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Type and Title of Submission


Title:

NICE care - preventing venous thromboembolism

Description:

The RCN's online learning resource on VTE is intended for a nursing audience ranging from health care assistants with little or no prior medical training, to registered nursing staff who have completed a degree. The resource was developed in response to the recommendation from the National VTE Leadership Summit (hosted by the All Party Parliamentary VTE Group and the Department of Health) for focussed learning content for nursing staff to further embed VTE prevention and the NICE guideline CG92, into mainstream clinical practice. The resource utilises engaging and accessible e-learning to deliver the content throughout the NHS and independent health care sectors to support the achievement of the required learning outcomes for this 'time challenged' audience.

Category:

2011-12 Shared Learning Awards

Does the submission relate to the general implementation of all NICE guidance?

No

Does the submission relate to the implementation of a specific piece of NICE guidance?

Yes

Full title of NICE guidance:

CG92 - Venous thromboembolism - reducing the risk

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?

Yes
Collaboration was freely provided by: Lifeblood - the Thrombosis charity; King's College Hospital; and the Dept of Health VTE Programme. Video content was reproduced with kind permission from eLearning for Healthcare, Dept of Health.


Description of submission


Aim

The RCN's role, as part of the 'Three Professions Group' (established following the National VTE Leadership Summit in 2009), was to provide learning material for nursing staff in order to embed VTE prevention in mainstream clinical practice(according to NICE guideline CG92). Recognising that an e-Learning solution would provide the most effective solution to a national training need, the RCN's online learning developers reviewed the existing e-Learning for Health VTE distance learning module and evaluated the 'e-VTE' content. Although suited to the learning needs of senior nurses, doctors and pharmacists, it was less appropriate to the needs of health care assistants, student and newly registered nurses. The RCN undertook to develop an online learning resource for more junior members of the nursing team which focussed on the role of the implementation of the NICE clinical guideline for the prevention of VTE. The College's commitment to deliver this learning extends beyond the NHS to reach nursing staff throughout the UK (and internationally) so open and free access was made available via a 'quick link' from the RCN website's home page. An added benefit being that members of the public (potential patients) are also able to access the learning. The identified learning need for nursing staff focussed on the practical aspects of VTE prevention, the tasks they need to DO rather than the theory they needed to KNOW. No assumptions could be made about familiarity with e-Learning so the user interface is as intuitive as possible. With little training time available to nursing staff, the content needed to achieve the required learning outcomes 'in the smallest possible nutshell', utilising all the engaging and interactive devices the technology has to offer.

Objectives

The primary objectives for the RCN were to: 1) Develop an engaging learning resource that would increase nursing staffs' awareness of NICE Clinical Guideline 92 and to implement it as standard clinical practice 2) Deliver the resource in the most flexible way in order to ensure its uptake is easy and attractive for individual nursing staff as well as health care employers throughout the UK who could blend it into their institution's VTE programme. The secondary objective (beyond the RCN's means to measure quantitatively) was to ensure the learning content contained the required information to support the following learning outcomes: 1) explain what the acronym 'VTE' stands for 2) describe the basic anatomy and physiology of VTE formation 3) identify at least three kinds of 'typical' patient at risk of developing VTE 4) understand when and how, to carry out a VTE risk assessment 5) explain the difference between 'pharmacological' and 'mechanical' prophylaxis, and it is appropriate/inappropriate to use each one 6) describe the key points when fitting patients for anti-embolism stockings 7) describe the key points when fitting patients for other anti-thromboembolic mechanical devices including intermittent pneumatic compression devices and footpumps 8) describe the key points when talking to patients/carers about VTE risk and prevention.

Context

The first national NHS VTE Leadership Summit, hosted jointly by the Health Department and the All Party Parliamentary Group in June 2009 identified that much more was required to make VTE prevention a clinical priority for the NHS. A continuing challenge identified at the Summit was the need to raise professional awareness and improve training for health professionals on risk assessment and prevention of VTE. As part of the RCN's membership of the 'Three Professions Group', established following the National VTE Leadership Summit in 2009, the College accepted the role of providing learning material for nursing staff. Recognising an e-Learning solution would provide the most effective and efficient solution to a national training need, the existing e-Learning for Health VTE distance learning module (e-VTE) was evaluated. The modules were assessed as well suited to the learning needs of senior nurses, doctors and pharmacists but was less suited to those of health care assistants, student nurses and newly registered nurses. Consequently, the RCN developed an online learning resource to compliment the e-VTE modules. Designed for more junior members of the nursing team it focusses on the nursing role in the implementation of the NICE Clinical Guideline 92. In this way, the RCN's content adds value to the e-VTE module and, with kind permission of e-Learning for Health, re-used some of the video elements to reduce development costs and ensure consistent messages across both resources. The RCN's VTE online learning is freely available via the website in an effort to reach the widest possible number of nursing staff throughout the UK (and internationally) and to make blending this learning as part of a health care provider's VTE programme simple and straightforward. An added benefit of providing open access is that members of the public are also able to access the learning.

Methods

The intended nursing audience ranged from health care assistants, with little or no prior medical training and typically hailing from a non-traditional educational background, to degree level nursing staff. The identified learning need for nursing staff focussed on the practical aspects of VTE prevention, the tasks they need to do rather than the theory they needed to know. No assumptions could be made about familiarity with eLearning so the user interface is as user friendly and intuitive as possible. With little training time available and so many competing information demands on nursing staff, the content needed to achieve the required learning outcomes 'in the smallest possible nutshell', utilising all the engaging and interactive devices eLearning technology has to offer in order to: 1) Reduce the reading load by focusing on the practical elements of what nursing staff needed to DO and providing information to support those outputs rather than lots of theory through the use of animations, video and audio elements. 2) Maximise learner engagement with the content by ensuring it is relevant and immersive through the use of: authentic audio-visual material; engaging animations and interactive elements such as quizzes and case studies; and practical tools such templates for an action plan and a reflective learning record to support the learning into practice. The content is divided into four key, stand-alone, learning sections each designed to take no longer than 20-minutes to finish. This enables nursing staff to dip in and out of the learning as time (and location) permits completing the sections in an order that suits individual learning needs, via a web browser or mobile device. Collaborative support from Lifeblood, King's College Hospital and the Dept of Health together with access to video content from e-Learning for Health, enabled this resource to be developed within the RCN's core budget and did not incur any additional costs.

Results and evaluation

The free access via the RCN website limits the available evaluation data largely to web-hits to the resource and a user feedback survey. The RCN used the benchmark of 10,000 hits to the 'e-VTE' modules in its first year as a target for monitoring and measuring the successful uptake of its own VTE online learning resource. This target was achieved within nine months of its launch on the RCN website and by twelve months, over 11,000 learners had accessed the resource. Feedback from individual nursing staff demonstrated the content was supporting them to implement guideline 92 into standard practice with 92% reporting the resource as relevant to their clinical practice and comments such as: "I had no idea the assessment should be carried out more than once because the medical staff do it. I can now ask for a review if patients condition changes and flag up the review prior to discharge". The resource has also been successfully incorporated into health care providers' local training programmes as evidenced by the following comment: "[With] the need to train over 3,000 staff, I embarked on the task of developing our own VTE E-Learning package. Having a link to the RCN-NICE care-preventing venous thromboembolism is just so invaluable to all our staff, to enable them to access facts, guidelines, assessment tool guidance, videos and practical help. I would like to thank you for all your support on behalf of the Pennine Acute Trust" (Clive Laight - Thromboprophylaxis Nurse, Pennine Acute Hospitals NHS Trust). The resource is listed in the Education and best practice resources section of the Fifth Annual Audit of Acute NHS Trusts' VTE Policies (2011) and is also being signposted to via other websites as evidenced by this feedback request: "It's all very worthwhile. Make no mistake; it will help save many lives. Excellent stuff. Can we link it to the Lifeblood website please??" (Beverley J Hunt, Medical Director, Lifeblood the Thrombosis Charity).

Key learning points

The success of the RCN's VTE online learning can be largely attributed to the collaboration with key stakeholders such as Lifeblood, the thrombosis charity, King's College Hospital, and the Department of Health including e-Learning for Health. Their expertise as clinical reviewers and access to high quality audio-video assets ensured accurate content to be managed within RCN's core budget for this work. A critical factor in its success was engaging key stakeholders in the project from the beginning. Online learning must be designed to be interesting, relevant, focused and easy to use to maximise the benefits of the e-learning method. While there is other online material available, the RCN's VTE resource is specifically tailored to the learning needs of its target audience of nurses and HCAs. Even when online learning is designated as 'mandatory', learners will find ways to avoid it if they find it to be tedious, uninspiring and irrelevant (just as they do with face-to-face training). So, a critical pitfall to avoid is delivering online learning that is essentially an information dump and doesn't offer any practical outputs on completion, particularly when designing online content for a nursing audience.

View the supporting material

Contact Details

Name:Rosemary Brown
Job Title:Programme Manager, Online Learning
Organisation:Royal College of Nursing (UK)
Address:20 Cavendish Square
Town:London
County:London
Postcode:W1G 0RN
Phone:02076473652
Email:rosemary.brown@rcn.org.uk
Website:http://www.rcn.org.uk

 

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This page was last updated: 11 January 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.