NHS Greater Glasgow and Clyde medical emergency training

This programme has equipped senior mental health nurses to deliver medical emergency training. Ward staff can now identify deterioration in physical health. They have developed the confidence to respond quickly and effectively to serious incidents and use emergency equipment properly.

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How it started

Before this programme, there was no systematic approach to responding to medical emergencies in inpatient mental health settings, and not all wards had the necessary equipment, such as defibrillators. Staff also lacked confidence and competence, to call for expert assistance except in extreme circumstances like loss of consciousness, resulting in poorer outcomes for patients. They decided to develop an in-house resource to train all mental health inpatient staff, and to equip those trainers to take a local leadership role in emergency situations.

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Partners

  • medical emergency lead
  • trainers and their line managers
  • Glasgow Caledonian University
  • inpatient staff including: nurses, medical staff, allied health professionals, community staff who may also work on wards.

Process

Twenty trainers were recruited to the development programme. Since 2011 the total number has expanded to 34. The trainers are senior charge, charge and staff nurses with five years’ experience or more, who expressed an interest and were nominated by their managers. The development programme was delivered to trainers in sessions lasting two-and-a-half hours over eight weeks. Each one-day medical emergency course is run by two trainers for groups of up to 12 staff. The course is based on UK Resuscitation Council guidelines, adapted for a mental health context. The training covers:

  • physical assessment
  • choking risks and management
  • use of equipment, including pulse oximeters and defibrillators
  • vital signs
  • medical emergency or alert calling criteria
  • recognising and treating anaphylaxis
  • resuscitation guidelines
  • causes of cardio-respiratory arrest
  • CPR sequence
  • airway adjuncts
  • safe deployment of automatic external defibrillation.

As long as core team and individual performance objectives are met, trainers can build realistic and locally sensitive scenarios into each course. Participants are allocated roles during training, such as auxiliary nurse or doctor, to reinforce learning through individual and team responses.

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Outcomes

As of December 2011, 1,700 staff had received medical emergency training, and all wards now have immediate access to emergency response equipment. Staff report that they are now more confident in calling for help at an earlier stage of physical deterioration and taking action until help arrives The training has led to better and earlier engagement with ‘failing’ patients. Staff now have an increased understanding of the physical healthcare needs of patients with serious mental health problems. This has encouraged a more holistic approach to patient health. Staff are more able to take account of patients’ physical symptoms as well as their mental health histories. Several trainers have been promoted, because of their increased confidence and improved presentation skills as well as their understanding of the evidence base of comorbid physical illness.

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Evaluation

Trainers are evaluated on their course delivery, individually and collectively. Six-monthly evaluation reports are circulated to senior managers to validate the whole programme and individual trainers. Trainees are asked to rate their levels of knowledge understanding around 17 competences before and after training. Overall there is significant shift from ‘poor’ to ‘excellent’, and the scenarios and role-play exercises were especially well received.

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Lessons learned

  • more time was required to recruit trainers and gain managers’ support for the benefits
  • some staff withdrew their initial interest because of lack of confidence, especially about delivering training to doctors
  • additional capacity is required for ongoing trainer support and supervision
  • admin support is needed to circulate course dates and arrange attendance registers, to free up trainers’ time
  • there have been gaps in take-up. Doctors are more likely to request training as a discrete group, although this undermines the objective of developing team responses to medical emergencies on the wards.

What’s next for the project?

The programme intends to obtain formal validation for the training, and to ensure that 80 per cent of all mental health inpatient staff in Greater Glasgow and Clyde are trained each year. It also hopes to use peer support to extend the trainers’ skills, covering topics such as the administration of IV cannulation and fluids without medical supervision.

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Related documents and links

Contact

Pat Spencer
Medical emergency lead
NHS Greater Glasgow and Clyde Mental Health Services
Orchard 5, The Orchards
135 Panmure Street
Maryhill
Glasgow
G20 7SJ
tel: 0141 531 5911
email: pat.spencer@ggc.scot.nhs.uk

 

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