The Physiotherapy role in Critical Care Outreach –stretching professional boundaries

1. The Physiotherapy role in Critical Care Outreach –stretching professional boundaries John McShane BSc MSc CSP South East Coast Critical Care Conference 2018

2. Journey • Short bio • Initial job role • New and extended skills • How did I get interest in these • How did I overcome boundaries • What can the role now offer • Other tools in quest

3. Qualified at Brunel Uni • Worked year in NI (Band 5 rotational) • Worked in Queen Mary Roehampton/Kingston(Band 5 rotational and then static Band 6 resp) • Moved to ESH as Band 6 (resp) • Obtained a Band 7split role of Physio in CCOT/Team leader Physiotherapist

4. Felt stuck • Felt skills and knowledge had kind of hit a stalemate (?young and naive) • Wished to be able to do undergraduate course again to consolidate skills • Took the next step and enrolled in MSC Critical Care

5. Outreach Role • Vacancy arose in an already existent post • Joined a nursing team as the sole physio • Main objectives of my new role: -provide specialist RespAx and Rx (incl NIV) -facilitate ongoing rehab of post ICU patients -provide teaching for range of staff on wards

6. Skills at this point Physio specific: • Auscultation • CXR reading • Physio treatment (suction, respiratory adjuncts) • Knowledge of ventilation/weaning • Trachey care knowledge • Rehab/exercise knowledge

7. What changed? And how did I feel? • I progressed to reviewing non Resp patients with different problems • However I had regular feelings of being out of my depth/ in the way/ not productive • I needed to start gaining skills similar to my nursing colleagues to increase mine/ teams productivity as well as patient care

8. First Steps • Enrolled in IV cannulation course • Supported by physio manager who was keen for my progression

9. Next • To support the acute role, I attended the local ALS course and successfully passed but also was selected to proceed to train to be an instructor (yep I was equally surprised)

10. ABG’s • As a team we lead the acute NIV service and so it was agreed that being able to perform ABG sampling would be extremely useful • We were taken through a competency process with one of our ICU consultants and hence gained competence in this skill

11. Things beginning to change.. • All of a sudden I had a MSc, could cannulate and take blood, perform ABG’s and was actively teaching ALS. • This definitely increased my confidence and standing within the team • It also opened more doors and questions.. ‘if I teach staff which drugs (including dose) to give in emergency situations but cant actually do this myself, does this seem right??’

12. IV administration quest • I came across many barriers in my bid to provide IV drugs • No one wanted to commit to my cause • Main barrier was lack of pharmacology knowledge at undergraduate level • I started looking at ways around this

13. IV administration quest (cont) My options were: • Simply keep asking and being rejected • Find a pharmacology course to boost knowledge • Enrol in a NMP course (which has inbuilt pharmacology education and qualify with an additional skill)

14. NMP-decision made • I chose the latter which was actually the path of least resistance. • It satisfied management regarding my knowledge base, the course was subsidised and I was able to argue that NMP skill had real potential to improve patient care 6 months later and I had qualified “Easy yeah?”

15. Wrong! I still had additional hurdles to overcome e.g. • Approving my prescribing formulae with pharmacy • Updating the local NMP policy (which had no previous mention of physiotherapy) • Completing the local IV study day and the ICU IV study day

16. I got there in the end but it did take over 2years from when I first had the desire to provide IV medication • Took persistence, lots of appeasing, patience and I took the positive that it gave me time to consolidate other knowledge.

17. ?any other skills along the way

18. Lung Ultrasound • I already had good relationships with ICU consultants and following discussions with one in particular, embarked upon learning lung ultrasound • I was already familiar with its benefits but having practical hands on and utilising web based resources soon became the norm.

19. Lung Ultrasound • I’m now at the stage of completing accreditation in this skill which provide better recognition and standardisation of techniques.

20. So where am I at now? • Now working full time in CCOT • Non physio based skills to date.. • Have had lots of time to consolidate knowledge and understanding of the acutely unwell patient and now have clinical experience as well as skills to support my care

21. Tips for anyone embarking on new roles or areas of work… • You have to want it (even after rejection!) • Find out who ur allies are and who supports ur cause • Is there a clinical need? • Can you do anything to improve yourself as a suitable prospect? • Use all resources-social media for learning is not new but holds a Gold mine of information • Remember that skills must = improved patient care

22. Questions???