THE ALERT EXPERIENCE AT HEREFORD

1. THE ALERT EXPERIENCE AT HEREFORD Janet Price Critical Care Outreach Team

2. The Facts • Over 500 members of staff have attended the Alert course at Hereford NHS Trust since it began in January 2002 • Until recently it took place 5 times a year at the Professional Development Centre (PDC) • Attendees have included all members of the multidisciplinary team • Critical Care Outreach has taken the lead over the last 5 years • Other faculty members were volunteers from various departments • Every candidate was asked to complete an evaluation as the Alert day progressed and certainly before they were allowed home!

3. The Problems • Reduced attendance over last 2 years • Difficultly in retention and recruitment of faculty • Concern locally and nationally about the early recognition and treatment of the critically ill patient • Increased need to support ward staff in a climate of reduced resources • Concerns that the Alert course would lose its momentum and impact

4. Collecting Evidence • Questionnaire circulated to 125 previous candidates to investigate impact of Alert on continuing practise • Document produced to summarize 2 years course evaluation (information was acquired during every Alert course ) • Analyze workplace of previous candidates to evaluate acute areas within the Trust where attendance to the Alert course was low. • Contact with Portsmouth to update on recent developments

5. Problems encountered Have you ever tried to milk a cow? That’s how hard it was to get a good response to the questionnaire sent to previous candidates! Only 14 people replied but there was a 100% agreement that the day had significantly helped them in dealing with acutely unwell patients and that they would like to attend an update if possible. It was also agreed by all the respondents that the manual was a useful source of information and that they would recommend the course to a colleague.

6. Course evaluation questions 125 candidates were asked 20 questions over a 2 year period and encouraged to complete evaluation forms as each Alert study day progressed rather than wait until home time when the responses may have been rushed and inaccurate. Questions included ; • How well did the course meet personal objectives? • Did the manual meet individual needs? • Was the style of teaching and content of the day appropriate and did it encourage a learning environment? • Did the powerpoint presentations enhance the teaching? • Did the training include expected and relevant topics? • Lectures and scenarios were all listed individually to be commented on. Candidates were given choices (from very poor to excellent) to describe individual sessions with free format for comments.

7. Illustrating the evaluation

8. Harvesting Positive Feedback As can be seen from the previous slide the feedback was enormously positive and the comments gave us valuable information which most importantly included : • That the ABCDE approach advocated repeatedly throughout the day was defined as a systematic and structured approach to patient assessment • That the course was a good balance of theory and practise • Many candidates commented that the course had increased their confidence and made them more aware of warning signs • The scenarios were described as excellent by the majority of candidates because it allowed them to practise their skills • Many expressed that the course highlighted the need to seek early expert help but at the same time gave valuable information on immediate interventions

9. Gathering Constructive Comments • It was commented that the powerpoint presentations needed updating and some candidates found them ’ a bit repetitive’ • Several topics were identified as not included , the most relevant of which was perhaps Sepsis • Some candidates found it difficult to learn alongside other disciplines and commented that there should be separate courses for nurses and doctors! • It was commented that there should be a course designed for HCA’s • It was identified that a shortened ‘refresher’ course would be beneficial and that the course should be mandatory

10. Mustering Staff to Meeting • Invites extended to senior sisters, medical staff, management and existing faculty to ensure a balanced attendance • Results of the questionnaire and 2 years course evaluation attached to invites for staff to view prior to meeting • Careful preparation of agenda to ensure all aspects were discussed

11. Sowing Modified Seeds The meeting was well attended and significant modifications made in order to address the problems that were being faced • The Alert course is to become mandatory for staff working in acute areas • Sepsis to be included in the course alongside communication • Critical Care Outreach to design new scenarios and use these to lead 2 hour update sessions • Alert course for HCA’s to be launched by the PDC with assistance from the Outreach Team. • Increase networking with Portsmouth to update on recent developments and utilise e-learning • Faculty recruitment to continue within the boundaries of professionalism

12. Reaping the rewards • The profile of the alert course has risen and work has begun on the new mandatory status and on correlating a list of attendees • The success of the course has been highlighted and its educational value confirmed • The care of the acutely unwell patient at Hereford could potentially be enhanced further with increased training of acute staff. • Hereford Hospital asked to present their experience at conference in Portsmouth!

13. Acknowledgements The success of the Alert course at Hereford Hospital has been a team effort and The Outreach Team would like to thank the following groups of people • The PDC staff for correlating the course feedback • Senior colleagues within the organisation for their support • The faculty for putting up with our regular emails asking for help • And finally Portsmouth Hospital for all their support and for inviting us to present our experiences

14. Any Questions ?