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1. The Oxford ALERT Programme
Siobhan Teasdale
Clinical Educator AICU Outreach Team
John Radcliffe Hospital
September 2009
2. ALERT in Oxford
Started January 2002
15 courses 1st June 2008-31st May 2009
Up to 25 candidates per course
Roughly half nurses, half medical students/doctors, 2 physiotherapists per course plus observers
Compulsory for medical students
Approx 360 candidates a year
3. ALERT in Oxford Became a Trainer’s centre January 2003
1st June 2008- 31st May 2009:
2 External Train the Trainer’s days [28 candidates]
1 Internal Train the Trainer day [7 candidates]
Grand total approx 400 candidates per year
4. Practicalities Resources:
Clinical Educator
Medical Director
Independent Cost centre
Support from Outreach and the AICU SPR’S
Secretary
Laptop
Kadoorie Centre
5. Practicalities Currently 42 ‘active’ members of faculty, half nurses, half doctors, 3 physiotherapists
Criteria:
Minimum SPR, Senior Staff Nurse or Senior Physiotherapist.
Recommended
Clinically credible
Good at teaching.
Teach at least twice a year.
6. Practicalities Faculty ‘encouragement’
Constructive feedback on teaching techniques
Tea, coffee and doughnuts
Lunch vouchers
Honoraria
7. Practicalities Number of faculty needed per course
2 throughout day
6 for scenarios
Manuals
posted out to candidates
handouts at the end
8. Practicalities Finances:
Medical school funds medical student places
ETTT days income generate
Surplus places sold to Private Sector
No charge to ORH nurses or physiotherapists
9. Oxford “changes” Changing round the program
Communication earlier
Maintain ABC lecture order
Move demo back
Increased numbers to 25 per course
Other teaching techniques: group work, videos, MCQ’s, simulation
10. Oxford ‘changes’ AGM
Annual dinner
Annual report
Wandering Star
11. Feedback
Verbal feedback is positive
Direct and indirect
Medical, nursing, physio, management
Compulsory feedback form
Enjoyable and Valuable
Used to improve the course
Arrest rate / ICU admissions rate
12. Assessment Not included in Oxford ALERT
Candidates successfully attend the complete course
Links with ‘RAID’ training
Local view
What’s possible?
What’s helpful?
13.
The ALERT
Five Minute
Multiple Choice
14. Question One Below are several forms of intravenous access.
Rank them according to how quickly 250 mls of Gelofusine can be administered through them, with the fastest first (1 = fastest; 5 = slowest)
A Pink (20G) Cannulae (Venflon) using a pressure bag
A triple lumen central line
A PICC line (Peripherally Inserted Central Catheter)
A Grey (16G) Cannula (Venflon)
A Green (18G) Cannula (Venflon)
15. The time it takes to give250 mls of Gelofusine A Grey (16G) Venflon
1 minutes 20 seconds
A Pink (20G) Venflon with a pressure bag (with 300mmHg pressure)
2 minutes (pressure at least halves the time)
A Green (18G) Venflon
3 minutes
A triple lumen central line
3 minutes 30 seconds (on largest lumen)
A PICC line (Peripherally Inserted Central Catheter)
Too slow to bother timing!
16. Question Two A patient on your ward is breathing inadequately with a respiratory rate of 4 per minute. Their airway is patent and the crash team is on its way. You should …
Give oxygen and observe for a respiratory arrest
Attempt bag mask ventilation with maximum oxygen flow
Intubate the patient with an endotracheal tube or laryngeal mask
17. Question Two A patient on your ward is breathing inadequately with a respiratory rate of 4 per minute. Their airway is patent and the crash team is on its way. You should …
Give oxygen and observe for a respiratory arrest
Attempt bag mask ventilation with maximum oxygen flow
Intubate the patient with an endotracheal tube or laryngeal mask
18. Question Three A patient on your ward has a tracheostomy. They are cyanosed and having trouble breathing. Help is on its way but you want to give oxygen at as high a concentration as possible.
The safest set up for delivering Oxygen acutely is ….
19. Question Three A partial rebreath mask (mask with reservoir bag) held over the mouth and nose
A partial rebreath mask (mask with reservoir bag) held over the tracheostomy
28% humidified oxygen through a “tracheostomy mask” over the tracheostomy
A partial rebreath mask (mask with reservoir bag) held over the tracheostomy and another mask held over the face
Pushing green oxygen tubing down the tracheostomy and turning the flow on the wall as high a possible
20. Question Three A partial rebreath mask (mask with reservoir bag) held over the mouth and nose
A partial rebreath mask (mask with reservoir bag) held over the tracheostomy
28% humidified oxygen through a “tracheostomy mask” over the tracheostomy
A partial rebreath mask (mask with reservoir bag) held over the tracheostomy and another mask held over the face
Pushing green oxygen tubing down the tracheostomy and turning the flow on the wall as high a possible
21. Question Four The following drugs are often life saving for a patient with a low fluid output:
Oxygen
Frusemide
Saline
Viagra
22. Question Four The following drugs are often life saving for a patient with a low fluid output:
Oxygen
Frusemide
Saline
Viagra
23. Question FiveTrue or False
“You should stop a patients oxygen before taking arterial blood gases in order to accurately assess their oxygen exchange”
24. Question FiveTrue or False
“You should stop a patients oxygen before taking arterial blood gases in order to accurately assess their oxygen exchange”
25. Question FiveTrue or False
“The respiratory rate is a useful observation for predicting patients’ deterioration”
26. Question FiveTrue or False
“The respiratory rate is a useful observation for predicting patients’ deterioration”
27. Question FiveTrue or False
“Patients rarely deteriorate suddenly. Usually doctors and nurses suddenly notice that a patient is ill!”
28. Question FiveTrue or False
“Patients rarely deteriorate suddenly. Usually doctors and nurses suddenly notice that a patient is ill!”
29. Question FiveTrue or False
“Diuretics such as Frusemide help prevent renal failure on the wards”
30. Question FiveTrue or False
“Diuretics such as Frusemide help prevent renal failure on the wards”
31. Question FiveTrue or False
“Shock can be present, even when the blood pressure is normal”
32. Question FiveTrue or False
“Shock can be present, even when the blood pressure is normal”
33. Question FiveTrue or False
“The ALERT course is a fun day out for the whole family”
34. Question FiveTrue or False
“The ALERT course is a fun day out for the whole family”
35. Any questions?