|
|
Education & training (c)
Summary of Indicators
| |
C. Education and training |
 Education
1
4 points |
There is a record of all practice-employed clinical
staff having attended
Training/updating in basic life support skills in the preceding
18 months |
Education
2
4 points |
The practice has undertaken a minimum of six
significant event reviews in the past 3 years |
Education
3
2 points |
All practice-employed nurses have an annual appraisal |
Education
4
3 points |
All new staff receive induction training |
Education
5
3 points |
There is a record of all practice-employed staff
having attended training/updating in basic life support skills
in the preceding 36 months |
Education
6
3 points |
The practice conducts an annual review of patient
complaints and suggestions to ascertain general learning points
which are shared with the team |
Education
7
4 points |
The practice has undertaken a minimum of twelve
significant event reviews in the past 3 years which include
(if these have occurred):
· Any death occurring in
the practice premises
· Two new cancer diagnoses
· Two
deaths where terminal care has taken place at home
· One
patient complaint
· One suicide
· One section under
the Mental Health Act |
Education
8
3 points |
All practice-employed nurses have personal learning
plans which have been reviewed at annual appraisal |
Education
9
3 points |
All practice-employed non-clinical team members
have an annual appraisal |
There is a record of all practice-employed
clinical staff having attended training/updating in basic life support
skills in the preceding 18 months
Education 1.1 Practice guidance
The primary care team members deal with cardio-pulmonary collapse
relatively rarely, but require to have up-to-date skills to deal
with an emergency. This is best undertaken at regular intervals
through practical skills-based training sessions, as it is known
that these skills diminish after a relatively short time. The timescale
has been set pragmatically at 18 months, although many practices
offer training on a more frequent basis.
This training may be available from a variety of providers including
your local Accident and Emergency Department, BASICS, the PCO or
out-of-hours co-operative, Red Cross, St John's Ambulance or equivalent.
It may be sufficient for one individual in the team to attend for
external training and then cascade this within the team.
Education 1.2 Written evidence
Attendance at CPR training should be listed. (Grade B)
Education 1.3 Assessment visit
Staff should be questioned on the date of their last CPR training.
Education 1.4 Assessors' guidance
Assessors should confirm by checking the CPR attendance list that
practice-employed clinical staff have attended.
The practice has undertaken a minimum of
six significant event reviews in the past 3 years
Education 2.1 Practice guidance
Significant event review is a recognised methodology for reflecting
on important events within a practice and is an accepted process
as evidence for GMC revalidation.
Significant event analysis is not new, although its terminology
may have changed. It was first known as critical event monitoring.
It provides structure to an activity which anyway happens informally
between health care professionals. It is the discussion of cases
and events and the learning obtained through reflection. Due to
its reflective nature, it can be viewed as an extension of audit
activity. Discussion of specific events can provoke emotions that
can be harnessed to achieve change. For it to be effective, it needs
to be practised in a culture that avoids blame allocation and involves
all disciplines within the practice.
The following steps are useful in introducing significant event
analysis to a practice:
1. A multidisciplinary meeting to explain the concept.
2. Consideration of events which should be important to the practice
but need not imply criticism of the practice. The practice can construct
a core list as a basis to stimulate discussion or it can use the
one published in the RCGP Occasional Paper (see reference at end
of this section). Some of the examples from this are below.
Preventative care:
Measles
Unplanned pregnancy
Non-accidental injury
Squint diagnosed by an ophthalmologist
Acute care:
Sudden unexpected death
Death occurring on the practice premises
Suicide or suicide attempt
All new cancer diagnoses
Myocardial Infarction
Terminal care death at home
Section under Mental Health Act
Chronic disease:
Diabetic hypoglycaemia
Leg ulcer or amputation
Asthma - hospitalisation
Epilepsy – status epilepticus
Organisation:
Investigation received but not acted upon
Breach of confidentiality
Any patient complaints
Upsetting of staff
3. Mechanism for identification of events. A logbook kept at reception
may be helpful or an electronic logbook held on the practice computer
system. Any mechanism should allow all team members to contribute.
4. Significant events meetings. These are generally multidisciplinary
and chaired, and notes should be taken. Each attendee should be
encouraged to take along at least one significant event. The meeting
can choose which to discuss first and anybody can have the right
to veto if that area is considered too sensitive.
The events are then discussed, first highlighting the aspects of
high standard and then those standards that can be improved. A decision
about the case needs to be reached.
This can be:
- celebration of excellent care
- no change
- audit required
- Immediate change required.
Follow-up of these decisions should be arranged and this may occur
at the next significant event analysis meeting.
These reports should be laid out in a form consistent with either
of the two following suggested formats:
A.
- Description of event. This should
be brief and can be in note form.
- Learning outcome. This should
describe the aspects which were of high standard and those which
could be improved. Where appropriate it should include why the event
occurred.
- Action plan. The decision(s) taken
need to be contained in the report. The reasons for these decisions
should be described together with any other lessons learned from
the discussion.
B.
- What happened?
- Why did it happen?
- Was insight demonstrated?
- Was change implemented?
Reference:
Royal College of General Practitioners. Significant Event Auditing:
Occasional Paper 70. London: RCGP, 1995.
A description of significant event audit is also available in: Robinson
LA, Stacy R, Spencer JA, Bhopal RS. How To Do It: Use facilitated
case discussions for significant event auditing. BMJ 1995; 311:
315-318.
Education 2.2 Written evidence
Each case report must consist of a short commentary setting out
the relevant history, the circumstances of the episode and an analysis
of the conclusions to be drawn. Evidence should be presented of
any clinical and organisational changes resulting from the analysis
of these cases. (Grade A)
Education 2.3 Assessment visit
The reviews should be discussed.
Education 2.4 Assessors' guidance
The practice should report their analyses in a form consistent with
either of the two following methods:
A. Statement of the problem or event, learning outcome and action
plan or
B. What happened? Why did it happen? Was insight demonstrated? Was
change implemented?
The practice should involve all team members who were stakeholders
in the event in the case discussion.
All practice-employed nurses have an annual
appraisal
Education 3.1 Practice guidance
Appraisal is a constructive opportunity to review performance objectives,
progress and skills and identify learning needs in a protected environment.
The learning needs identified may be personal to the appraisee and/or
organisational learning needs which the appraisee has agreed to
fulfil. The outcome of the appraisal should be a written action
plan agreed between appraiser and appraisee which could include
a personal learning plan for the appraisee.
Practices which have established appraisal schemes for the nursing
team use varying professionals as appraisers. The agreed structure
of the scheme should include identification of which individual(s)
will take on the role of appraiser. It is important that all team
members who are appraisers are adequately trained in appraisal techniques.
Some further guidance on appraisal can be found on the ACAS website
(www.acas.org.uk)
and in the ACAS advisory booklet: Employee Appraisal.
http://www.acas.org.uk/publications/B07.html
The practice could draw on the professional practice and appraisal
skills of a lead nurse in the PCO.
Education 3.2 Written evidence
The appraisal system should be described. (Grade C)
Education 3.3 Assessment visit
The doctors and practice-employed nurses should be questioned on
the nurses' appraisals
The appraisal system for practice-employed nurses should be discussed
with the nurses themselves and the person responsible for managing
the appraisal scheme eg GPs, nurse, practice manager.
All new staff receive induction training
Education 4.1 Practice guidance
The use of a structured induction programme will help new staff
fit more quickly into the practice and support them in becoming
effective team members. It is useful to establish a programme of
induction for a post, but to remember that it may need to be used
flexibly, for example when an employee:
- is returning to work after a long absence
- has not worked before
- as a disability
- is from an ethnic minority group.
A programme could include:
- going through terms and conditions of employment
- meeting other members of the practice team, possibly including
shadowing
- clarifying areas of responsibility and accountability
- practice codes and/or standards and regulations including Health
and Safety/special hazards, uniforms, arrangements for working overtime,
time in lieu etc
- familiarisation with protocols and procedures including employment
procedures eg sickness absence policy
- training in the responsibilities of the post.
This list is not exhaustive.
Clear recording of the areas covered in the programme and regular
reviews of progress will help establish the standard of performance
which is expected and help the manager and new member of staff to
identify remaining areas of lack of knowledge and understanding.
This will help the new team member to feel valued and supported.
Education 4.2 Written evidence
If a new member of staff has commenced after 1 April 2003, the induction
programme which has been implemented should be sampled. (Grade B)
Education 4.3 Assessment visit
The induction programme should be inspected.
Education 4.4 Assessors' guidance
It may be useful to speak to the newest member of staff as well
as inspecting the induction programme itself if he or she has commenced
in post after 1 April 2003.
There is a record of all practice-employed
staff having attended training/updating in basic life support skills
in the preceding 36 months
Education 5.1 Practice guidance
Although it is rare for practice non-clinical staff to have to deal
with a cardio-pulmonary collapse, the situation may arise within
or outwith the practice premises.
See Education 1.
The interval for training is pragmatically set at three years although
many practices offer training on a more frequent basis.
Education 5.2 Written evidence
Attendance at CPR training should be listed. (Grade B)
Education 5.3 Assessment visit
Staff should be questioned on the date of their last CPR training.
Education 5.4 Assessors' guidance
Confirmation that practice non-clinical staff have attended training
should be obtained by checking the CPR attendance list.
The practice conducts an annual review of
patient complaints and suggestions to ascertain general learning
points which are shared with the team
Education 6.1 Practice guidance
Practices and clinicians generally find complaints stressful. It
is important that the practice view complaints as a potential source
for learning and for change and development.
Reports should include a summary of each complaint or suggestion
and an identification of any learning points which came out of the
review. It may be useful to agree at the time of each review how
the learning points or areas for change will be communicated to
the team; it is likely that not all team members will be involved
in every review meeting for various reasons. It will also be useful
to identify an individual responsible for implementing the change
and monitoring its progress.
These reports may form part of the written evidence for the indicators
on significant event analysis (Education 2 and Education 7).
Education 6.2 Written evidence
Reports/minutes of team meetings where learning points have been
discussed should be made, with a note of the changes made as a result.
(Grade A)
Education 6.3 Assessment visit
The issue of learning from complaints should be discussed with staff
and doctors.
Education 6.4 Assessors' guidance
Assessors should discuss with team members their involvement in
reviews of patient complaints and suggestions and how the learning
points are shared with the team.
The practice has undertaken a minimum of
twelve significant event reviews in the past 3 years which include
(if these have occurred):
- Any death occurring in the practice premises
- Two new cancer diagnoses
- Two deaths where terminal care has taken
place at home
- One patient complaint
- One suicide
- One section under the Mental Health Act
Education 7.1 Practice guidance
Detail of methodology on significant event analysis is given in
Education 2.
This indicator is more prescriptive in the requirement to report
on specific occurrences in the practice. Clearly if certain of these
events have not occurred, eg patient suicide, then this should be
stated in the evidence.
Education 7.2 Written evidence
Each review case report must consist of a short commentary setting
out the relevant history, the circumstances of the episode and an
analysis of the conclusions to be drawn. Evidence should be presented
of any clinical and organisational changes resulting from the analysis
of these cases. (Grade A)
Education 7.3 Assessment visit
The reviews should be discussed.
Education 7.4 Assessors' guidance
The practice should report on its analyses in a form consistent
with either of the two methods described in Education 2.
All practice-employed nurses have personal
learning plans which have been reviewed at annual appraisal
Education 8.1 Practice guidance
The production of a personal learning plan may be one of the outcomes
of the appraisal system. The plan could record the agreement between
appraiser(s) and appraisee on areas for further learning, how they
will be achieved, who is responsible for organising them, within
what timescale, and how progress will be reviewed. It may also include
learning areas which have been identified as an organisational need
but which have been agreed at the appraisal as an individual development
area for the appraisee to take forward. This information should
be recorded.
Education 8.2 Written evidence
The staff appraisal system should be described. (Grade C)
Education 8.3 Assessment visit
A discussion should be held with practice-employed nursing staff
about their personal learning plans.
Education 8.4 Assessors' guidance
Personal learning plans should be discussed with practice-employed
nursing staff.
All practice-employed non-clinical team
members have an annual appraisal
Education 9.1 Practice guidance
Appraisal is a constructive opportunity to review performance objectives,
progress and skills and identify learning needs in a protected environment.
The learning needs identified may be personal to the appraisee and/or
organisational learning needs which the appraisee has agreed to
fulfil. The outcome of the appraisal should be a written action
plan agreed between appraiser and appraisee which could include
a personal learning plan for the appraisee. In addition the opportunity
could be taken to review and update the appraisee's job description.
Education 9.2 Written evidence
The staff appraisal system should be described. (Grade C)
Education 9.3 Assessment visit
A discussion should be held with practice-employed non-clinical
staff about their experience of appraisal.
Education 9.4 Assessors' guidance
It may be useful to discuss the appraisal system with the non-clinical
staff themselves, the practice manager and the GPs.
|
