or on occasion elsewhere in the UK. Approximately 200 children are critically ill or injured in remote and rural Scotland annually.
In the first seven years after the service was set up in 2001, 2680 referrals were received by the service, resulting in 1834 retrievals from 43 hospitals. This averages out at 335 referrals and 229 retrievals annually.
The paediatric retrieval teams’ commitment to providing this service throughout mainland and island Scotland within hours of initial referral is assisted by three educational ventures: study days run on the mobile unit, retrieval team training, and referring hospital feedback sessions. These ventures aim to ensure that safe provision of resuscitation, intensive therapy and transfer to PICU can be delivered by both the referring hospital practitioners and the retrieval team members. Case feedback to the referring hospitals on outcome following retrieval and PICU admission is an essential part of the clinical governance process.
The teams use the mobile unit to deliver their Paediatric Retrieval Outreach study day, consisting of lectures and practical sessions which are followed by simulated scenarios using the SimBaby simulator. Twenty study days have been delivered over the two-year pilot to a mixed audience including GPs, nurse practitioners, emergency medicine physicians, anaesthetists, paediatricians and medical and nursing students. Feedback has been extremely positive with over 90% of candidates rating equipment, tutors, organisation and the overall experience as ‘excellent’ or ‘good’ on a five-point scale.
During the pilot, the study day has been delivered on the mobile unit by David Rowney, Heather Blyth, Margaret Currer, Jon McCormack and Dennis Kerr from the Royal Hospital for Sick Children, Edinburgh, and by Sandra Stark, Neil Spenceley, Mark Davidson and Jennifer Scarth, from the Royal Hospital for Sick Children, Glasgow.
42 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Figure 8. Venues of Paediatric Retrieval Outreach study days in the pilot period Total number of courses: 20
Venue Number of courses 2009 & 2010 Fort William 1 Wick 1 Oban 1 Stranraer 1 Shetland 4 Borders 4 Orkney 4 Western Isles 2 Islay 2
The same evaluation process for the study days has been used as for all education sessions delivered on the unit, although a slightly different form was used to capture additional information required by the service. 137 participants completed the initial evaluation form, and of these, 61 participants gave consent to be contacted with the follow-up survey. 11 completed surveys were received from these participants, a response rate of 18%.
At least 82% of respondents had cared for a sick child in their unit since attending the day, one person had been off sick, and one didn’t complete the question.
All respondents felt that the day had made a positive, lasting impact on their practice. Practical changes included having normal observation charts on walls, use of the drug guidelines provided by the retrieval team, increased knowledge about the retrieval service and support available during stabilisation, implementation of an acute asthma treatment plan, and the introduction of paediatric resuscitation bags in GP practices.
Comments were made by respondents of a lasting impact from the day in that respondents felt more confident after practising some of the rarely-needed but vital skills on the study day, and that they better understood different roles in the care of the child and so were able to communicate better.
In terms of the unit itself, respondents appreciated the realism of the scenarios, the video feedback and debriefing, and the quality of facility available locally, saving time and travel costs.
43 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Figure 9. Breakdown by role of participants in Paediatric Retrieval Outreach study day for the pilot period Total Number of Responses: 137
19% Medical & GP 50% Nursing & Midwifery 9% Other 22% Information not completed
Figure 10. Participants’ rating of the Paediatric Retrieval Outreach study day: quality of tutors for the pilot period Total Number of responses: 137
95% Excellent 4% Good 1% Information not completed
44 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
A selection of comments that demonstrate the impact of the study day are: “I really enjoyed the study day, and I took so much from it. I have since been part of 2 arrests involving children and I was able to use the valuable information from the study day in both situations (both children were recovered). One of the situations may have been very different as I had to maintain the child while help arrived, something I may have struggled with had I not taken part in the course. I cannot thank the team enough, their knowledge and teaching style really benefitted me! Thank you again!” 3rd year Student Nurse, Wick “With improved knowledge gives greater confidence dealing with children. I have dealt with a number of paediatric cases since the course. I am now more aware of the needs of the child, what to assess and how to utilise the information. Also, I am now better equipped to discuss a child’s condition with a doctor in order to deliver earlier treatments on scene.” Paramedic, Western Isles “[This training has had] a significant impact on my practice as it has given me greater confidence and insight in areas of care I had previously not been part of. An example of care that I benefitted from this training was when a young child was admitted to the hospital with breathing difficulties, I felt comfortable and confident enough to deal with the patient and assist the doctor with his duties even though I had no previous pediatric training other than what was provided by the skills unit.” Staff Nurse, St. Brendan’s, Barra “[I now] Use WETFAG on wall in treatment room as well as [the] folder [given and used by the team], also more confident in contacting team with queries.” Staff Nurse, Western Isles “I had used the folder [given by the retrieval team] beforehand but other people in the hospital where I work became more interested in it. The folder and the internet site are used regularly particularly the salbutamol monograph. We already have normal values on our observation charts. I think the day for me mainly helped with relationships with the retrieval team and for team training for the theatre team. The team also kindly tailored the session to the requirements of the theatre team during the practical airway session.” Consultant Anaesthetist, Shetland Isles
45 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Scottish Ambulance Service and the mobile unit
During the pilot the CS MEN has developed a good working relationship with the Scottish Ambulance Service (SAS). The Project Manager was grateful for SAS’s help with buying the chassis, developing the unit, and for advice with practical and logistical issues during the build. During the pilot, SAS have been able to benefit from the facility, with 55 members of the service attending courses onboard the unit, including seven who participated in Paediatric Retrieval Outreach courses. The sessions SAS staff took part in ranged from DNR, CPR to Venepuncture, IV Access and Male Urinary Catheterisation. “Whole course was interesting, Ron Lilly, Clinical Lead Manager for South West Scotland, based at the Paisley Ambulance Station, hosted a visit in December 2009 for his staff to practise and especially Cannulation Skills” update their clinical skills. Paramedic from Glentress Ambulance In May 2010 we met Steve Watkins, Training Officer for the South East Division who had “Just hope we will see the unit recently been appointed the lead for the National Clinical Simulation Group established on a regular basis” by Scottish Ambulance Service. Aiming to become more involved in future use of the Paramedic from Lerwick Station mobile unit and to increase access to clinical skills simulation, he arranged for three members of the training team to complete the Faculty Development Course.
Figure 11. Breakdown by professional group of SAS Figure 12. Breakdown by venue of SAS staff who staff who participated in educational participated in educational sessions sessions on the mobile unit in the pilot on the mobile unit in the pilot period period Total number of responses: 90 Total number of responses: 90
12% Ambulance Care Assistant
1% Ambulance Contractor 3% Stranraer (estimated numbers) 39% SORT 37% Ambulance Technician 2% Shetland 4% Kinlochbervie 10% Ambulance Paramedic 16% Borders 26% Islay 1% Ambulance Provider 7% Western Isles 3% Isle of Tiree 39% SORT Technicians/Paramedics
46 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Faculty Development in SAS In addition to those who participated in education, four staff facilitated training sessions, two in the Borders, one in the Shetland Isles and one on the Isle of Islay. Three had completed the Faculty Development Course at the Scottish Clinical Simulation Centre prior to the arrival of the unit.
The mobile unit Faculty Development Course at the Scottish Clinical Simulation Centre was completed by the following during the pilot: 4 Paramedic Team Leaders (3 from SORT, 1 from Isle of Islay) 3 Paramedics (from Shetland, Fife and SORT) 2 Practice Placement Educators (1 from the West Division & 1 from Borders/South East Division) 1 Divisional Training Officer (from South West Division)
“We will develop opportunities for staff to access clinical skills simulation by working in partnership with the Clinical Skills [Managed Educational] Network and scoping and building capacity with our own infrastructure.” Scottish Ambulance Service Strategy for Learning 2009-2013
Special Operations Response Team In 2010 we worked with Jim Dickie, Resilience Manager for the National Risk & Resilience Department, Special Operations Response Team (SORT). They utilised the unit as part of a two-week training programme in February and for two days in May. The additional space and equipment provided by the unit enabled the team to practise their clinical skills, including IV access in several different challenging environments. In total 35 SORT Paramedics and Technicians participated in the training.
In August 2010 the unit was planned to attend each of the three regions for a week at a time, enabling all staff to complete clinical skills updates. Unfortunately only the session in Edinburgh went ahead on that occasion, but SORT hopes to use the unit regularly in future.
Jim Dickie also offered for his team to transport the vehicle between SORT venues for future visits, and a training day held in Falkirk on 19 July 2010 was attended by three staff; one from the East (James Wallace) and two from the North (Ray Robertson and Pauline Lawtie) where they learnt how to deploy the unit. James Wallace returned the unit to Falkirk on 9 August after a visit to the SORT office in Edinburgh. In addition to SORT drivers, Jason Wallace, a Paramedic in Shetland has also driven the unit, transporting it from Lerwick to the Isle of Yell and back, kindly giving two days of his time. This followed 2.5 hours of onsite training on how to deploy the unit in June 2010.
47 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
7.4 Resources and programmes The categories of skills delivered on the unit are: a) Emergency Care Adult; b) Emergency Care Child; c) Emergency Care Maternity; d) Communication Skills; e) Clinical Assessment; f) Patient Management; g) Cross Sector Skills; and H) Procedural Skills.
A list of sessions by category is:
a) Emergency Care Adult A&E Scenario Workshops Head & Spinal Injury & Large Lacerations in A&E Airway Management ILS ALS Management of Acute MI Anaphylaxis Management of Diabetic Emergencies BLS Medical Emergencies (SOB/Chest Pain/ Chest Trauma and Chest Drain Management Cardiac Arrest) Critically Ill Surgical Patient Multi-Professional Emergency Workshop EMRS Training Day Resuscitation Updates FY2 Training: Assessment of Acute Abdomen Sepsis
b) Emergency Care Child Care of Critically Ill Baby and Child Neonatal Resuscitation & Transport Core Competencies for Sick Children Newborn Examination Cord Prolapsed Newborn Life Support Emergency Delivery NG & PEG Feeding Intubation Paed BLS Managing Post-Partum Haemorrhage Paed Outreach Study Day Managing Shoulder Dystocia Paed Trauma and IO Needles Naso-Gastric Fine Bore Tube Insertion PILS
c) Emergency Care Maternity Maternal Haemorrhage Obstetric Emergencies Maternal Resuscitation
d) Communication Skills Anaphylaxis Maternal Resuscitation Care of Critically Ill Baby and Child Multi-Professional Scenarios Head & Spinal Injury & Large Lacerations in A&E Neonatal Resuscitation & Transport Management of Diabetic Emergencies
48 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
e) Clinical Assessment ALERT Management of Diabetic Emergencies ALS Multi-Professional Scenarios Anaphylaxis Practical Ophthalmology Chest Trauma and Chest Drain Management Rhythm Recognition Critically Ill Surgical Patient Sepsis FY2 Training: Assessment of Acute Abdomen Theatre ILS Head & Spinal Injury & Large Lacerations in A&E f) Patient Management ALS FY2 Training: Assessment of Acute Abdomen Anaphylaxis Head & Spinal Injury & Large Lacerations in A&E Asthma Session Management of Diabetic Emergencies Chest Trauma and Chest Drain Management Mental Health Crisis Management Course Critically Ill Surgical Patient Monitoring Skills Day Dementia Training Multi-Professional Scenarios DNAR Sepsis Emergency Care Framework Transfusion Management g) Cross sector skills Clinical Governance meeting with workstations Joint Scenarios with Coastguard, NHS and SAS h) Procedural Skills Airway Management LMAs Blood Gases Male Catheterisation Basic Ventilation Paed Trauma and IO Needles Cannulation Perineal Suturing Central Venous Access Rapid Sequence Intubation Chest Drains Self-revision Skill Stations ECG Session Self-directed Learning (Venepuncture Head & Spinal Injury & Large Lacerations in A&E & Cannulation) Hickman Line Management Suturing Workshop Interpreting Blood Results Urinary Catheterisation including Supra Pubic IO Access Venepuncture IV Drugs
49 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
The resources CS MEN has developed on priority These are: skills are published on the NHS Shared Learning 1. Practice/simulated practice environments are website (http://www.sharedlearning.scot.nhs.uk) supportive, safe and appropriate for the activity so all staff can access them under a creative undertaken commons copyright licence. Each resource has 2. Mentors/facilitators of practice are appropriately an interactive on-line component with tests and qualified, provide high standards of skills assessments to cover theory, and downloadable teaching and engage in Continuing Professional workshops for simulated practice that can be run Development in local facilities or on the mobile unit where local 3. Learning opportunities are well-organised with facilities are not available. Once a staff member a clear set of outcomes/objectives for the course/ has completed and passed the theory, they can session take part in a simulated practice session followed by supervised practice, before being signed off as 4. Practice/simulated practice teaching is competent in the skill. These resources are complex underpinned by evidence and best practice and time-consuming to develop, but warmly 5. Reliable and validated protocols are used to received by health boards once complete. assess performance Each is developed by author groups in which the 6. Debriefing - feedback is incorporated to promote CS MEN ensures a mix of both professional and safe rehearsal and consolidation of skills geographic representation. The pack development 7. To enhance quality, a range of multi-service process is attached at Appendix 4. This element of feedback mechanisms are in place and used the CS MEN’s work is not specific to the mobile unit to refine the course/session and a number of packs are now being developed 8. Communication systems are in place between using this process, led by practitioners in health skills providers and relevant stakeholders boards in central as well as remote areas. e.g. Educational Institutions/NHS Scotland/ A simple self-assessment questionnaire for use with Professional organisations skills sessions that use simulation was developed in 9. Practice/simulated practice learning is Year 1 of the CS MEN, piloted in Year 2, and rolled principle-based and courses/sessions are out to all health boards in Year 3. The questionnaire mapped against KSF/SCQF. was developed using quality assurance workplace Principles 5, 6 and 9 have proved the most learning guidance principles and the HPC, NMC challenging over the pilot. and GMC/PMETB guidance on quality assurance was also utilised in structuring the form. The Whilst recognising that it is an additional challenge questionnaire focuses on nine principles that all to local venues to provide training that meets all sessions of simulated practice should meet. these standards, venues have been asked to use the questionnaire for skills sessions delivered on the unit. In another project stream, the CS MEN is working towards this questionnaire being adopted by all health boards for all skills education where simulation is used. Most boards have now endorsed the questionnaire and are in different stages of adopting it. Use of the questionnaire for courses run on the unit has also helped achieve adoption of the questionnaire for courses run off it. The questionnaire is available from the CS MEN office.
50 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
7.5 Value for money 7.5.1 Revenue The two-year pilot cost £160,791.21 to run. Now that the project is well established, the CS MEN has calculated that it can be continued for The only staff costs included in the project costs are annual operating costs of approximately £107,000. for the dedicated mobile unit Project Officer, who This includes a full-time Project Officer, with two supports the unit full-time and joined the project days/four sessions of Project Management. team six months into the pilot. Staff costs of the Project Manager and Project Administrator are not included in the project costs but in the core CS MEN budget.
Unit transportation (including driver time, accommodation, return travel, ferry crossings) 65,919.75 Fuel 4,345.57 Costs of CS MEN team to unit at Falkirk 1,398.87 O-licence & vehicle maintenance costs 21,306.73 Maintenance, servicing and replacement parts: simulation and IT equipment 6,254.42 Faculty Development Courses 6,344.13 Publicity 8,123.63 Signage, stationery & postage 5,444.69 Hospitality 193.15 Consumables 2,098.26 Software & broadband for anti-virus updates 392.95 Staff costs (1x Project Officer for last 18 months of the pilot) 38,969.06 TOTAL revenue full pilot 160,791.21
7.5.2 Summary of capital costs Summary of capital costs (including VAT, where applicable)
Base unit 39,384.00 Customised pods 139,950.00 Physical unit, storage & signage 10,876.92 AV system & installation 27,889.27 Patient simulators 44,478.53 Part-task trainers 6,771.69 Other equipment/accessories 4,933.48 Couches, tables and chairs 2,851.08 TOTAL capital 277,134.97
51 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
8. Summary and Recommendations
The mobile unit as part of the Clinical Skills In particular in relation to each phase of Managed Educational Network has made a development of the mobile unit, it is important significant contribution to the skills proficiency of to note the following: remote and rural practitioners, and there are clear Design and planning phase of the unit instances of where this training has impacted on patient care. The whole system involved in delivering The storage capacity was challenging due to the a high-standard skills education programme to pods severely limiting access to the storage units remote and rural practitioners is complex and underneath the vehicle. requires a dedicated infrastructure support, The logistics have required the presence of a given the delivery option used during this pilot. dedicated mobile unit Project Officer to ensure The mobile unit has made an enormous there is minimal disruption to the programme contribution over the past two years, despite at each venue. She has played a crucial role in the extreme weather conditions, to the skills coordinating each visit, providing support to development of healthcare practitioners, visiting the host and ensuring transport and facilities 26 venues, delivering 227 education programmes are prepared and stocked. to over 1700 staff and developing approximately A pool of dedicated drivers would certainly address 100 trained faculty. It has generated requests the high costs of the current arrangement and for repeat visits with new venues currently being a number of options such as linking to Scottish considered and is fully booked for 2011. It has Ambulance Service could potentially save £15,000. increased the ability of health boards to release The O-licence requires 12-weekly safety checks and practitioners for training who would otherwise these have at times been challenging to incorporate have had backfill issues as well as travel and but scheduled time for repairs, restocking and accommodation costs to face. equipment checks is essential.
52 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Implementation phase Future developments In the majority of venues there has been an There are a number of ways in which the mobile excellent balance between national and local clinical skills unit could be further enhanced and programmes and there were several stories of the developed following this evaluation, where there direct impact that training has had on patient care are clear opportunities for improving efficiency. (see practitioner stories on Pages 36 to 39). These include:
By its very nature the mobile unit has been a focus 1. The development of dedicated national skills for other educational initiatives; for example, educators for the mobile unit exercises with Search & Rescue teams in Shetland 2. The development of a driving pool with and as an integral part of the two-week ‘Festival technical capability of Learning’ in Orkney. However, one of the major 3. The design of a core programme or curriculum challenges in the implementation phase has been for remote and rural practitioners getting protected time for practitioners to attend 4. Enhancement of the unit for surgical skills educational sessions on the unit. development through a satellite connection A dedicated funding stream to maintain and 5. Enhanced links to BASICS and RRHEAL develop the mobile clinical skills unit as part of the 6. Use of the facility for patient skills education ongoing national skills education provision for the 7. Use of the unit to be built into local delivery health service needs to be considered a priority, as plans. does research and development to ascertain how often the mobile unit should visit each venue to An important outcome of this two-year pilot is the minimise skills fade. change in practice which has resulted in building healthcare professionals’ confidence in relation to their clinical skills, with better patient outcomes. The unit has provided many remote and rural locations with access to a well-equipped facility that can support ongoing skills development in their own community.
53 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Appendix 1 - Breakdown by profession of people who attended educational sessions on the unit 1 3 2 1 3 6 1 1 3 1 1 5 5 3 1 2 2 2 7 1 1 4 2 1 3 1 9 1 9 2 3 6 1 1 2 3 2 1 4 1 2 2 1 2 1 1 1 1 2 2 3 3 2 1 1 1 1 8 1 1 2 1 1 2 2 6 1 6 7 9 2 7 1 1 4 1 9 2 1 8 1 1 4 14 14 11 13 25 23 33 19 13 15 14 35 11 33 11 44 11 57 48 90 902 247 176 376 Total
1 6 7 3 1 4 0 2 7 0 2 0 0 0 20 Mull Isle of
1 1 1 3 3 2 1 1 1 1 8 1 9 2 1 7 2 1 2 0 0 0 0 0 59 17 32 Lochgilphead 3 6 9 0 5 1 0 2 0 0 0 0 3 18 Tiree Isle of
2 2 1 1 0 1 1 6 3 1 5 0 2 9 0 1 1 0 0 34 30 Borders 1 2 1 1 2 1 1 2 1 2 1 3 5 2 1 2 4 1 2 1 4 1 8 1 9 1 6 0 0 73 10 19 20 23 Islay
1 1 1 1 0 1 2 1 7 1 2 1 1 1 2 2 0 0 0 0 46 18 24 2010 Dunoon 6 1 4 1 1 0 1 2 2 1 5 2 1 3 1 2 0 0 8 0 6 0 61 17 13 30 Orkney
3 1 3 2 4 0 1 1 3 4 1 2 1 1 2 1 3 9 0 4 0 0 72 31 14 18 10 Shetland
1 1 1 1 1 1 2 5 7 1 1 1 6 2 4 2 0 1 0 0 4 50 19 19 Isles Western
4 9 0 0 0 1 7 1 2 2 1 4 0 1 0 0 4 Kinlochbervie 0 0 1 1 6 2 4 0 2 1 0 4 3 20 35 10 Stranraer 0 0 0 0 0 0 0 0 35 35 SORT 4 2 1 3 1 1 3 1 7 2 3 1 8 2 8 1 4 1 0 8 0 0 2 96 33 21 42 Isles Western 1 1 2 1 2 5 0 1 1 3 2 1 1 0 0 0 0 36 12 13 10 Orkney 1 1 1 1 5 4 1 0 1 2 1 1 2 1 3 1 1 0 3 0 1 90 15 39 14 56 14 Borders 1 1 9 0 1 1 4 1 2 1 1 1 1 1 1 0 1 0 3 2 27 11 Shetland 2009 6 2 1 0 0 1 2 0 0 1 0 3 0 Stranraer
1 3 2 2 4 2 1 0 1 2 2 1 4 2 1 2 1 2 3 2 1 1 3 0 7 3 6 0 87 28 19 40 Oban 0 1 8 2 2 1 0 0 0 0 3 0 25 11 11 Wick
8 1 1 9 0 3 1 6 5 4 2 1 0 6 6 3 0 0 38 12 Fort William
Nursing and Midwifery Smoking Cessation Advisor Social Care Worker RNLI Senior Social Care Worker Manager (Local Government) Receptionist Home Carer Head Teacher Fire Fighter Community Nursing Sister RSCH Nurse
Totals Community Nurse Midwife Registered Nurse
Information Not Completed Registered General Nurse Oral Health Educator Community Nurse Public Health Nurse Oral Health Support Worker Care Worker Trainee Dental Nurse Trainee School Health Co-ordinator Paediatric Nurse Practitioner Paediatric Occupational Therapist Practice Nurse General Dental Practitioner
Community Nursing Assistant Dentist GP ST2 Nurse Practitioner Dental Surgeon Nurse Auxiliary Dental Therapist GP ST1 Nurse Dental Nurse GP ST Programme Director Minor Injury Nurse Dental Hygienist GP S1 Acute Medicine Midwife
Dentistry GP Returner Lead Midwife Unscheduled Nurse Manager Sister Ward GP Restart Infection Control Nurse Treatment Room Nurse Treatment GP Locum Incontinence Nurse Theatre Sister GP Fellow Heart Failure Specialist Nurse Nurse Hospital Children’s Theatre Team Leader Theatre Team GP/Locality Clinical Director Health Visitor Student Nurse Health Care Assistant Staff Nurse Bank
Allied Health GP Family Health Nurse Staff Nurse Clinical Practice Facilitator Staff Grade A&E/Surgery Doctor SHO Surgical Senior House Officer General Practitioners Evening Nurse Sister Phlebotomist Hospital Practitioner Medical Student ST 3 Paediatrics Emergency Nurse Practitioner Enrolled Nurse Clinical Co-ordinators FY 2 Charge Nurse District Nurse Senior Staff Nurse SORT Technicians/Paramedics FY 1 Healthcare Science Bank Staff Nurse Ambulance Provider FT STA Consultant Anaesthetists FT Anaesthetic Nurse Senior Charge Nurse Cardiovascular Co-ordinator Leader Physio/Rehab Team Breakdown of Profession Ambulance Paramedic Operating Department Practitioner Instructor Physiotherapy Technical Advanced Paediatric Nurse Practitioner Senior Anaesthetic Nurse PractitIoner Medical Ambulance Technician Ambulance Contractor Ambulance Care Assistant 54 (excluding Trainers) Emergency Services CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care 1 3 2 1 3 6 1 1 3 1 1 5 5 3 1 2 2 2 7 1 1 4 2 1 3 1 9 1 9 2 3 6 1 1 2 3 2 1 4 1 2 2 1 2 1 1 1 1 2 2 3 3 2 1 1 1 1 8 1 1 2 1 1 2 2 6 1 6 7 9 2 7 1 1 4 1 9 2 1 8 1 1 4 14 14 11 13 25 23 33 19 13 15 14 35 11 33 11 44 11 57 48 90 902 247 176 376 Total
1 6 7 3 1 4 0 2 7 0 2 0 0 0 20 Mull Isle of
1 1 1 3 3 2 1 1 1 1 8 1 9 2 1 7 2 1 2 0 0 0 0 0 59 17 32 Lochgilphead 3 6 9 0 5 1 0 2 0 0 0 0 3 18 Tiree Isle of
2 2 1 1 0 1 1 6 3 1 5 0 2 9 0 1 1 0 0 34 30 Borders 1 2 1 1 2 1 1 2 1 2 1 3 5 2 1 2 4 1 2 1 4 1 8 1 9 1 6 0 0 73 10 19 20 23 Islay
1 1 1 1 0 1 2 1 7 1 2 1 1 1 2 2 0 0 0 0 46 18 24 Dunoon 6 1 4 1 1 0 1 2 2 1 5 2 1 3 1 2 0 0 8 0 6 0 61 17 13 30 Orkney
3 1 3 2 4 0 1 1 3 4 1 2 1 1 2 1 3 9 0 4 0 0 72 31 14 18 10 Shetland
1 1 1 1 1 1 2 5 7 1 1 1 6 2 4 2 0 1 0 0 4 50 19 19 Isles Western
4 9 0 0 0 1 7 1 2 2 1 4 0 1 0 0 4 Kinlochbervie 0 0 1 1 6 2 4 0 2 1 0 4 3 20 35 10 Stranraer 0 0 0 0 0 0 0 0 35 35 SORT 4 2 1 3 1 1 3 1 7 2 3 1 8 2 8 1 4 1 0 8 0 0 2 96 33 21 42 Isles Western 1 1 2 1 2 5 0 1 1 3 2 1 1 0 0 0 0 36 12 13 10 Orkney 1 1 1 1 5 4 1 0 1 2 1 1 2 1 3 1 1 0 3 0 1 90 15 39 14 56 14 Borders 1 1 9 0 1 1 4 1 2 1 1 1 1 1 1 0 1 0 3 2 27 11 Shetland 6 2 1 0 0 1 2 0 0 1 0 3 0 Stranraer
1 3 2 2 4 2 1 0 1 2 2 1 4 2 1 2 1 2 3 2 1 1 3 0 7 3 6 0 87 28 19 40 Oban 0 1 8 2 2 1 0 0 0 0 3 0 25 11 11 Wick
8 1 1 9 0 3 1 6 5 4 2 1 0 6 6 3 0 0 38 12 Fort William
Nursing and Midwifery Smoking Cessation Advisor Social Care Worker RNLI Senior Social Care Worker Manager (Local Government) Receptionist Home Carer Head Teacher Fire Fighter Community Nursing Sister RSCH Nurse
Totals Community Nurse Midwife Registered Nurse
Information Not Completed Registered General Nurse Oral Health Educator Community Nurse Public Health Nurse Oral Health Support Worker Care Worker Trainee Dental Nurse Trainee School Health Co-ordinator Paediatric Nurse Practitioner Paediatric Occupational Therapist Practice Nurse General Dental Practitioner
Community Nursing Assistant Dentist GP ST2 Nurse Practitioner Dental Surgeon Nurse Auxiliary Dental Therapist GP ST1 Nurse Dental Nurse GP ST Programme Director Minor Injury Nurse Dental Hygienist GP S1 Acute Medicine Midwife
Dentistry GP Returner Lead Midwife Unscheduled Nurse Manager Sister Ward GP Restart Infection Control Nurse Treatment Room Nurse Treatment GP Locum Incontinence Nurse Theatre Sister GP Fellow Heart Failure Specialist Nurse Nurse Hospital Children’s Theatre Team Leader Theatre Team GP/Locality Clinical Director Health Visitor Student Nurse Health Care Assistant Staff Nurse Bank
Allied Health GP Family Health Nurse Staff Nurse Clinical Practice Facilitator Staff Grade A&E/Surgery Doctor SHO Surgical Senior House Officer General Practitioners Evening Nurse Sister Phlebotomist Hospital Practitioner Medical Student ST 3 Paediatrics Emergency Nurse Practitioner Enrolled Nurse Clinical Co-ordinators FY 2 Charge Nurse District Nurse Senior Staff Nurse SORT Technicians/Paramedics FY 1 Healthcare Science Bank Staff Nurse Ambulance Provider FT STA Consultant Anaesthetists FT Anaesthetic Nurse Senior Charge Nurse Cardiovascular Co-ordinator Leader Physio/Rehab Team Breakdown of Profession Ambulance Paramedic Operating Department Practitioner Instructor Physiotherapy Technical Advanced Paediatric Nurse Practitioner Senior Anaesthetic Nurse PractitIoner Medical Ambulance Technician Ambulance Contractor Ambulance Care Assistant (excluding Trainers) Emergency Services 55 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Appendix 2 – Faculty Development Course descriptor
Faculty Development Programme Mobile Clinical Skills Unit An Introduction to Simulation: making it work
Course Description This is a comprehensive and interactive two-day course focusing on the development of faculty engaged in simulation-based education onboard the Mobile Clinical Skills Unit (MCSU). The course provides a mixture of theoretical basis and practical application of simulation in training and education. A combination of short presentations and hands-on workshops cover development of learning objectives, scenario design and basics of video debriefing as well as the technical aspects of running the simulators (SimMan / SimBaby) and audiovisual equipment (smots™) onboard the unit. Participants work in small multiprofessional groups with close instructor interaction.
Course Aims To prepare and equip participants for their role as simulation faculty to maximise the educational benefit for their learners from the simulation facilities available to them on the MCSU. To facilitate increased confidence in using mid-fidelity simulation technology to facilitate learning on the MCSU.
Course objectives At the end of this two-day course, participants should have: • clarity as to the role, duties and responsibilities of a MCSU simulation facilitator • been able to identify curriculum focussed learning objectives for scenario-based training sessions appropriate to the clinical setting and clinical staff in the host health board
• designed a basic clinical scenario to achieve those learning objectives
• addressed the challenges of creating an appropriate learning environment on the MCSU • increased confidence in their ability to setup and use SimMan to create realistic clinical scenarios applicable to a multi-disciplinary learner group • developed skills to setup and operate smots™ audiovisual equipment to record activity and enhance debriefing • an increased knowledge of the skills set required for and been observed in their application of facilitated debriefing to ensure achievement of intended learning outcomes
56 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Appendix 2 – Faculty Development Course descriptor
Who should attend? Clinical staff wishing to use the facilities of the MCSU and develop themselves as educators using simulation as a methodology for developing skills and competence in multi professional groups
Course Content The course will provide candidates through short lectures and hands-on workshops, with the opportunity to develop skills as simulation faculty onboard the MCSU. With the majority of the course being undertaken onboard the unit, candidates will have the opportunity to reflect on and develop necessary skills in the three key components of mobile simulation education and training, being: I. equipment II. course design and implementation III. debriefing.
Hands-on sessions with the MCSU equipment will be followed by scenario design and running of multiple scenarios with feedback from experts on the challenging area of debrief.
57 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Appendix 3a – Evaluation form for participants
Evaluation of the Mobile Unit wish Clinical you you particular the the as as repetitive stimulating tedious Any Any like like would would descriptors descriptors organise? organise? interesting pointless baffling you you to to many many that that as as Group Group Use Use irrelevant worthwhile instructive Steering Steering programmes programmes session. session. or or Unit Unit skills skills waste of time valuable predictable threatening Mobile Mobile this this workshops workshops for for Network Network theoretical vague supportive simulators helpful practical describe describe best best suggestions suggestions which which Educational Educational uninteresting any any words words nothing new challenging boring have have the the Managed Managed you you ………………………………………………………………………………………………………… informative Circle Circle Do Skills Skills issues to do with teaching and learning that you would like have more information about?
dull relevant convenient 11. enjoyable Future Visits of the Mobile Unit 12. Contact Information (Optional) Name: Job title: ……………………………………………………………………………………………………… Place of work and email address:…………………………………………………………………………. The mobile clinical skills unit is funded by NES and managed the Clinical Skills Managed Educational Network, who gratefully acknowledge the support of Project Steering Group and the team in Clinical Skills Centre at University of Dundee or feel free to add in others: 13. Any other comments? Very Poor Very Poor all day Excellent skills for excellent care Poor Poor pm CLINICAL SKILLS Managed Educational Network Satisfactory Satisfactory am Good Good Excellent Excellent Evaluation of the Mobile Unit What were the least useful aspects or those that need most improvement? Overall rating of the unit Pre-event organisation Organisation on the day Meals/refreshments Mobile unit facilities Quality of equipment What was your main goal for the meeting? In general, did meeting accomplish this? What were the most interesting or useful aspects of programme?
1. 2. 3. 4. 5. 6. 7. Quality of tutors 9. Before you leave today we would be grateful if take the time to complete this evaluation form. This will help us to improve our services you and ensure that future programmes for the mobile unit meet your needs. Session attended Date: ______Overall Rating Quality of Programme Organisation and Venue Your Expectations and Realisations 8. 10.
58 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Appendix 3a – Evaluation form for participants Appendix 3b – Evaluation form for trainers
Evaluation of the Mobile Unit Evaluation of the Mobile Unit – Educators/Trainers MAYBE NO ………………………………………………………………………………………………………… If yes or maybe, how long do you want between visits? (every 3 months, 6 annually, bi-annually etc) Any other comments? Do you have any suggestions for things that need to be changed / improved added? Do any of these things need to be addressed immediately (before the unit reaches next venue)? Do you want to use the unit deliver education/training again? (Please circle) YES What did you expect of the unit? was different to your expectations?
15. 6. Future Visits of the Mobile Unit 12. 13. 14. Contact Information Name: Job title: ………………………………………………………………………………………………………………… Place of work and email address:……………………………………………………………………… The mobile clinical skills unit is funded by NES and managed the Clinical Skills Managed Educational Network, who gratefully acknowledge the support of Project Steering Group and the team in Clinical Skills Centre at University of Dundee this complete complete Very Poor to to Poor time time Excellent skills for excellent care the the take take Satisfactory CLINICAL SKILLS Managed Educational Network would would
Good you you if if grateful grateful Excellent be be would would we we today today leave leave Evaluation of the Mobile Unit – Educators/trainers Other (please specify):______General information circulated by the NHS Board Part of your normal work (without job being backfilled) Part of your normal work (with job being backfilled) Taken as annual leave Other (please specify): ______General information circulated by the venue Personal contact made from people at the venue The Clinical Skills MEN website Posters advertising the visit Personal contact with the Clinical Skills MEN team (likely Jean Ker/Jeanette Stevenson/Jerry Morse) you you
g. Where did your expectations about the unit come from (please tick all that apply)? a. Was it clear how to use everything? Did you the instruction cards for equipment? Were there any additional instructions you needed? In the pilot phase of project we want to establish where educators’ time has come from, enable us to look at how the unit could be sustained in longer term. Was time you spent on the unit: a. b. c. Did you have / could find everything needed to run your session? Was anything missing? d. Rating of using the unit today b. Potential rating of using the unit c. e. d. f.
evaluation form. 5. 4. Before Before Overall Rating Your Time 2. Your Expectations and Realisations 3. 1. 2.
59 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Appendix 3c – Follow-up survey Contact Information Name: …………………………………………………………………………………………………………………………….. Job title: …………………………………………………………………………………………………………………… Place of work and email address:………………………………………………………………………………………. The mobile clinical skills unit is funded by NES and managed the Clinical Skills Managed Educational Network, who gratefully acknowledge the support of Project Steering Group and team in Clinical Skills Centre at the University of Dundee your are are (include What What public. public. the the Excellent skills for excellent care of of members members CLINICAL SKILLS Managed Educational Network for for education education skills skills for for Unit Unit Mobile Mobile Follow Up Survey - Mobile Unit the the utilise utilise to to keen keen are are What course or skills training did you undertake on the mobile unit? What impact has this training had on your own practice? Please give examples? What suggestions do you have to improve the next visit? What new skills education have you identified that would benefit the service provide? We Additional comments? We are evaluating the impact of unit, to help NES decide whether it should be funded for future use. Thank you for completing the evaluation form after attending a session on unit when it was in Looking Back 1. 2. 3. What were the 3 most useful aspects of visit mobile unit? 1. 2. 3. Looking Forward 4. 5. 6. venue) and for giving us your details. Now that a few months have passed we are keen to review what, if any, lasting impact the visit had on your practice. Please could you take a few minutes to answer the questions below and return by reply this email? feel free to include any additional suggestions or comments. Contact Information (Optional) suggestions for training in your area? 7.
60 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
Appendix 3c – Follow-up survey Appendix 4 - Pack development process
Excellent skills for excellent care adapted for use and monitor use Disseminate Pack disseminated and (co-ordinated by link person) Health boards implement 5 CLINICAL SKILLS Managed Educational Network
Review
Original pack updated. (co-ordinated by link person) new updated version and monitor use Co-ordinator Author group Health board Health boards ensure original pack is replaced with ’critical friends’) by original author group). Process includes: literature and peer reviews; policies/guidelines checked for updated versions. Quality Assure and through the CS MEN) Pack reviewed every two years (or at intervals deemed appropriate (co-ordinated by link person) CSMEN self assessment tool by link person person link (reviewers identified by (by author group peers/colleagues/ Draft pack internally reviewed Draft pack externally reviewed Content ratified by health boards 6 4 Draft workshop quality assured using For further information visit www.csmen.ac.uk/projects/resources
Develop Work collated Work to author group Allocated topics written Literature review disseminated and referenced to evidence base Draft pack developed and refined 3
Establish among authors content agreed and time line set and multi-professionally) Topic distribution agreed Topic participate (ensuring equal Potential authors invited to Literature search conducted Literature search representation both nationally identified; simulated workshop Author group meet - pack content 2
Generic Skills Pack Development Decide Topics identified Topics as link person for pack Best practice identified Subject experts identified and availability of skills education Health boards contacted to aid in: identification of experts in the field and: nominating one named person 1 Current/available resources identified Current/available resources All of CS MEN’s educational packs are mapped to the KSF and can be found by searching the NHS Shared Learning site at www.sharedlearning.scot.nhs.uk/home
61 Evaluation of the pilot of the mobile clinical skills unit 1 January 2009 to 31 December 2010
Acknowledgements
The pilot of the mobile skills unit was managed by the Clinical Skills Managed Educational Network team, who would like to thank the following for their contribution to its success from its inception to the end of the pilot: 1. Professor Philip Cachia, Postgraduate Dean, East Deanery Scotland and Beverley Beasant, NES National Project Officer, for developing the Scottish Clinical Skills Strategy and drawing up the business case for the unit 2. Professor Jean Ker, Clinical Lead CS MEN, for clinical leadership of the project 3. Jeanette Stevenson, Educational Projects Manager CS MEN, for commissioning the design and build of the unit and managing the project throughout the pilot 4. Felicity Garvie, Project Administrator CS MEN, for procuring all equipment and consumables for the unit and organising its deployment throughout Scotland from January – May 2009 5. Sarah Race, Project Officer - Mobile Unit CS MEN, for organising its deployment throughout Scotland from June 2009 onwards and taking responsibility for all operations, including managing relations with venues and trainers 6. Jerry Morse, CS MEN Regional Champion for the North of Scotland, for the many site visits he made and for training and enabling faculty to use the unit on site 7. Dr Nikki Maran, Director, and Dr Simon Edgar, Educational Co-ordinator, of the Scottish Clinical Simulation Centre, for developing and running the faculty development courses to train local educators in the use of the unit 8. Dr Colville Laird, Director of BASICS, for advice and assistance on educational and equipment issues for the unit in its initial phase 9. Michael Jackson, Fleet Manager of Scottish Ambulance Service, for assistance in procuring the chassis and advice on the build 10. The Paediatric Retrieval Teams from the Royal Hospitals for Sick Children in Edinburgh and Glasgow 11. The staff at the Clinical Skills Centre, University of Dundee, particularly the Business Manager, Gordon Clark and his team for technical support in the initial phase of the unit’s deployment 12. Cebotec Ltd, Falkirk, for building the unit, its technical maintenance, driver services and support 13. Members of the original Mobile Unit Working Group for their guidance on equipping the unit, and members of the subsequent Mobile Unit Steering Group, chaired by Richard Carey, CEO NHS Grampian 14. All suppliers of simulation and audio-visual equipment, and consumables for the mobile unit 15. All the local hosts and trainers responsible for the educational programmes for NHS Scotland staff and others that have been run on the unit at remote and rural venues, who are too numerous to mention but whose support has been invaluable to the success of the pilot 16. The CS MEN Regional Champions and all others who have championed the use of the unit in their region.
62 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
63 CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care
www.csmen.ac.uk