Welsh School of Anaesthesia Welshschool.Co.Uk

Welsh School of Anaesthesia – welshschool.co.uk Trainee Name ……………………………………

Core Level Critical Incident Log Book

This is a curriculum based critical incident log book for core level training. Trainees and simulation trainers should use this log book to identify training requirements (as trainees move between hospitals).

The log book does not dictate in what order critical incidents should be taught - critical incidents 13 to 30 (advanced) can precede critical incidents 1 to 12 (basic). Managing these scenarios can be assessed with CEX or CBD.

6 critical incident skills which can be assessed using DOPS (or CEX or CBD) are also included.

The use of simulation for teaching and assessment is expected to cover many of the scenarios as trainees may not come across them during the course of clinical practice.

Critical incidents encountered within clinical practice should have a reflective e-portfolio entry. This is not necessary if the incident is encountered during simulation training.

Evidence of critical incident training experience also includes:  Resus course certificates (ALS / ATLS / APLS / MEPA / CRISP / other).  Presentations of critical incidents at quality and safety meetings.  Evidence of submitting serious incident reports.  Producing or contributing to clinical risk guidelines.  Teaching on relevant courses.

Revision date: This log book should be revised in response to syllabus or training changes.

Revision history

Version 1 October 2016. Version 2 August 2017 Version 3 October 2017

1 Welsh School of Anaesthesia – welshschool.co.uk Trainee Name …………………………………… Guidance for completion

All core trainees need to complete the critical incident module

1. Trainees are required to complete at least one DOPS,CEX and CBD for the module sign off on eporfolio.

2. Trainees are required to show evidence of completion of the Welsh School of Anaesthesia critical incident logbook at ARCP (as per checklist)

The logbook is designed as a personal record/reflection of critical incidents and can be signed and completed by trainees :

Management of critical incident (1-30)

 Tick the experience of critical incident e.g. clinical, informal discussion, simulation, meeting, incident report or other relevant setting.  Trainee date and sign entry.  Tick CBD, DOPS or CEX if completed and add to eportfolio.  Trainee should add detail to each incident eg reflection of incident, course attended, teaching, risk meeting etc….

Critical incident skill

 This section focuses on generic skills eg non technical, situational awareness.  Tick the experience, add detail/reflection and date and sign.  Tick CBD, CEX or DOPS if completed and add to eportfolio.  This section lends itself to having been on courses eg simulation or resus where all of these skills can be demonstrated together in practice. Reflect on the courses.

The document is designed to help trainees cumulatively log their critical incidents. Trainees should aim to add to it during their training and complete each section by completion of core training.

2 Welsh School of Anaesthesia – welshschool.co.uk Trainee Name …………………………………… Core Level Critical Incident Logbook

Management of Critical Incident Experience ePortfolio (Basic) (tick) (tick if required)  Simulation training  CBD 1.Cardiac and/or respiratory  Clinical experience Date …………………….  CEX arrest  Informal discussion  M&M meeting Signature  Reflection  Critical incident report ……………..  Simulation training  CBD 2.Unexpected fall in SpO2 with  Clinical experience Date …………………….  CEX or without cyanosis  Informal discussion  M&M meeting Signature  Reflection ……………..  Critical incident report  Simulation training  CBD 3.Unexpected increase in peak  Clinical experience Date …………………….  CEX airway pressure  Informal discussion  M&M meeting Signature  Reflection  Critical incident report ……………..  Simulation training  CBD 4.Progressive fall in minute  Clinical experience Date …………………….  CEX volume during spontaneous  Informal discussion  Signature  Reflection respiration or IPPV M&M meeting  Critical incident report ……………..  Simulation training  CBD 5.Fall in end tidal CO2  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature  Reflection  Critical incident report ……………..  Simulation training  CBD 6.Rise in end tidal CO2  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature  Reflection  Critical incident report ……………..  Simulation training  CBD 7.Rise in inspired CO2  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature  Reflection  Critical incident report ……………..  Simulation training  CBD 8.Unexpected hypotension  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature  Reflection  Critical incident report ……………..  Simulation training  CBD 9.Unexpected hypertension  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature  Reflection ……………..  Critical incident report  Simulation training  CBD 10. Sinus tachycardia  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature  Reflection ……………..  Critical incident report  Simulation training  CBD 11. Arrhythmias:  Clinical experience Date …………………….  CEX  Informal discussion  ST segment changes  M&M meeting  Reflection  sudden tachyarrythmias  Critical incident report Signature  sudden bradycardia ……………..  ventricular ectopics  broad complex tachycardia  ventricular fibrillation

 Simulation training  CBD 12. Convulsions  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting  Reflection 3 Welsh School of Anaesthesia – welshschool.co.uk Trainee Name ……………………………………  Critical incident report Signature ……………..

4 Welsh School of Anaesthesia – welshschool.co.uk Trainee Name ……………………………………

Management of Critical Incident Experience ePortfolio (Advanced) (tick) (tick if required)  Simulation training 13. Difficult/failed mask  CBD  Clinical experience Date …………………….  CEX ventilation  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training  14. Failed intubation CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training 15. Can’t intubate, can’t ventilate  CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training  16. Regurgitation/Aspiration of CBD  Clinical experience Date …………………….  CEX stomach contents  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training 17. Laryngospasm  CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training  18. Difficulty with IPPV, sudden CBD  Clinical experience Date …………………….  CEX or progressive loss of minute  Informal discussion  M&M meeting Signature ……………..  Reflection volume  Critical incident report

 Simulation training  19. Bronchospasm CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training 20. Pneumothorax and tension  CBD  Clinical experience Date …………………….  CEX pneumothorax  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training  21. Gas / Fat/ Pulmonary CBD  Clinical experience Date …………………….  CEX embolus  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training 22. Adverse drug reactions  CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training  23. Anaphylaxis CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting Signature ……………..  Reflection  Critical incident report  Simulation training 24. Transfusion reactions,  CBD  Clinical experience Date …………………….  CEX transfusion of mis-matched  Informal discussion  M&M meeting Signature ……………..  Reflection blood or blood products  Critical incident report

 Simulation training 25. Inadvertent intra-arterial  CBD  Clinical experience Date …………………….  CEX 5 Welsh School of Anaesthesia – welshschool.co.uk Trainee Name ……………………………………  Informal discussion Signature ……………..  Reflection injection of irritant fluids  M&M meeting  Critical incident report  Simulation training 26. High spinal block  CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting  Reflection  Critical incident report Signature ……………..  Simulation training  27. Local anaesthetic toxicity CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting  Reflection  Critical incident report Signature ……………..

 Simulation training  28. Accidental decannulation of CBD  Clinical experience Date …………………….  CEX tracheostomy or tracheal  Informal discussion  M&M meeting  Reflection tube  Critical incident report Signature ……………..

 Simulation training  29. Coning due to increased CBD  Clinical experience Date …………………….  CEX intracranial pressure  Informal discussion  M&M meeting  Reflection  Critical incident report Signature ……………..

 Simulation training  30. Malignant hyperpyrexia CBD  Clinical experience Date …………………….  CEX  Informal discussion  M&M meeting  Reflection  Critical incident report Signature ……………..

6 Welsh School of Anaesthesia – welshschool.co.uk Trainee Name ……………………………………

Critical Incident Skill Experience ePortfolio (tick) (tick if required)  Simulation training  CBD Demonstrates good non-technical  Clinical experience Date …………………….  CEX skills:  M&M meeting  DOPS Signature ……………..  effective communication  Critical incident report  Reflection  team-working  leadership  decision-making  high situation awareness  Simulation training  CBD Demonstrates the ability to recognise  Clinical experience Date …………………….  CEX early a deteriorating situation by  M&M meeting  DOPS Signature …………….. careful monitoring.  Critical incident report  Reflection

 Simulation training  CBD Demonstrates the ability to respond  Clinical experience Date …………………….  CEX appropriately to each incident listed  M&M meeting  DOPS Signature …………….. above.  Critical incident report  Reflection

 Simulation training  CBD Shows how to initiate management of  Clinical experience Date …………………….  CEX each incident listed above.  M&M meeting  DOPS Signature ……………..  Critical incident report  Reflection  Simulation training  CBD Demonstrates ability to recognise  Clinical experience Date …………………….  CEX when a crisis is occurring.  M&M meeting  DOPS Signature ……………..  Critical incident report  Reflection  Simulation training  CBD Demonstrates how to obtain the  Clinical experience Date …………………….  CEX attention of others and obtain  M&M meeting  DOPS Signature …………….. appropriate help when a crisis is  Critical incident report  Reflection occurring.