1. Foresight Training for Nurses Joanna Parker Head of Safer Practice

2. Aims of the presentation Background and introduction to foresight training The NPSAs foresight training programme for nurses Foresight in action: Interactive workshop

3. The 3-bucket model for assessing risky situations (Reason, 2005) 1 2 3 SELF CONTEXTTASK

4. Preventing something bad from happening The neonatal arterial switch operation study Risk assessing the task, context and self

5. Foresight - scoping study of previous work

6. Examples of foresight training Non-technical skills training in aviation Western Mining Corporation. Take time, take charge (Hopkins) Metropolitan police: hazard awareness training ESSOs step back by five programme BPs integrity management training. Approach to scene training by London Ambulance NHS trust Situation, Background, Assessment and Recommendation (SBAR) (IHI, 2006)

7. Learning outcomes Three bucketLearning outcome(s) Self- Current capacity to do this task safely - negative life events - stressors at work - knowledge and competence - fatigue - over-confidence / lack of confidence - involuntary automaticity Context-Distractions and interruptions - Human factors issues; e.g. design, environment - Goal conflicts - Culture (includes power distance) - Time pressure - Conflicting or missing information - Team focus (i.e. groupthink)

8. Three bucketLearning outcome(s) Task- task complexity / difficulty - novel task - recently changed procedure or process - last step in a task sequence - no task procedures available - workarounds and non-compliance Learning outcomes - continued

9. FORESIGHT TRAINING FOR NURSES: STAKEHOLDER ENGAGEMENT

10. Foresight training for nurses A foresight training resource for NHS nurses in acute, primary care and mental health settings Engaged stakeholders to shape the development of the training programme in the following ways: –Identifying and developing nursing foresight scenarios in primary care, mental health and acute settings –Identifying where foresight training fits with existing nursing education and training

11. Focus Groups 23 June, (primary care), 12 July (acute), 20 July, (mental health) SWOT analysis of foresight training Storytelling to identify potential scenarios

12. Focus Groups 12-19 attendees from a range of jobs Concept of foresight resonated with participants; three buckets model is a useful conceptual framework Foundations already in place (i.e. Reflection in Action, good reporting culture) Confusion about near misses – foresight will address this and raise near miss reporting rates

13. Focus group feedback Need to engage other professional groups, i.e. Phase 2. Releasing staff for training and cost involved. Importance of linking it to other training- not stand alone! Need an implementation strategy which considers the broader organisational context.

14. THE TRAINING PROGRAMME

15. TRAINING SCENARIOS Unrecognised deterioration / deterioration not acted upon Blood transfusion Management of diabetes in the community Obstetrics scenario Dual prescription of an anti-psychotic drug Nurse prescribing scenario in primary care Both video-based and paper-based to ensure flexibility

16. Four types of scenario Spot the difference scenarios Reflection in action Story-telling Garden path scenarios

17. Training materials Combination of video-based and paper-based Multi-media to fit with local circumstances Ranging from 20 minutes to 45 minutes Based on real-life incidents, as sourced from the NPSAs National Reporting and Learning System and the nursing focus groups Accompanied by a facilitators guide

18. What are the benefits? Facilitates learning about patient safety risks from more experienced nurses. Improves nurses ability to recognise and intervene at the first symptoms of a problem. Raises awareness of patient safety incidents, and in particular, near misses. This in turn could lead to improved near miss reporting rates.

19. Implementation Foresight training resources will be available at www.npsa.nhs.uk and the RCNs Learning Zone from June 2007 www.npsa.nhs.uk An off the shelf, flexible resource Designed to fit into mandatory training programmes and team handovers NPSA is working to raise awareness of the training amongst other professional groups

20. INTERACTIVE WORKSHOP

21. DETERIORATION INCIDENT Watch the video Think about the unfolding scenario Contextualise in terms of the three buckets model

22. Media Clip E:\NPSA_SC1_Rough_Cut1.mpg

23. The 3-bucket model for assessing risky situations (Reason, 2005) 1 2 3 SELF CONTEXTTASK

24. Whats in the buckets? Work in small groups Discuss what was in the self, context and task buckets Write one factor down on each post it note 20 minutes to discuss as a group 15 minutes group feedback

25. FURTHER INFORMATION CAN BE FOUND AT: www.npsa.nhs.uk 4 – 8 Maple Street, London W1T 5HD