Shared learning database

Bradford Teaching Hospitals
Published date:
June 2009

The aim of this educational project is to effectively implement the NICE acutely ill Guidelines (2007) into our Emergency Department, providing staff with a standardised learning "in practice" document that will allow us to assess skills in clinical scenarios. The document also aims to improve patient care by equipping our emergency nurses with effective assessment and monitoring skills that are knowledge based. The course consists of a training manual that all staff are expected to read prior to commencement of the course, the day itself consists of two initial lectures followed by scenario based teaching. The day ends with an MCQ paper and course evaluation. See attached lesson plans. The training package ideology is based around an Andragogical model of learning, it hopes to assist learner's to enhance their capability to function as self directed learner's.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of the teaching package is to give staff an understanding of the importance of using a structured approach to the assessment of the Acutely Ill Adult. It also allows staff to physically practise their assessment skills using scenarios. It also gives staff the chance to use and familiarise themselves with the NICE document in a structured clinical setting. The scenario based training also aims to highlight areas of required development and allows plans for development to be put in place in clinical practice. 1. For staff to demonstrate an understanding of the structured clinical assessment of the Acutely Ill Adult and MEWS. 2.To introduce the NICE Competency working document 3.To identify required areas of development for individual staff in clinical practice.

Reasons for implementing your project

Clinical Governance highlighted areas of development around the Assessment of the Acutely Ill Adult in Emergency Care. No structured training had occurred previously specifically around this area. We wanted to devise training that specifically targeted this area and ensured all staff (from all Bands) had the same baseline of knowledge. Training had originally been classroom based around Power Point presentations, this appeared to have little or no effect on actual patient care. The idea was developed to use scenario based teaching, using the NICE competencies we wrote and developed a training manual, scenarios and assessments. This allowed us to see staff in "action" and identify points for development, staff could then be supported in practice to achieve these development points.

How did you implement the project

The training programme is still in its infancy at the moment however: 1. Staff were able to easily follow a structured assessment process to assess acutely ill patients. 2.The NICE document has just been rolled out in clinical practice and staff are starting to use this although support in practice is required to motivate staff to utilise the document. 3. Staff are been supported in practice by myself and the senior team, the programme allows discussions to take place which develops learning both on the training day and in clinical practice. We still have problems with equipment for the day and are at present sourcing funding for this. We are currently bidding for funding for publication of our training manual. The other barriers we have encountered are around staff attitudes towards the training. No-one likes to stand up and be counted, however after two courses feedback from staff is good and this is breaking down barriers for us.

Key findings

Each course is evaluated by staff attending and considerations of this evaluation is made by ourselves and the course changed accordingly. The course has only just begun and so we have limited evidence of improvement to patient care at present, although we do have plans to audit patient attendances and discharges in relation to MEWS, including staff responses to particularly high MEWS scores. We are currently developing our MEWS chart to cover Action points on high MEWS scoring patients. We aim to link theory and practice together with this training package.

Key learning points

The assessment of the Acutely ill adult is a key skill that is required by all staff in Emergency Departments around the country. The NICE competency document can be used as a basis for development of training in this area. The development of a competency based scenario training day allows you to observe staff in clinical situations without risk to the patient, it can also act as a forum for discussion. The training pack can also be developed to include other areas of emergency care for example transfer training and safe administration of blood products. Useful tips: you need a dedicated team around you, be flexible and willing to change using course evaluations as a guide, expect obstacles and frustrations initially.

Contact details

Deb Lau/ Elizabeth Moseley
Bradford Teaching Hospitals

Tertiary care
Is the example industry-sponsored in any way?