COMPASS © Train the Trainer

Learning Outcomes

• Apply adult learning principles to facilitate at least two of the case scenarios including the escalation of patient care MET/RR and the ISBAR communication

• Recognise the physiological changes that occur in each of the case scenarios and facilitate the participants understanding of these changes

• Identify the challenges that can occur during scenario based training and have the knowledge and skills to manage them

• List the resources needed to be able to facilitate each of the case scenarios

Learning Outcomes

Trainers- What is in it for you?

• Personal satisfaction and enhanced self esteem

• Recognition from Peers as an expert in your field

• Evidence to include in your resume that you support education in your local area

• Evidence to include in your Professional Portfolio

To be certified as a COMPASS trainer you need to:

• Complete the COMPASS© Train the Trainer session

Adult Learning Principles

Adults are internally motivated and self-directedAdults resist learning if they feel it is “thrust upon them”Important to develop rapport and be approachableProvide feedback

Adults bring life experiences and knowledge to learning experiences

Assist them to draw on those experiencesFacilitate reflective learning opportunities

Adults are goal orientedAsk questions that motivate reflection, inquiry and further research.

Adult Learning Principles

Adults are relevancy orientedTraining should focus on situations faced by the participants in their work place. “Have you ever seen a ‘Gladys’ in your workplace?”

Adults are practicalTrainers should assist participants in learning how to deal with each case as if it was occurring in real life in

the clinical setting.

Adult learners like to be respectedTreat participants as equalsAllow them to voice opinions

COMPASS© Program

• Pre-learning– Manual/Supplement– Online learning application– Quiz

• Face-to-Face– Lecture

• Physiology links to vital signs• Observations Charts• Escalation Process• Communication

– Scenario Based Learning

Scenarios

• Engaging learning opportunity• Active learning• Participants able to demonstrate

understanding from Pre-learning and Lecture• Flexible

– Role Play– Some scenarios can be achieved through low-high

fidelity simulation– Can be delivered as an interactive in-service

ACT Health Format

• Delivered in undergraduate education

• Orientation course for all nursing and junior medical staff

• Modified Lecture for Senior Medical “COMPASS Pro”

• Annual Refresher for nurses – new cases

• Junior Medical Education – new cases

Resources

COMPASS WEBSITEwww.compass.act.gov.au

Log in and registration - Free

Aims based on Participants Occupation

Recognise abnormal vital signs

Ability to communicate to correct person/s

Ability to escalate if concerns not addressed

Ability to make further assessments

Ability to direct management of the patient

Student EN√ √ √

Student RN√ √ √ √

Student Medical√ √ √ √ √

EN√ √ √ √

RN√ √ √ √

Senior RN or Team leader

√ √ √ √ √

Intern/RMO√ √ √ √ √

Lecture

• Explanation of the requirements of Standard 9• Link of vital signs to physiology

– Oxygen Delivery Chain

• Introduction to the Observation Chart features and how to complete

• Introduce the relevant escalation process• ISBAR communication

Case Studies/Role Plays

• Discuss/Simulate– Interpretation of the deteriorating patient– Practice ISBAR communication– Escalation Processes – MET & MEWS– Briefly describe first line treatments

• Oxygen• Positioning• Indications for IV therapy/medications

– Discuss the patient presentation in relation to the Oxygen Delivery Chain

Connect with the Group

• Each group of participants will be different

• Try & make the course relevant to the group in order to engage them

• Relate questions and feedback to the participant areas

• Where possible target the scenarios

Group Characteristics

• Teaching in an interdisciplinary context

– Every participant has a different background (Medical, Nursing, Allied Health)

– Different levels of experience and knowledge

– Every participant should have the same basic level of knowledge (Pre-learning)

– Session needs to be non-threatening

– Extension exercises for a more experienced group

Challenging ones

• The quiet ones

• The noisy ones

• The ones who use the scenario to voice their local issues

• Reluctant Learner

Stllit tlk

Quiet One

• Difficult to assess what this learner is thinking

• Not necessarily a non-learner (Absorbing)

• May require extra support

• Allocate a less threatening role

• Rotate asking questions so all are involved

Noisy One

• Enthusiastic to share knowledge with the group

• May monopolise the group discourage the others

• May ask the complex questions (answer only relevant questions)

• If difficult to interject – wait for them to breathe.....thank them for their response and rephrase or redirect to another participant

Voices Local Issues

• Participant who uses scenario to discuss what happened to them the other day...

• May have a positive/negative effect on the group

• A short anecdote may be useful

• If disruptive offer to discuss post scenario as the issue is specific to their area

Reluctant Learner

• Less interrupting but can still send a negative behaviour in the rest of the group

• Some may find interdisciplinary learning challenging/intimidating

• Try to link relevance

• Try to create area specific scenario/questions

Satellite Talker

• Disruptive

• Instructor may choose to stop main discussion and link the satellite discussion back to the main group

• Alternatively use a direct approach and point out the disruptive behaviour and bring group attention back to topic

FEEDBACK DURING CASES

• Constructive– Motivated to improve practice

• Timely– Influence future learning

• Prompt– Can recall thinking at the time

• Supportive of learning– Will improve performance in future situations

• Focused– Achievement and what worked well

The learner that struggles

• No formal assessment• Local health service needs to establish local

guidelines for instructors to follow up poorly performing candidates

FREQUENTLY ASKED QUESTIONS

• Does it really work?Control Pilot p-value

Number of patients (%) 1157 985

Unplanned ICU admissions 21(1.9) 5(0.5) 0.005

Unexpected hospital deaths 11(1.0) 2(0.2) 0.03

All hospital deaths 30(2.6) 6(0.6) <0.001

Cardiac arrests 4(0.4) 0(0)

MET Referral 25(2.2) 38(3.9) 0.03

FREQUENTLY ASKED QUESTIONS

• But some senior staff don’t seem to worry about the escalations?

• “Do I always need to call a MET/Emergency Response?”

Run a Course

• Confirm – Date– Participants– Instructors (Ratio 1:6)

• Room (s)• AV Equipment• Ensure participants receive pre-reading• System for monitoring pre-learning

completion

Prior to assisting with scenario:

• Confirm sessions you are able to assist with

• Be aware of which scenario you will be facilitating

• Prepared for the allocated scenario

• Refresh your physiology• Enthusiastic Expert

• Notify the course coordinator prior to the day of the course if you require any assistance or practice with the scenario

On the day of the session

• Arrive at least 5 minutes before the case scenario is due to start

• Ensure you have all the material required

• Follow the format of the case scenario and ensure all key learning objectives have been achieved by the end of case scenario

Case Scenario 2- Postop

• Simple management: IVC, IV fluids, Oxygen

• Blood volume has due to the bleeding, leading to Cardiac Output

• BP (BP = CO x TPR) to compensate an HR

• RR - pain or lactic acidosis from inadequate oxygen delivery because CO fallen

Case Scenario 3- AF

• Sick patients must always go back to bed• Hypoxia should be treated with oxygen even with CAL• Always check an un-recordable BP manually

• Her hands are cool therefore Cardiac output

• The Heart Rate does not allow for adequate cardiac filling and

so SV and CO

• Then BP (BP = CO x TPR)

• Left atrium will not expel all the required blood

• Left atrial pressure will build up and patient will develop pulmonary oedema

Case Scenario 4- Hypo

• Do a Blood Glucose Level (BGL) if there is any change in mental state or alertness

(including confusion/aggression/drowsiness)

• If the patient is conscious they should receive glucose tablets and a beverage

• If the patient is unconscious they should receive IV glucose (need large vein to give concentrated glucose)

Case Scenario 4- Hypo (Cont)

• IV access and oxygen is required

• Aftercare following the initial bolus of glucose includes: Ongoing BGL monitoring more frequently Monitor oral intake Reassess with medical staff the next scheduled dose of insulin

• If the patient proceeds to a seizure the important point to highlight in this case is still glucose and oxygen and MET ???

Errors that can be highlighted during Case Studies

• Incomplete set of vital signs (all core obs= RR, SpO2, HR, BP, Temp, LOC)

• Incorrect level of escalation (i.e.-MET/Review)

Take home messages for participants

• Vital signs are vital• Understand why they have changed• Teamwork• Management plans• Communication: ISBAR• Ask for help• Documentation• You can make a difference to a patient’s outcome

Demonstrated Case Scenario

Now its your turn!