WA Health Stroke Education Framework. Operational Guide. · The WA Health Stroke Education Framework (the Framework) is designed for acute and subacute care stroke clinicians across

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WA Health Stroke Education Framework. Operational Guide.

Applying learning to practice

TRAining Centre in Subacute Care (TRACS WA)

Version: 2.0 | Date: 14/03/2016

Updated Version 3.0 Date: 08/05/2018

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Contents Contents .................................................................................................................................... 2

Introduction ................................................................................................................................. 3

Aim of the Framework ...................................................................................................... 3

Design of the Framework ................................................................................................. 3

Components of Framework ....................................................................................................... 4

Stroke learning domains .................................................................................................. 5

Level descriptors .............................................................................................................. 6

Applying the Framework ............................................................................................................ 7

Linking to Quality Health Care Standards ........................................................................ 7

Job Descriptions .............................................................................................................. 7

Professional Development ............................................................................................... 7

Education opportunities ................................................................................................... 7

Stroke Education Resources Sample only ....................................................................... 9

Example of Learning Activties Sample only .................................................................. 12

Education and Training Record Sample only ................................................................. 17

Diagram 1: National Safety and Quality Health Standards……………………………………..4 Diagram 2: WA Health Stroke Education Framework…………………………………………...8

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Introduction

Aim of the Framework

The WA Health Stroke Education Framework (the Framework) is designed for acute and subacute care stroke clinicians across nursing, medical and allied health disciplines to improve stroke education across WA Health. Essentially, it outlines a broad set of minimum requirements around knowledge and skills according to the level of experience that have been identified as fundamental to delivering quality stroke care. This set of knowledge and skills has been developed in consultation with stroke clinicians as well as referenced to clinical literature and existing stroke education resources.

The Framework aims to promote consistency in clinical practices and structured performance development review processes that meet the Australian Council of Health Care Standards (ACHS) National Safety and Quality Health Standards (NSQHS) and EQuIP Content 1 and contribute to the National Health Performance Framework (NHPF)2 reporting. This relationship is illustrated in Diagram 1, which maps Stroke Education to the relevant Standards and aligns with a set of Stroke KPIs which will be collected across WA Health.

The Framework has been developed by the TRAining Centre in Subacute Care WA (TRACS WA) in consultation with the Aged and Continuing Care Directorate under the direction of the WA Stroke Services Director, Dr Andrew Wesseldine.

Design of the Framework

The Framework outlines a fundamental set of broad knowledge, skills and experience around stroke care. The framework is not intended to address individual discipline core competencies, but is a guide to assist staff caring for stroke patients to plan stroke specific learning opportunities across disciplines and across roles. It combines education, learning methodologies, performance improvement and reporting into an overarching professional development strategy that can be translated into all areas of stroke care across metropolitan, regional and remote areas. The Framework is designed to be used flexibly across metropolitan and regional health sites. It is adaptable, having the capacity to support cohesive inter- professional teams that are more flexible and responsive to evidence based changes in practice. It not only recognises the existence of prior learning and established educational support, but facilitates the transfer of learning across professional boundaries. The Framework can be used as a reference document for the development of career pathways, job descriptions for recruitment and the performance management processes.

1 Australian Commission on Safety and Quality in health Care (ACSQHS) (November 2017) Sydney 2 National Health Performance Authority 2012

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Diagram 1 ALIGNING WA HEALTH STROKE EDUCATION AND RELEVANT NATIONAL STANDARDS

NSQHS STANDARDS

WA HEALTH STROKE KPIS WA Stroke

Model of Care Recommendation

NSQHS / EQuIP (Second Edition)

Acute Stroke Clinical Care

Standard RoGS

1. Governance for Safety and Quality in Health Organisations

2. Partnership with Consumers

3. Preventing & Controlling Healthcare Associated Infections

4. Medication Safety 5. Patient Identification and

Procedure Matching 6. Clinical Handover 7. Blood and Blood Products 8. Preventing and managing

Pressure Injuries 9. Recognising and responding to

Clinical Deterioration in Acute Health Care

10. Preventing Falls and Harm from Falls

EQuIP Standards 11. Service Delivery 12. Provision of Care 13. Workforce Planning and

Management 14. Information management 15. Corporate Systems and Safety

1. Receiving Stroke Unit Care a. Admission into a stroke unit

3, 4, 7 1.33, 6.3, 6.4, 6.5, 6.6 3 Effectiveness

2. Receive intravenous thrombolysis if ischaemic stroke

5 1.15, 4.1, 4.3, 4.4, 8.9, 8.10, 8.13

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3. Brain Imaging 4 8.9, 8.10, 8.13

4. FeSS Management 12 4.4, 5.1, 5.4, 5.5, 6.4, 6.6

5. Aspirin within 48 hours of stroke onset if ischaemic stroke

3 4.1, 4.2, 4.3, 4.5, 4.6, 4.7, 4.11

Efficiency

6. Early rehabilitation a. Assessment by PT within 48hrs b. Rehab within 48hrs of assessment

7 1.27, 1.33, 2.5, 2.6, 2.7 4

7. Minimise risk of another stroke 12 2.5, 2.6, 2.7 5

8. Transition from hospital care a. Written care plan b. Discharge summary sent to GP

10, 12, 13 2.5, 2.6, 2.7, 4.3, 4.5, 4.6, 4.7, 4.8, 5.13, 5.14, 5.19

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9. Further rehabilitation a. Patient met with MDT team to

discuss care plan b. Rehabilitation goal setting

c. Referred for further rehab

8 2.5, 2,6, 5.13, 5.14, 5.17, 5.25, 6.4, 6.6

10. Carer training and support a. Carer support needs assessment b. Carer training

8 1.19, 1.20, 1.21, 1.25, 1.26, 1.27

6 Equity

11. TIA Management 6, 12 8.3, 8.4, 8.6, 8.9, 8.13

12. Annual Education 14,15 1.22, 1.23, 1.24, 1.28

Clinical

Intervention Procedural Interpersonal Organisational Policy

LEARNING DOMAINS

Ethical

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Components of the Framework

Stroke learning domains

A central theme of the Framework is that it is not discipline specific but supports existing professional competencies by identifying broad areas of knowledge and skills that are part of the spectrum of good clinical practice in the area of stroke care.

For the purposes of this document knowledge and skills can be defined as:

o Knowledge: What do I need to know?

o Skills: How do I apply what I know?

A third factor is experience which can be defined as:

o Experience: How do I maintain and improve my knowledge and skills?

This broad set of skills, knowledge and experience is aligned to six learning domains which

have been guided by those identified in the Australian Stroke Specific education framework3.

These are:

1. Clinical Intervention

2. Procedural

3. Interpersonal

4. Organisational

5. Ethical

6. Policy

Clinical staff will work towards and demonstrate this broad set of knowledge and skills identified as fundamental to providing quality stroke care.

3 Australian Stroke Coalition

Level descriptors

Specific knowledge and skills can be categorised according to the degree of understanding expected for each area by a set of level descriptors. Experience is the level of familiarity and proficiency expected. These are:

NEW PRACTITIONER

The level of knowledge and skill required is general and the clinician operates best when guided by specific instructions, boundaries and support.

New graduate or person returning to clinical practice after a significant absence.

CURRENT PRACTITIONER

The level of knowledge and skills is detailed on a factual level and practices demonstrated are technically sound and replicated, based on what has been learned from previous experiences.

1 – 3 years continual practice

EXPERIENCED PRACTITIONER

The level of skill and knowledge is comprehensive with a detailed understanding of the theory underpinning practice. The experienced practitioner is a role model to the less experienced practitioner providing opportunities to discuss and reflect on practice.

3+ years’ experience and continual practice

STROKE TEAM LEADER

The level of skills, knowledge and experience calls for the ability to critically examine, evaluate, plan and apply the application of theories within the area of practice and seek out opportunities to learn and facilitate learning in others.

Management, Senior Specialist or Lead positions

The Framework recognises the diverse range of roles that contribute to the overall journey and care of the stroke patient, as well as the level and intensity of input. For each of these roles, the level of knowledge and skill required is determined by a range of factors such as the specific role within the stroke unit, geographical location, level of staffing and ready access to specialist expertise and equipment.

In particular it promotes practical, interdisciplinary and collaborative learning opportunities to improve health outcomes for patients who experience a stroke that can be directly linked to nationally recognised quality health care standards.

Clinicians can determine their current level and identify which level they need to aim for

themselves and / or with input from their direct supervisor.

Applying the Framework

Linking to Quality Health Care Standards

A key objective in the design of the Framework has been to align it to the Australian Council on Healthcare Standards (ACHS) National Safety and Quality Health Service Standards 2nd Ed. (NSQHS) and EQuIP Content and the National Health Performance Framework (NHPF). The framework can assist health sites to identify gaps between current and best practice outcomes for stroke patients and implement evidence-based improvement strategies. TRACS WA has developed a quality improvement guide called “Aiming for Excellence: A Guide for Subacute Care” that can assist stroke units to assess how well they are achieving best practice standards and can be used to assess progress against the National Safety and Quality Health Service Standards (NSQHS), EQuIP Content and the WA Stroke KPIs. A copy of the tool is located on the TRACS WA website www.subacutecare.org.au.

Job Descriptions The Framework is a reference point to help determine the level of knowledge, skills and experience required for particular roles within a Stroke unit. The framework recognises the diverse range of roles that contribute to the overall journey and care of the stroke patient, and the factors that influence degree of knowledge and skill that is expected of individual staff caring for stroke patients.

Professional Development The Framework supports existing professional development processes within WA Health. Health professionals in consultation with their line manager can refer to the Framework to address skills gaps as well as career progression opportunities.

Education opportunities

The Framework provides a pathway to Stroke educaiton and training opportunities. The TRACS WA website (www.subacutecare.org.au) provides a comprehensive list of training resources that can be accessed by all WA health professionals. At the end of this document are examples of what is currently available to staff.

Diagram 2: WA Health Stroke Education Framework Level Descriptor

New Practitioner New Graduate Clinician returning to work

Existing Practitioner 1-3 years continuous practice

Experienced Practitioner/ 3+ years’ experience /continuous practice/ Leadership position

Stroke Team Leader Leadership / Management position

Learning Domains

Knowledge/ Skills/ Experience

Knowledge / Skill Knowledge / Skills Knowledge/ Skills Knowledge / Skills

Clinical Intervention

Basic Neuroanatomy Physiology and presentation of Stroke (CNS, cerebrovascular & cardiac systems) Signs and symptoms of Stroke (FAST) Risk factors and assessment Screening tests, early treatment and timeframes (vital signs, ABCDs) Pharmacological & non-pharmacological interventions ADL rehabilitation

Complications after stroke Time frame of changes Future risk of stroke/TIA Prevention Strategies Identification & treatment of stroke mimics Types of aphasia Stroke specific assisting and facilitating patient movement & positioning Bladder management Neuro assessment Discharge planning

Relevant methods of nutrition Assess motivation and augment management Stroke recovery pathways and meeting consumer expectations Management of cognitive problems

Procedural

Recovery pattern of stroke Understanding terminology Services available Stroke specific manual handling Accurate completion of paperwork

Terminology between professions Take & interpret thorough history & assessing mental capacity Pathway from acute to subacute Goal setting in Action Patient handover

Treatment plans – how to address treatment drop-outs Referrals to other agencies and services Patient flow practices Delegation

Interpersonal

Cultural awareness Principles of Goal setting Person Centred Care

Enabling strategies for patients Family dynamics- implications for lifestyle Person & family / carer led management

Interprofessional team building Negotiation skills Conflict resolution

Negotiating opportunities to work across health services Handling complaints

Organisational

Interprofessional practice Interprofessional practice Assess services available locally Assessment of psychological, physical, emotional & relationship problems for referral

Enabling Interprofessional practice Facilitating Stroke pathway Protocols for imaging & reporting Equipment, adaptations & assistive technology Maintenance plans Information sharing Implementing Quality improvement

Service coordination Community engagement Identify hard to reach groups Implement information sharing Local & regional pathways for transfer All agency involvement

Ethical

Methods of changing behaviour assuring adherence to therapy The principles of chronic condition self-management, self-efficacy, community integration.

Create an open & honest environment for stroke survivors and families Social & relationship changes for survivor & carer(s)

Translate the views of those affected by stroke into service planning, development, delivery & monitoring

Incorporating ethics into Stroke unit Advocacy & methods for empowering people with stroke

Policy Stroke policy development Inter –unit handover

Clinical Risk Management

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Stroke Education Resources SAMPLE ONLY Below is a list of resources available to Stroke clinicians. The list is not exhaustive but provides clinicians with a guide of what is available and where it is located. More resources are located on the TRACS WA website www.subacutecare.org.au including:

A repository of stroke specific literature and resources;

A calendar of stoke specific educational events.

An online portal to access stroke related resources

Resource Learning Domains

New Practitioner

Current Practitioner

Experienced Practitioner

Team leader

Broad Information

NSF Rehabilitation Stroke Services Framework (2013) http://strokefoundation.com.au/health-professionals/national-stroke-services-frameworks/

Clinical

Intervention, Organisational

, Policy

NSF Acute Stroke Services Framework (2015) http://strokefoundation.com.au/health-professionals/national-stroke-services-frameworks/

Clinical Intervention,

Organisational, Policy

WA Health Model of Care” Stroke Services (2012) https://healthpoint.hdwa.health.wa.gov.au/search/pages/results.aspx?sq=1&k=Stroke%20Model%20Of%20Care

Clinical

Intervention,

Organisational, Policy,

Ethical

General Stroke e-learning resources

e-Stroke (national Stroke Foundation Australia) – www.estroke.com.au Clinical

Intervention, Procedural

STARS (Scotland NHS) www.stroketraining.org Clinical

Intervention, Procedural

SCoT (Scotland NHS) www.scotonline.org Clinical

Intervention, Procedural

SARRAH (Services for Australian Rural and Remote Allied Health) http://sarrah.org.au/content/resources

Clinical

Intervention, Procedural

Resource Learning

Domains

New

Practitioner

Current

Practitioner

Experienced

Practitioner

Team

leader

Clinical Guidelines

NSF: Stroke Clinical Guidelines for Stroke Management (2017) http://strokefoundation.com.au/health-professionals/clinical-guidelines/

Clinical

Intervention, Procedural,

Organisational

, Policy, Ethical

WA Health Services Stroke Clinical Guidelines onsite e.g. http://cmsdata.smahs.health.wa.gov.au/default.aspx?stream=inline&ID=50336&FileName=stroke.pdf https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/NMAHS/SKHS/Cl_CC126_Thrombolysis_in_Acute_Stroke.pdf

Clinical

Intervention, Procedural,

Organisational, Policy,

Ethical

Research

Stroke specific Research review articles http://www.researchreview.com/au/Clinical-Area/Neurology/Stroke.aspx

Clinical

Intervention,

Policy

Interpersonal

Being Age Friendly http://online.communitywest.com.au/

Interpersonal,

Ethical, Policy

Communication skills http://intranet.health.wa.gov.au/trainingcourses/events/event.cfm#140

Interpersonal,

Ethical,

Organisational

Interprofessional Practice https://www.ecu.edu.au/community-engagement/health-advancement/interprofessional-learning-resources/overview https://healthsciences.curtin.edu.au/faculty/ipe.cfm

Organisational

, interpersonal,

policy

SCIPE Supervisor’s Manual Subacute Care Interprofessional Education

http://www.subacutecare.org.au/j/index.php/scipe-2

Organisational

, policy

Resource Learning Domains

Essential Practitioner Experienced Practitioner

Team leader

Leading and Managing Teams http://intranet.health.wa.gov.au/trainingcourses/events/event.cfm#85

Interpersonal,

Ethical, organisational,

policy

Aiming for Excellence – A guide for subacute care www.subacutecare.org.au

organisational,

policy

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Example of Learning Activties – Sample only

Below is a list of learning activities recommended for stroke clinicians at different levels in their career. This list is not exhaustive but is a guide only to assist clinicians direct their learning to achieve the required level of knowledge and skill as outlined in the Framework.

Learning Activities

New (New Graduate / returning to work)

Current (1- 3years) Experienced Team leader

All staff new to stroke

Meet with supervisor re planning for your stroke education program – identify discipline specific skill/ knowledge gaps

Access Stroke resources at www.subacutecare.org.au and add to favourites

Read NSF Clinical Guidelines Read site specific clinical

guidelines Identify relevant Stroke

Service pathway Register to access e-stroke

online learning program. Work through e stroke

modules Establish contact with your

Service Stream Discipline Lead Familiarise yourself with

Stroke community/ support services in your area

Contact discipline Stroke Interest group to arrange to attend next meeting

Observe clinical handover Request opportunity for skills

exchange Present case at

interdisciplinary meeting

Consider post grad

qualification

Review progress against

knowledge and skills

required in role

Participate WA Health

Stroke education

opportunities

Continue to complete e

stroke online modules

Attend discipline specific

interest group (if

available)

Visit the agencies that

refer stroke patients to

you and those to whom

you refer

Participate in case

review discussions with

team

Review your learning

progress with supervisor

Participate Stroke CoP

Participate in Skills

exchange

Work towards post grad

qualification

Review progress against

knowledge and skills

required in role

Network with stroke

practitioners

Initiate mentoring to

less experienced stroke

clinicians

Lead case review

discussions with team

Initiate skills exchange

Present at Stroke

interest groups or

similar

Participate in quality

improvement activities

Work towards post grad

qualification

Review progress against

knowledge and skills

required in role

Quality and or case

study

Attend a Stroke

Conference at least

every two years -

Represent your service/

discipline or state in a

Stroke related Group

Network with stroke

practitioners

Facilitate skills

exchange

Facilitate in quality

improvement activities

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Learning Methodologies

While there are multiple educational resources available to staff who are interested in learning more about stroke, the challenge is how to best plan for educational opportunities in a busy clinical environment. Staff are encouraged to identify their own knowledge and skills gaps and source educational opportunities to meet their learning requirements. These methodologies are not discrete but should be combined to achieve the most effective results. Learning Description

Continuous Learning Continuous learning is about expanding one’s skills set so that a professional is flexible enough and able to adapt to changes in the work environment. The changes may be in clinical practice, technological advancements or reporting procedures. . It can be achieved through:

o Day to day clinical practice o Observing and discussions with experienced colleagues o Asking for help from a colleague when something is not understood o Accessing on site and off site training opportunities

Workplace learning Workplace learning is when activity in the workplace is in fact driving learning and development. This means that in a health setting learning is being dictated by the needs of the patients, is evidence based and leads to an improvement in the quality of care delivered4. Workplace learning is one of the most effective methods for consolidating new skills learned from another educational setting. Examples may include:

o Mentoring by experienced colleagues o Shadowing clinicians in the workplace o Supervision o Peer feedback o Reflective practice (including case studies) o Team meetings with educational focus o Journal clubs o Building partnerships with other health sites, particularly between regional and metropolitan, o Peer consultation groups

4 Manley, K., Tichen, A& Hardy, S., 2009. “Work-based learning in the context of contemporary health care education and practice: A concept analysis.” Practice

Development in Health Care, 8(2), pp.87-127.

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E learning

E-learning is a flexible method of learning, particularly for those in remote regions as well as those who work part time or are unable to attend onsite training. It can be supported through a variety of technologies including desk top computers, laptops, mobile devices, and web based applications such as email and social networking sites. E-learning is often used as a pre- or post- exercise to support and consolidate a face to face and workplace learning. Examples may include:

o Online competency-based modules

o Online learning tailored to specific learning gaps

o Webinars

o Streamed presentations

o Virtual classrooms

o Forums

Face to face Face to face learning opportunities will always be an integral component of any educational program. Group education provides the opportunity for spontaneous discussion and exploration of topics relevant to the learner’s area of interest. Face-to-face education may be provided internally, or by other organisations both external to and within WA Health. Examples may include but are not limited to:

o Orientation workshops

o Specific key knowledge and skills based workshops

o Seminars

o Community agency / Peak Body presentations

o Joint educational events

Interprofesional Learnig Interprofessional learning can be defined as:

learning arising from interaction of members of two or more professions. This may be a product of interprofessional education or happen spontaneously in the workplace or in education settings.5

A valuable outcome of incoporating Interprofessional learning within stroke units is the increase in communication and collaboration between professions in the workplace and will only serve to improve the overall quality of care for the patient.

Evidence based practice Evidence based practice is a component of continuous learning and allows health professionals to integrate the best available information with person centred care into their current working environment6.It combines background core clinical knowledge and

5 Freeth, D., Hammick, M., Reeves, S., Koppel, I., & Barr, H., 2005. “Effective Interprofessional Education: Development, Delivery and Evaluation:, Oxford, Blackwell

publishing..

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skills with researched knolwedge. The clinician applies the knowledge and skills in the workplace on a case by case basis thereby continuing the learning journey. Evidence based practice can be used to address knowledge and skills gaps in the workplace.

Skills Exchange Program The Skills Exchange Program is characterised by the sharing of professional learning and skills between a specific group of professionals who have common practices, work environments, goals and client groups. Informal linkages and skills exchanges are already a feature of the WACHS service. This program seeks to manage the process to achieve more coordinated and sustained outcomes

7 and will be supported by processes brokered by TRACS WA.

Telehealth Telecommunications technology provides the opportunity for face to face interactions of health workers in remote regions with health care experts located in metropolitan areas.

Examples of this type of technology include

o Telehealth

o Scopia

o Skype

Reflective practice Reflective Practice Is a way of reviewing your own practice to improve the way you work. It is very useful for health professionals who want to continue learning throughout their lives. The act of reflection is a great way to increase confidence and become a more proactive and qualified professional.

6 Sackett, DL., Straus, SE., Richardson, WS., Rosenberg, W., Haynes, RB., eds.2000. “Evidence Based Medicine: How to to Practice and Teach.” EBM, 2nd Ed.London, UK:

Churchill Livingstone: 15-18. 7 Subacute Skills Exchange Framework, ACCD 2011 updated 2018

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Learning Tools The TRACS WA website provides a suite of tools that support existing Performance Development Review processes. For example, a key supporting tool that can be incorporated into existing performance-related documentation is the WA Stroke Interprofessional Education and Training Record .This tool will be available to download from the dedicated WA Stroke Services section of the TRACS WA website.

It is designed to assist staff to identify their current level of knowledge and skills, reflect on their practice and plan a development pathway that can be used as part of the generic learning and development cycle illustrated below. The record can also be used as a formal component of the Performance Development Review process to support stroke data reporting and overall organisational professional development reporting requirements.

The overall learning and development plan is a living document that should be updated as actions are completed. Ideally, the whole plan should be revisited every three months but it really depends on the number of and complexity of activities recorded.

Identify (Identify areas for

development)

Plan (Plan how to develop

SKA–what resources/support do I

need?)

Action (Implement action within set

timeframe)

Review (Review – do

I need to take any further action?)

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Education and Training Record Sample only The Stroke Services Interprofessional Education and Training Record is used in conjunction with PDR to identify areas of development for health professionals delivering Stroke Care.

Record supporting evidence to indicate proficiency is being achieved through observation, demonstration of skill acquisition, reflective practice and professional development.

Name:_____________________________________ Date:__________ Level (circle correct level) NP C P EP L

Learning Domain

Current Areas for Development

External L & D Activities Undertaken

Internal L & D Activities Undertaken

Resources Utilised Links/Mentor Identified

Evaluation Methodology

Clinical Intervention

Ex: Physiology & presentation of stroke Signs & symptoms of stroke (FAST) Risk factors & assessment

Ex: TRACS COP (MNWC) Ex: Case study Stroke specific training modules/sessions(RITH) Stroke education sessions (WACHS)

Ex: e-Stroke (NSF) TRACS WA (Learning Activities Plan to address Clinical Skill Gaps) Medications after stroke (NSF)

Ex: Stroke Coordinator

Ex: Supervision Certificates of completion

Procedural Screening tests – vital signs, ABCDs Use of assessment tools ADL rehabilitation

Simulation Workshop Neurology Inpatient Core Competencies (SCGH)

WA Model of Care: Stroke Services (2012) Risk stratification tool for TIA

Telehealth with all facilities

Reflective Practice Certificates of completion Supervision

Interpersonal Person Centred Care e-learning –Being Age Friendly

Certificate of completion Peer and patient feedback

Organisational N/A

Ethical The principles of chronic condition self-management, self-efficacy, community integration.

Intro to motivational interviewing

Reflective practice - journal Peer networking Certificate of completion Peer and patient feedback

Policy N/A