1. The Development of a Cardiothoracic and Oesophageal Teaching and Assessment Programme for Nurses, Surgical Assistants, Physiotherapists and Allied Health Professionals Mike Poullis

2. Why ? Large staff turnover secondary to expansion MMC FY 1 and 2 “Float through” ALERT © course – no assessment, and not Cardiothoracic High ITU readmission rate Large number of critical incidents could have been preventable

3. Solution Educate –Doctor –Nurses, Surgical Assistants, Physiotherapists and Allied Health Professionals Course with assessment

4. Lectures Every week Same day, time, and place Start at the beginning Cover whole Cardiothoracic and oesophageal surgery Didactic, with questions at end Encourage ideas for new topics Rolling talk schedule

5. Topics Anatomy, physiology and pathology of the heart Anatomy, physiology and pathology of the lung Thoracic surgery Low BP in cardiac surgery patients Oesophageal surgery CABG, coronary anatomy, on and off pump surgery and conduits Inotropes ITU and Ward Rounds Thoracic surgery complications Pre op tests in Cardiothoracic surgery ECG interpretation Coagulation Innovations in thoracic surgery Aneurysms

6. Format of lectures Anatomy Physiology Basic science Pathology Surgery of heart, lungs, and oesophagus Complications applicable to everyday practice AS MANY PICTURES AS POSSIBLE

8. Techniques Different pathologies –Lung cancer –Pneumothorax –Pleural effusions –Lung biopsies Different operations –Bronchoscopy & oesophagoscopy –Mediasteinoscopy –Mediasteinotomy / Chamberlains –Thoracoscopy VATS –Mini thoracotomy –Full thoracotomy –Pneumonectomy / Lobectomy / Wedge Chest drains Post operative care

9. Complications Air Leak Atalectasis Sputum Retention Chest Infections Atrial Fibrillation Bleeding Wound Infections MRSA Bronchopleural Fistula Post Pneumonectomy Problems Post Pneumonectomy Empyema Lobectomy Space Problems Medical Problems Recurrent Disease Inadequate Resection

10. Advertise Notice on every ward surgical and medical Email Student nurse turnover All available at http://www.mpoullis.com/nurse%20talks/Nurse.htm

11. Course With Assessment ALERT © SAVE more lives REACT course –REcognition And Correct Treatment

12. REACT Course Based on ACLS, and ALERT © course principles Unlike ALERT © it is free In course assessment Test before start of day to make people read manual Give whole course away on website http://www.mpoullis.com/alert/react.htm

13. Format Of REACT Introduction Health and safety Assessing the critically ill patient Clinical cases and scenarios 1-7 Clinical cases and scenarios 8-13 Summary Hands on practical and Assessments Feedback and questions

14. Hands On Practical And Assessments Airway (Consultant anaesthetist) Rhythm recognition (ALS instructor) Recognition and management of sick patients (Ward sisters) Case studies (Consultant Surgeons)

15. Case Studies Breathless Hypotensive Oliguric Generally unwell High or low glucose Low oxygen saturations High / low heart rate Unconscious Positive fluid balance Pain Abnormal Labs – Creatinine, and clotting High temperature Post Pneumonectomy problems

16. Assessment Core and specific dimensions in the NHS KSF Each dimension has 4 levels

17. Core Dimensions 1. Communication. 2. Personal and people development. 3. Health, safety and security. 4. Service improvement. 5. Quality 6. Equality and diversity.

18. Specific Dimensions - Total of 24 Health and Wellbeing Estates and Facilities Information and Knowledge General

19. Levels 1Undertake tasks related to the assessment of physiological and/or psychological functioning 2Contribute to the assessment of physiological and/or psychological functioning 3Assess physiological and/or psychological functioning and develop, monitor and review related treatment plans 4Assess physiological and/or psychological functioning when there are complex and/or undifferentiated abnormalities, diseases and disorders and develop, monitor and review related treatment plans

20. Simplified Course attendance Airway Rhythm recognition Assessing the critically ill Cases

21. Feedback Forms 20 maximum Don’t mix doctors and nurses unlike ALERT Distribute manual a few weeks before course

22. Accreditation SCTS Applied ALERT Course not accredited with –Resuscitation council –Department of Health Not a CNST requirement

23. ALERT Advantages –Well known –Well structured –Great for general surgery Disadvantages –Not Cardiothoracic and oesophageal –No assessment –Doctors and nurses mixed –Not accredited –Cost –Rigid

24. REACT Advantages –Cardiothoracic and oesophageal –Assessment –Doctors and nurses not mixed –Cost –Kudos for our unit Disadvantages –Not well known –Not accredited Applied to SCTS –No track record

26. Part Of A Wider Teaching Program Courses Web Based teaching

27. Courses Imaging in Cardiothoracic and oesophageal surgery Perfusion Terms and techniques in aortic surgery Basic Science and Cardiothoracic Surgery http://www.mpoullis.com/courses.htm

29. Web Based Teaching Cardiac Thoracic Oesophageal Aortic Basic Science http://www.mpoullis.com/teaching.htm#Do ctor_

30. Any Questions DVDs at the front www.mpoullis.com