The Development of a Cardiothoracic and Oesophageal Teaching and Assessment Programme for Nurses, Surgical Assistants, Physiotherapists and Allied Health.

The Development of a Cardiothoracic and Oesophageal

Teaching and Assessment Programme for Nurses, Surgical Assistants, Physiotherapists and

Allied Health Professionals

Mike Poullis

Why ?

• Large staff turnover secondary to expansion

• MMC• FY 1 and 2 “Float through”• ALERT

© course – no assessment, and not

Cardiothoracic• High ITU readmission rate• Large number of critical incidents could

have been preventable

Solution

• Educate– Doctor– Nurses, Surgical Assistants, Physiotherapists

and Allied Health Professionals

• Course with assessment

Lectures

• Every week• Same day, time, and place• Start at the beginning• Cover whole Cardiothoracic and

oesophageal surgery• Didactic, with questions at end• Encourage ideas for new topics• Rolling talk schedule

Topics• Anatomy, physiology and pathology of the heart• Anatomy, physiology and pathology of the lung• Thoracic surgery• Low BP in cardiac surgery patients• Oesophageal surgery• CABG, coronary anatomy, on and off pump surgery and conduits• Inotropes• ITU and Ward Rounds• Thoracic surgery complications• Pre op tests in Cardiothoracic surgery• ECG interpretation• Coagulation• Innovations in thoracic surgery• Aneurysms

Format of lectures

• Anatomy• Physiology• Basic science• Pathology• Surgery of heart, lungs, and oesophagus• Complications applicable to everyday

practice

• AS MANY PICTURES AS POSSIBLE

Techniques• Different pathologies

– Lung cancer– Pneumothorax– Pleural effusions– Lung biopsies

• Different operations– Bronchoscopy & oesophagoscopy– Mediasteinoscopy– Mediasteinotomy / Chamberlains– Thoracoscopy VATS– Mini thoracotomy– Full thoracotomy– Pneumonectomy / Lobectomy / Wedge

• Chest drains• Post operative care

Complications• Air Leak• Atalectasis• Sputum Retention • Chest Infections• Atrial Fibrillation• Bleeding• Wound Infections• MRSA• Bronchopleural Fistula• Post Pneumonectomy Problems• Post Pneumonectomy Empyema• Lobectomy Space Problems• Medical Problems• Recurrent Disease• Inadequate Resection

Advertise

• Notice on every ward surgical and medical

• Email

• Student nurse turnover

• All available at

http://www.mpoullis.com/nurse%20talks/Nurse.htm

Course With Assessment

• ALERT ©

• SAVE more lives

• REACT course– REcognition And Correct Treatment

REACT Course

• Based on ACLS, and ALERT© course principles

• Unlike ALERT© it is free

• In course assessment• Test before start of day to make people read

manual• Give whole course away on website

http://www.mpoullis.com/alert/react.htm

Format Of REACT

• Introduction• Health and safety• Assessing the critically ill patient• Clinical cases and scenarios 1-7• Clinical cases and scenarios 8-13• Summary• Hands on practical and Assessments• Feedback and questions

Hands On Practical And Assessments

• Airway (Consultant anaesthetist)

• Rhythm recognition (ALS instructor)

• Recognition and management of sick patients (Ward sisters)

• Case studies (Consultant Surgeons)

Case Studies

• Breathless• Hypotensive• Oliguric• Generally unwell• High or low glucose• Low oxygen saturations• High / low heart rate• Unconscious• Positive fluid balance• Pain• Abnormal Labs – Creatinine, and clotting• High temperature• Post Pneumonectomy problems

Assessment

• Core and specific dimensions in the NHS KSF

• Each dimension has 4 levels

Core Dimensions

1. Communication.

2. Personal and people development. 3. Health, safety and security.

4. Service improvement.

5. Quality

6. Equality and diversity.

Specific Dimensions - Total of 24

• Health and Wellbeing

• Estates and Facilities

• Information and Knowledge

• General

Levels

1 Undertake tasks related to the assessment of physiological and/or psychological functioning

2 Contribute to the assessment of physiological and/or psychological functioning

3 Assess physiological and/or psychological functioning and develop, monitor and review related treatment plans

4 Assess physiological and/or psychological functioning when there are complex and/or undifferentiated abnormalities, diseases and disorders and develop, monitor and review related treatment plans

Simplified

• Course attendance

• Airway

• Rhythm recognition

• Assessing the critically ill

• Cases

Feedback Forms

• 20 maximum

• Don’t mix doctors and nurses unlike ALERT

• Distribute manual a few weeks before course

Accreditation

• SCTS Applied

• ALERT Course not accredited with– Resuscitation council– Department of Health

• Not a CNST requirement

ALERT

• Advantages– Well known– Well structured– Great for general surgery

• Disadvantages– Not Cardiothoracic and oesophageal– No assessment– Doctors and nurses mixed– Not accredited– Cost– Rigid

REACT

• Advantages– Cardiothoracic and oesophageal– Assessment– Doctors and nurses not mixed– Cost– Kudos for our unit

• Disadvantages– Not well known– Not accredited Applied to SCTS– No track record

Part Of A Wider Teaching Program

• Courses

• Web Based teaching

Courses

• Imaging in Cardiothoracic and oesophageal surgery

• Perfusion

• Terms and techniques in aortic surgery

• Basic Science and Cardiothoracic Surgery

• http://www.mpoullis.com/courses.htm

Web Based Teaching

• Cardiac• Thoracic• Oesophageal• Aortic• Basic Science

• http://www.mpoullis.com/teaching.htm#Doctor_

Any Questions

DVDs at the front www.mpoullis.com