ct colonography service staff training and competency …...ct colonography service staff training...
Post on 29-May-2020
5 Views
Preview:
TRANSCRIPT
CTC Competency Record V1.0 Page 1 Created by BCS CTCREDG – Mar 2018
CT Colonography Service
Staff Training and Competency Record
CTC Competency Record V1.0 Page 2 Created by BCS CTCREDG – Mar 2018
Foreword
The CT Colonography Radiographer Education Development Group (CTC REDG) was set up in 2015 to review and develop guidelines for CTC education and practice. Membership of this group includes experienced CTC radiographers who are involved in the delivery of short courses and credit-bearing postgraduate awards to support the development of CTC services. Delivering these successful programmes of study has highlighted the wide variation in current CTC practice and education across the UK, and this has provided the momentum to explore what constitutes best practice in all aspects of CTC service delivery.
While the majority of CTC referrals are via the symptomatic service, many Trusts are involved in the provision of CTC examinations for the Bowel Cancer Screening Programme (BCSP). For a national screening programme to be both safe and effective it is important, where possible, to standardise the practice between centres. For this reason our CTC REDG activities have been supported by the Public Health England BCSP Radiology committee, and we are grateful to Public Health England who generously funded the activities of our group.
This Training and Competency Record has been designed by the CTCREDG members as a proforma checklist and tool that may be used to record the acquisition of skills, attitudes and behaviours required for effective CTC practice. The first section covers Level 1-3 of the CTC Service Practitioner Framework, and the second section covers the additional levels. The completion of this proforma can be informed by various competency and skills acquisition assessment methods, including our CTC DOPS (Directly Observed Procedural Skills) toolkit, which provides easy to use checklists for observing clinical skills in those developing their CTC expertise. We recommend that this document is used in conjunction with the CTC REDG Training and Education Framework.
We hope that you will find the information provided in these documents useful in supporting the continuing professional development of CTC service practitioners.
Yours sincerely,
Prof Julie Nightingale, Sheffield Hallam University
Rachel Baldwin-Cleland, London NW University Healthcare NHS Trust
(Co-chairs of the CTC REDG)
CTC Competency Record V1.0 Page 3 Created by BCS CTCREDG – Mar 2018
Level 1-3 Competency
This section of the document covers Levels 1 to 3 of the ‘CTC Service Practitioner Framework’: Novice Beginner; Novice; Competent
CTC Competency Record V1.0 Page 4 Created by BCS CTCREDG – Mar 2018
CT Colonography Service - Staff Training / Competency Record
Trainee name : …………………………….. Role / Band : ……………………………….
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Underpinning knowledge
Demonstrate knowledge of:
- Anatomy and physiology of the colon
- Medicines management and administration
- Principles of CT scanning
- Radiation protection
- Patient care pre, during and post CTC
CTC Competency Record V1.0 Page 5 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
- Consent and communication recognising the patients’
needs and any barriers to communication
- Common appearances of colorectal polyps and
cancer
- Staging of colorectal cancer
- Local policies, IR(ME)R policies and roles, PGDs
- Referral pathways and how these may differ (e.g.
BCSP)
- Evidence of reflection
- CPD activity
CTC Competency Record V1.0 Page 6 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Pre-Procedure - Aim: Demonstrate pre-procedure preparation
Patient preparation
Understand and demonstrate knowledge of the following
topics:
- local application of the legal framework for the
prescribing and administration of bowel preparation
- patients diet prior to the procedure
- importance of fluids prior to the procedure
- types of local bowel preparations used
- the potential extreme laxative response from the
bowel preparation
- potential drug interactions with CTC preparation
- alternative investigations
Familiarisation and understanding of the relevant equipment
Demonstrate knowledge and safe use of the automated
insufflator
Demonstrate the correct way to turn CO2 cylinder on/off and
replacement of the cylinder
Identify the controls of the insufflator and describe their
function
CTC Competency Record V1.0 Page 7 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Identify the features of the rectal tube and describe the
function of these features
Demonstrate the correct use of rectal catheter lubrication gel
/ jelly, and incontinence pads for patient comfort
Demonstrate attachment and removal of the tubing from the
insufflator
Demonstrate the appropriate pressure at the beginning of
insufflation
Understand the significance of the pressure/volume
indicators
Understand the importance of monitoring the level of
discomfort experienced by the patient, how to reassure them
and adapt the technique if this occurs
Familiarisation and understanding of the relevant risks
Identify the potential risk factors (patient and environmental)
of colonic perforation during CTC
Describe the process of events that will occur if a patient
perforates during the CTC
Describe the process of events that will occur if a patient
perforates after the CTC
Explain the importance of a chaperone during the tube
insertion and removal
CTC Competency Record V1.0 Page 8 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Demonstrate knowledge of safe medicines storage,
availability and handling, including:
- prescribing / administration framework
- equipment required
- aseptic technique
- safe administration including patient checks pre,
during and post administration
- correct disposal
- record keeping
Infection control
Display appropriate infection control techniques, including:
- clean scanner bed, position bed roll and incontinence
pad
- aseptic preparation of medicines / equipment
- hand washing/sanitation pre and post patient contact
- correct use of gloves, aprons and wipes available for
patients and equipment
- correct disposal of rubbish / used equipment
CTC Competency Record V1.0 Page 9 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature
Comments
Patient privacy and dignity
Demonstrate good social skills and correct patient preparation in the following areas:
- “Hello my name is………”
- adherence to local policy of Confidentiality, Privacy and Dignity
- check ID; local policy for positive identification
- indication for procedure checked
- compliance with preparation regime
- be able to explain the importance of the patient
visiting the toilet just prior to the CTC test
- ensure patient has been to the toilet prior to the test
CTC Competency Record V1.0 Page 10 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Informed Consent
Demonstrate correct consent procedure and technique:
- be able to fully explain the sequence of events during procedure to the patient
- understand and be able to complete the pre-procedure check list
- explain the risks and potential complications of
procedure and anti-spasmolytics (e.g. Buscopan)
- check patient understanding and provide opportunities for the patient to ask questions
Evidence of radiographer correctly completing signed
and dated pre procedure checklist’s
Log book
CTC Competency Record V1.0 Page 11 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
During the Procedure: Aim: Demonstrate technical proficiency of the examination
Aim: Demonstrate good interpretation of the insufflator pressure monitoring
Proficiency and knowledge
The radiographer demonstrates:
- correct positioning of the patient on the scanner for
rectal tube insertion, and knowledge of why this is
required
- correct safety instructions, handling and injection of
anti-spasmolytic (e.g. Buscopan)
- safe insertion of the rectal tube
- safe inflation the retaining balloon
- setting the initial pressure for insufflation
- correct positioning of the patient on the scanner for
the first scan
- appropriate support and care for the patient
- good teamwork skills
Understand the significance of pressure/volume indication
Demonstrate awareness of the departmental practice regarding patient position during insufflation and the typical volume required prior to performing the first scan
CTC Competency Record V1.0 Page 12 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Understand the barriers to achieving good insufflation and how to overcome them
Demonstrate patient awareness during the scan, constant monitoring, and assessing the needs of the anxious or claustrophobic patient
Identify and select the correct scan protocols
Correctly interpret the CT scout / scanogram to appropriately distinguish when to proceed with scanning
Correctly navigate the colon in continuity and quality assure distension in a timely manner
Identify complications of perforation or obstruction necessitating early termination of exam and medical review
Correctly reposition and justify the choice of the second position to ensure optimum distension
Correctly identify whether a third position is required
Correctly understand when to stop insufflation and vent
- natural end of procedure
- termination due to safety reasons
Demonstrate safe removal of the rectal tube and appropriate disposal
CTC Competency Record V1.0 Page 13 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Post Procedure
Post procedure care and information
Immediate post procedure Radiographer demonstrates:
- reassurance to patient regarding quality and completeness of the examination (or otherwise) and escorts to changing facilities
- explanation of post procedure safety – follows local policy on recovery time
- the importance of providing fluids to the patient, and displays knowledge of where to access these in the department
Recovery post procedure Radiographer ensures:
- abdominal distention has resolved - the patient has received the post procedure
information and reiterates aftercare information o Buscopan – possibility of red/painful eye o abdominal pain o diet and rehydration advice
- cannula has been removed if inserted - the patient has been advised who to contact for their
results
CTC Competency Record V1.0 Page 14 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Colon Navigation: Aim: Demonstrate technical proficiency at colon navigation
Preliminary clinical evaluation
Select the correct sequences for review
Demonstrate knowledge of the gross anatomy of the colon
Identify the colonic segments and IC valve
Select appropriate window/ level settings
Demonstrate the ability to navigate the entire colon sequentially and identify significant pathology:
- colonic cancer - large irregular polyps - perforation
Describe any significant pathology in the appropriate terms
Achievement of full competency Trainee Signature/ Date: …………………………………………… Supervisor Signature / Date: ...:…………………………………..
CTC Competency Record V1.0 Page 15 Created by BCS CTCREDG – Mar 2018
Level 4-5 Competency
This section of the document covers Levels 4 - 5 of the ‘CTC Service Practitioner Framework’: Proficient; Expert
CTC Competency Record V1.0 Page 16 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Authorising and protocolling
Describe the appropriate clinical indications warranting a CTC
Describe the legal and local framework under which authorisation occurs (e.g. IR(ME)R roles and responsibilities, authorisation guidelines etc.)
Describe the inappropriate clinical indications not warranting a CTC
Consistently and appropriately triage indications for CTC or abdominal CT
Logbook
Appropriately advise booking staff and patients on FAQs and alternatives (if warranted) relating to the following topics:
- diet - fluids - preparation - frailty of patient - drug interactions - bowel cancer screening pathways - alternative investigations
Achievement of advanced competency Trainee Signature/ Date: …………………………………………… Supervisor Signature / Date: ...:…………………………………..
CTC Competency Record V1.0 Page 17 Created by BCS CTCREDG – Mar 2018
Imaging Directorate Training / Competency Record - Reporting CT Colonography
Trainee name : …………………………….. Role / Band : ……………………………….
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Underpinning knowledge
- Demonstrate knowledge and use of dedicated CTC
image processing system
- Navigate (on an image review platform) through the
bowel from rectum to caecum in axial, sagittal and
coronal views
- Demonstrate extensive knowledge of 2D and 3D
endo-luminal review
- Demonstrate knowledge and skills to cross reference pathology in two differing image sequences
CTC Competency Record V1.0 Page 18 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
- Demonstrate knowledge of:
o anatomy and physiology of the colon (6
sections and location)
o location of the colonic flexures
o location of the Ileocecal valve and appendix
- Demonstrate knowledge of segmental mobility and its
effect on pathology positioning
- Demonstrate knowledge of:
o appearances of an appendectomy
o appearance of lipoma
o common / uncommon appearances of the
ileocecal valve
CTC Competency Record V1.0 Page 19 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
- Describe appearances of colorectal cancer and the
characterisation of annular carcinoma and semi-
circumferential tumour
- Describe in depth tumour staging and the
enhancement features of colorectal cancer
- Demonstrate knowledge of:
o common / uncommon appearances of
colorectal polyps
o colonic perforation
o pneumatosis coli
CTC Competency Record V1.0 Page 20 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
- Describe:
o common / uncommon appearances of
diverticular disease and subjective grading
o differentiate the reasons for the appearance of
bowel wall thickening
o characterisation of inflammatory stricture
o common / uncommon appearances of the
rectum and retention balloon in the axial,
coronal and sagittal perspective
CTC Competency Record V1.0 Page 21 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Reporting structure
Have read and understood the SCoR guidelines of
Preliminary Clinical Evaluation and Clinical Reporting
by Radiographers: Policy and Practice Guidance
Demonstrate knowledge of writing an appropriate report to
include:
o image review equipment specifications
o consent obtained
o bowel preparation used (faecal tagging or non-
faecal tagging technique)
o use of anti-spasmolytic, including route of
administration and quantity given. Where a
spasmolytic is not given the reason for non-
administration should be stated
o orientation of scan positions. e.g. dual / triple
and positions e.g. supine, prone etc.
o whether IV contrast has been used, volume
and rate administered
CTC Competency Record V1.0 Page 22 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Demonstrate knowledge of standard of examination quality
(Good, Adequate, Poor) – within BCS centres this must
comply with the ‘Minimum dataset for CTC reporting’
o be able to explain why the study qualifies for a
specific category
o display understanding that each report is
individual to the patient, and that these
categories may vary depending on the clinical
question for that referral
o be able to describe any limiting factors which
affect the quality of the study
o be able to record these limiting factors in an
appropriate written style
Understand that there can be anatomical and/or
physiological variations present and demonstrate
appropriate recording terminology to relay these findings if
present
CTC Competency Record V1.0 Page 23 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
Examples of such variations are:
o enlarged IC valves, of fatty attenuation
o incompetent IC valves, allowing large
quantities of CO2 gas to reflux into small bowel
o long / tortuous colon
o redundant loops of sigmoid colon
o inverted caecum
- Describe why the factors below may influence future
medical tests for patients
o long / tortuous colon
o redundant loops of sigmoid colon
o inverted caecum
CTC Competency Record V1.0 Page 24 Created by BCS CTCREDG – Mar 2018
Competency Assessment
method Date
Signature Comments
Staff / Trainee Supervisor
- Accurately find and describe report findings (within
BCS centres this must comply with the ‘Minimum
dataset for CTC reporting’ and comply with C-
Coding) in relation to:
o colonic carcinoma (morphology, size, and
anatomical location)
o colonic stricture (reason for and severity of
lumen occlusion)
o polyps (morphology, size, and anatomical
location)
o other intra-colonic findings (such as diverticular
disease, lipoma)
Achievement of advanced competency
Trainee Signature / Date: …………………………………………… Supervisor Signature / Date: ...:…………………………………..
CTC Competency Record V1.0 Page 25 Created by BCS CTCREDG – Mar 2018
References and reference material: Preliminary Clinical Evaluation and Clinical Reporting by Radiographers: Policy and Practice Guidance https://www.sor.org/learning/document-library/preliminary-clinical-evaluation-and-clinical-reporting-radiographers-policy-and-practice-guidance Intimate Examinations and Chaperone Policy https://www.sor.org/learning/document-library/intimate-examinations-and-chaperone-policy-0 Course of Study for the Certification of Competence in Administering Intravenous Injections https://www.sor.org/learning/document-library/course-study-certification-competence-administering-intravenous-injections Obtaining consent: a clinical guideline for the diagnostic imaging and radiotherapy workforce https://www.sor.org/learning/document-library/obtaining-consent-clinical-guideline-diagnostic-imaging-and-radiotherapy-workforce Have you paused and checked? IR(ME)R Referrers https://www.sor.org/learning/document-library/have-you-paused-and-checked-irmer-referrers The Diagnostic Radiographer as the entitled IR(ME)R Practitioner https://www.sor.org/learning/document-library/diagnostic-radiographer-entitled-irmer-practitioner Patient Identification: guidance and advice https://www.sor.org/learning/document-library/patient-identification-guidance-and-advice Team working in clinical imaging https://www.sor.org/learning/document-library/team-working-clinical-imaging Caring for People with Dementia: a clinical practice guideline for the radiography workforce (imaging and radiotherapy) https://www.sor.org/learning/document-library/caring-people-dementia-clinical-practice-guideline-radiography-workforce-imaging-and-radiotherapy
CTC Competency Record V1.0 Page 26 Created by BCS CTCREDG – Mar 2018
Acknowledgements With thanks to Public Health England for their generous funding of this work, and to the Society and College of Radiographers for
supporting this activity, for considering the documentation and our related study events for endorsement. In particular our thanks
go to Sue Johnson, SCoR Professional Officer, for her guidance and support throughout the development of these documents. We
wish to acknowledge the CTC REDG members who have contributed to the development of this document:
Janice Muckian St Marks - London NW University Healthcare NHS Trust
Craig Roe Leeds Teaching Hospitals NHS Trust
Sue Johnson Society and College of Radiographers
Anne Williams Bradford Teaching Hospitals NHS Foundation Trust
Dr Ingrid Britton University Hospitals of North Midlands NHS Trust, representative from PHE BCSP Radiology committee
Michael Smith University Hospitals of North Midlands NHS Trust
Mark Richardson University Hospitals of North Midlands NHS Trust
Paul Clarke University Hospitals of North Midlands NHS Trust
Stephen Wilson North West Anglia NHS Foundation Trust (Peterborough)
Liam Gale North West Anglia NHS Foundation Trust (Peterborough)
Maureen Furneaux Portsmouth Hospitals NHS Trust
Christine Bloor Royal Cornwall Hospital, Truro
Julie Nightingale Sheffield Hallam University, representative from PHE BCSP Radiology committee, co-chair CTCREDG
Rachel Baldwin-Cleland St Marks - London NW University Healthcare NHS Trust, representative from PHE BCSP Radiology
committee, co-chair CTC REDG
top related