Innovations in Precepting: Electronic Tracking

1. Innovations in Precepting:Electronic Tracking Kent Brown ACP Program Coordinator City of Winnipeg Fire Paramedic Service

2. Today’s Path • Evolution • The Program • Evaluation Relevance • The Platform • Costing • Strengths • Weaknesses • Opportunities

3. Evolution • The Past • Slow and time consuming • Subjective • Searchability • Storage

4. The Present • Portable • Interface friendly • User friendly • Multi-functional

5. Impetus • National Occupational Competency Profile • Internal technology advances. • Internal database advances. • Wired network throughout City of Winnipeg Fire Paramedic Service.

6. Impetus – cont. • “The accreditation process expects programs to design evaluation tools that ensure that the student's performance of each C and P Specific Competency is evaluated against clear competency criteria ….” • “ …that the evaluation is recorded and signed….” • “… that there will be documented evidence that the student has demonstrated these competencies in the required setting …”

7. The Path • Phase I – Internal - vision • Introduce • Analyze • Phase II – outsourced - reality • Alter • Analyze • Phase III – looking forward • Build upon

8. Phase I • iPAQ purchases • Internally developed program • Initial trial • Feedback • Lengthy • Collation • Intuitiveness • Analysis

9. “The Tyranny of the OR” Good Fast Cheap Please Pick Two

10. Hardware iPAQ Desktop PC Database Server Software Mobile VB + Add ons DB2 Internally Developed - contracted Precepting program (collection) Syncing program Analysis program Stuff

11. Costing • Hardware • Database – on site • Desktops – on site • iPAQ’s $1000 including software • Software • $10000 contract with Lynx Software • Old process • Manuals $6.35/student

12. Current Costing • iPAQ’s now ~ $500 • Cost recovery at $6.35 per manual • 500/6.35 = 79 students • Storage savings • Search time

13. Phase II - The Program • Please excuse our spelling. • Several courses • 20 + students per course

14. Process • The student is observed at the call. • Data is entered into the handheld as soon as possible after the call. • The preceptor goes over the data with the student citing any insufficiencies that is being entered. • Both sign off on comments.

15. Recording

16. Competence involves the demonstration of skills, knowledge and abilities in accordance with the following principles: • consistency (the ability to repeat practice techniques and outcomes) • independence (the ability to practice without assistance from others) • timeliness (the ability to practice in a time frame that enhances patient safety) • accuracy (the ability to practice utilizing correct techniques and to achieve the intended outcomes) • appropriateness (the ability to practice in accordance with clinical standards and protocols outlined within the practice jurisdiction)

17. 1 – Student had the opportunity, but did not demonstrate any of the critical behaviours of the specific competency. • 2 – Student demonstrates some or all of the critical behaviours with prompting or assistance from the instructor • 3 – The student performs safe, medically appropriate patient care, demonstrating all critical behaviours of the relevant patient care protocol or procedure. The provision of care by the student is organized, accurate and timely without prompting or assistance of the instructor.

18. End of the shift the data is downloaded electronically at the station and is stored in an electronic database

19. Process • Consistency – Internally Defined. • Program analyzes database to ensure consecutive 3’s • Automatically updates student profile. • Shares with all iPAQs in system

20. Collection and Analysis iPAQ 1 Desktop PC Site 1 Database iPAQ 2 Desktop PC Site 2 iPAQ 3

21. Data Analysis – Student Perspective • iPAQ recognizes display of consistency of competence – deletes competency from student record. • Desktop updates at database – to collate data from all iPAQs

22. Data Analysis – Program Perspective • Link to other databases (runsheet) • Searchability for: • Exposures/likelihoods • Preceptor participation • Themes/trends • Site specifics • Results have lead to core preceptorship program changes.

23. Storage • CD – To student Record • Program Files– Master Student Disc • Backed up on WFPS City Server

24. Expansion • Initial development for Phase 2 – approximately 2-4 months. • Adding additional educational programs, with different competencies, would now require one month as platform is in place.

25. Strengths • Perception of increased objectivity. • Standardization for “sign off” • Trackability • Searchability. • Immediacy • Intuitiveness • Storage

26. Weaknesses • Inservicing/IT/Resistance • Glitches/IT dependence • Power supply • Upload timing • Outliers • Firewalls • Queries – not intuitive

27. Opportunities • Other clinical sites • Database linkages • Field Quality Assurance • Operational Documents • Extension Programs – Central Database

28. Threats

29. Acknowledgements • Nathan Wiebe • Software Solution Developer, Lynx Graphics Ltd. • Deputy Chief Jim Brennan – WFPS • Doug Major – QI Officer (ret) - WFPS • Ross Bale – LIIA Paramedic WFPS