ACCP training A  personal  perspec,ve  

Lee Berry

• RN  qualified  1998  • Cri,cal  care  experience  2000-­‐2011  (university  teaching  hospital  SGH)  

•  ICU  • Medical  HDU  • Cri,cal  Care  Outreach  •  Lead  for  resuscita,on  2011-­‐2013  

Education

•  Formal  -­‐  University  of  Southampton  MSc  pathway    

• Key  components-­‐  

• History  taking  and  physical  assessment  • Pharmacology  and  Independent  prescribing  

• Modules  generic  not  tailored  to  ACCP  programme  

Education

•  Tutorial  programme  –    •  List  of  core  topics  selected  by  ACCPs    •  Formal  teaching  delivered  by  intensivits  and  anaesthe,c  consultants  

• High  fidelity  simula,on  sessions-­‐  • Core  clinical  decision  making  and  airway  skill  prac,ce  

• Non  ,metabled  opportuni,es  (Theatre,  ICU,  Outreach)  

Clinical rotations

• Rota,ons  at  RHCH  &  BNHH  

•  Intensive  care  unit    •  Theatre  • Cri,cal  care  outreach  

ICU  30  50%  

Anaesthe,cs  13  22%  

Outreach  17  28%  

Clinical  Alloca*on  

ICU   Anaesthe,cs   Outreach  

Practical procedures

•  Facilitated  by  ST3  and  above  during  clinical  alloca,on  

•  Intuba,on  &  Airway  skills  • Vascular  access,  CVC,  ‘vas  cath’  • Arterial  line  

Airway

Grade  1   Grade  2a   Grade  2b   Grade  3  

Total   26   9   6   2  

LMA   56  ETT   43  Total   99  

60%  21%  

14%  

5%  

Laryngoscopy  

Grade  1   Grade  2a   Grade  2b   Grade  3  

Airway  procedures  

LMA   56  

ETT   43  

Total   99  

Vascular access catheters

•  Supervised  in  theatre  and  ICU  • No  Immediate  complica,ons  

• Reduced  opportuni,es  in  ICU  for  line  placement  

• Pseudomyxoma  surgery  3-­‐5  cases  a  week  and  line  changes.  

10  

3  

11  

Vascular  Access  

CVC   Vas  Cath   Arterial  lines  

Clinical role not just procedures

• Working  within  ICU  medical  team  • Responsible  for  pa,ent  daily  review  and  presenta,on  on  consultant  ward  round    

• Undertaking  physical  assessment  and  interpreta,on  of  diagnos,c  informa,on    

• Ordering  of  diagnos,c  tests  •  Liaising  with  other  clinical  teams.  

•  Independent  prescribing  

Feedback

• Regular  360  feedback  from-­‐  

• Anaesthe,c  trainees  • Anaesthe,c  consultants  •  ICU  Nursing  staff  

• Cross  boundary  working  nature  of  role  has  led  to  misunderstanding  of  role  and  role  apprehension  among  a  small  number  of  medical  and  nursing  staff.  “Nurse  pretending  to  be  a  doctor?”  

Second year goals and beyond

•  To  become  involved  with  ICU  audit  

• M  &  M  mee,ngs  &  case  presenta,ons  

• Out  of  Hours  working  (weekends  /  nights)  Increased  learning  opportuni,es  but  maintaining  supervision  with  ICU  consultant  

• Complete  competency  document  and  final  assessment.  

FICM exit exam & National syllabus

•  FICM  exit  exam  not  yet  in  place.  In  hospital  exam  and  competency  document  equivalent?  

• Na,onal  syllabus  required  for  valida,on  and  role  consistency.