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FASP Fetal Cardiac Ultrasound Education in UK

FASP Fetal Cardiac Ultrasound Education in UK. BMUS Summer School 24th June, 2017 University College Dublin. Dr Rita Phillips Consultant Sonographer Advisor FASP UK Senior lecturer UWE. Bristol Advanced Practitioner Ultrasound RUH NHS Trust Bath. UK National Screening Committee (UKNSC).

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FASP Fetal Cardiac Ultrasound Education in UK

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  1. FASP Fetal Cardiac Ultrasound Education in UK BMUS Summer School 24th June, 2017 University College Dublin Dr Rita Phillips Consultant Sonographer Advisor FASP UK Senior lecturer UWE. Bristol Advanced Practitioner Ultrasound RUH NHS Trust Bath

  2. UK National Screening Committee (UKNSC) • Population screening programmes • NHS abdominal aortic aneurysm (AAA) programme • NHS bowel cancer screening (BCSP) programme • NHS breast screening (BSP) programme • NHS cervical screening (CSP) programme • NHS diabetic eye screening (DES) programme • NHS fetal anomaly screening programme (FASP) • NHS infectious diseases in pregnancy screening (IDPS) programme • NHS newborn and infant physical examination (NIPE) screening programme • NHS newborn blood spot (NBS) screening programme • NHS newborn hearing screening programme (NHSP) • NHS sickle cell and thalassaemia (SCT) screening programme • Screening and quality assurance (all programmes) FASP UK Fetal cardiac training project 2015-2017

  3. Fetal Anomaly Screening Programme Combined Screening Test/NIPT CRL between 45mms and 84mms Quadruple test between 14+2 weeks to 20 weeks Fetal anomaly screening 18+0 to 20+6 (completed by 23 weeks) FASP UK Fetal cardiac training project 2015-2017

  4. FASP • Policy • Standards • Education • Information for • Professional • Women • Quality assurance • Service specification • Operational guidelines FASP UK Fetal cardiac training project 2015-2017

  5. The National FASP Team • Andrew Rostron – ANNB Programmes Lead • Annette McHugh – Programme Manager • Shirley Vickers – Project Lead • Liane Powell –Project Lead • Tessa Morgan– Data Manager • Steve Kawandami – IT Specialist • Lorraine Martin – Project Support Officer • Advisors • Mr Pranav Pandya – Clinical Advisor and chair of the steering group • Dr Rita Phillips – Sonography Advisor • Professor David Wright – DQASS • Ian Smith & Carolyn Williams– Laboratory Advisors • FASP Advisory Board with representation from stake holders from across the pathways FASP UK Fetal cardiac training project 2015-2017

  6. Set out how NHS Screening Programmes should be commissioned and delivered throughout England Sets out the ‘must-do’s’ for delivery of the screening programme FASP UK Fetal cardiac training project 2015-2017

  7. FASP standards for 18+0 –20+6 weeks anomaly scan **Detections rates will be reviewed following implementation of screening as part of the combined screening strategy FASP UK Fetal cardiac training project 2015-2017

  8. FASP Ultrasound Images to archive Local protocols may have additional requirements for example placental site, amniotic volume etc FASP UK Fetal cardiac training project 2015-2017

  9. NCARDRS • The National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) records those people with congenital abnormalities and rare diseases • Historically 49% of births were monitored by 7 regional registers. • Unable to provide comprehensive outcome data for screening programmes in England • Capture data from all of England Via 9 regional centres • timely data collection • local and national data feeds • improved quality assurance • Benefits to individual patients, their families FASP UK Fetal cardiac training project 2015-2017

  10. Performance thresholds Acceptable: Detection rate ≥50% for each serious cardiac anomaly shown above. Fetal Anomaly Screening Programme Standards p 12; 2015-16 This is the area that detection rate needs improving FASP UK Fetal cardiac training project 2015-2017

  11. FASP-Fetal Cardiac ProtocolRationale, Training and Implementation for the 3VT view

  12. FASP Fetal Cardiac Protocol Smart Survey 2012 Recommendations by the FASP fetal cardiac expert working group Evidence supports that routine examination of the fetal heart using additional 3VV and 3VT views will improve detection rates for cardiac anomalies Particularly duct dependent abnormalities Benefits Ensure babies get appropriate and timely care after birth Increase the national detection rate of major cardiac abnormalities give parents earlier choice regarding the pregnancy options FASP UK Fetal cardiac training project 2015-2017

  13. FASP Fetal Cardiac Protocol FASP UK Fetal cardiac training project 2015-2017

  14. Training Needs Analysis Questionnaire survey carried out in May 2014 • Web based survey • 143 trusts across England were invited via screening support sonographers and screening support midwives • 123 trusts responded (86%) • All regions responded with a regional spread in non responders or no data. FASP UK Fetal cardiac training project 2015-2017

  15. Which region is your screening unit based? FASP UK Fetal cardiac training project 2015-2017

  16. Information gathered How many individual sonographers offer 20-20+6 weeks scan? What current practice for fetal cardiac examinations in their trusts? What theoretical training provision they currently accessed? What practical training for the fetal cardiac views did they access especially the 3VV AND 3VT view What requirements they needed for further training FASP UK Fetal cardiac training project 2015-2017

  17. Summary of results • Majority of trusts (75%) were already incorporating 3 vessel views in their fetal cardiac survey. • Small percentage (7%) currently using 3 Vessel and Trachea view (3VT). • 62% indicated they required full training and 33% require refresher training. • 85% use FASP/FMF basic on-line resource for their theory training. • Just under half of trusts (49.66%) are using in house training. • Most effective way of training is a combination of on-line training and practical in house training via nominated cardiac “Champions” FASP UK Fetal cardiac training project 2015-2017

  18. The project and training team FASP UK Fetal cardiac training project 2015-2017

  19. Cardiac champions Local nominated sonographer Training support to develop and enhance skills in fetal cardiac scanning Will work with local sonographers to identify learning needs Cascade training to sonographers in their Trust Provide feedback to sonographers to review techniques and improve standards Liaise with other champions Named contact for tertiary referrals Improve communication FASP UK Fetal cardiac training project 2015-2017

  20. Planned Fetal cardiac training FASP UK Fetal cardiac training project 2015-2017

  21. Regional workshops • Each trust nominate a cardiac sonographer to act as “Champion” • Champions invited to attend regional workshop/s • Lectures/forum to support • New standards and evidence of detection rates • Challenges & Solutions • Identify practical session needs and support • Opportunity to establish regional and national fetal cardiac networks • Sharing experiences • Resource package will be developed FASP UK Fetal cardiac training project 2015-2017

  22. Fetal cardiac and 3VT e-learning Champions were required to complete on line training before commencing practical training FASP UK Fetal cardiac training project 2015-2017

  23. Regional workshops Champions were invited to attend regional workshop/s Lectures/forum to support New standards and evidence of detection rates Challenges & Solutions Identify practical session needs and support Opportunity to establish regional and national fetal cardiac networks Sharing experiences Resource package was developed FASP UK Fetal cardiac training project 2015-2017

  24. Theory day FASP UK Fetal cardiac training project 2015-2017

  25. Practical “hands on” training day • Pregnant women recruited • Delegates worked in pairs • Each delegate had opportunity to scan at least 4 women • Each delegate had opportunity to work with at least 2 trainers • Signed off by trainers and given certificate of attendance FASP UK Fetal cardiac training project 2015-2017

  26. Additional resources FASP UK Fetal cardiac training project 2015-2017

  27. Theoretical and Practical “hands on” training

  28. Sonography training for the 3VT FASP UK Fetal cardiac training project 2015-2017

  29. Sonography training for the 3VT FASP UK Fetal cardiac training project 2015-2017

  30. Evaluation of 3VT training

  31. Project evaluation • The overall objective of the project was to support the training of sonographers to enable them to incorporate fetal cardiac outflow tract views as a routine element of the 18 to 20+6 week anomaly scan. • Evaluation of theory and practical days • Monitor the implementation of the cardiac protocol • Longer term objectives were also identified i.e. • To evaluate the detection rate of cardiac anomalies at the anomaly scan after the incorporation of the additional 3VT view. • To evaluate the referral rates and the false positive results on local and tertiary service provision. • To obtain data for the FASP four main conditions • Atrioventricular Septal Valve Defect(AVSD), Hypoplastic Left Heart Syndrome (HLHS), • Tetralogy of Fallot (TOF) and Transposition of the Great Arteries(TGA). FASP UK Fetal cardiac training project 2015-2017

  32. Feedback on theory and practical days FASP UK Fetal cardiac training project 2015-2017

  33. Training evaluation FASP UK Fetal cardiac training project 2015-2017

  34. Implementation of FASP cardiac protocol

  35. Implementation process FASP UK Fetal cardiac training project 2015-2017

  36. 1st January 2017 139 (96%) had implemented, 5 Trusts still to implement FASP UK Fetal cardiac training project 2015-2017

  37. 1st April 2017 142 (98.5 %) have implemented 2 trusts still to implement FASP UK Fetal cardiac training project 2015-2017

  38. Examples of how Trusts implemented the 3VT View

  39. Examples of sharing knowledge • Self assessments for learning needs • One to one training • Peer training • Group reviews • Regular feedbacks • Image audits • 3VT images stuck on notice board for dissemination. • Visits to tertiary centres FASP UK Fetal cardiac training project 2015-2017

  40. Image audits FASP UK Fetal cardiac training project 2015-2017

  41. Thank youany questions ?

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