Information regarding the grading within Student. Paramedic Practice Assessment Document (PAD)

Transcription

1 Information regarding the grading within Student Paramedic Practice Assessment Document (PAD)

2 This information booklet provides instruction on how to use the Student Paramedic Practice Assessment Document (PAD). The PAD has been designed to reflect similar content as those in use at other Universities within the EEAST region. You may mentor another student from a different University and whilst the PADs are essentially the same some minor differences will be evident depending on the University. These differences relate to the learning taxonomy or levels the student must achieve within their placements assessments. The Anglia Ruskin University utilises the Steinaker and Bell Taxonomy where a student progresses from exposure to internalisation. The final end point of dissemination is not utilised within the PADs. University of East Anglia uses a system which again possesses 4 levels from Dependent to Independent based on Grow s Stages of Development of Learning Autonomy (1991). Whilst the terminology may differ in each University s own PAD, the levels however will remain the same when you are assessing the student paramedic, from 1-4. The Anglia Ruskin University PAD possesses a grade 0 where a student fails to engage with their Paramedic Educator, Associate Paramedic Educator or other qualified and registered assigned clinical supervisor. This will then require a Cause for Concern form, included within the PAD to be completed and sent to the Course Leader so that appropriate support and action can be instigated for the student to progress. The UEA apply a slightly different approach to this in that any concerns over the student s likelihood to achieve the required level in practice may trigger a Development Action Plan and further support from the Link Lecturer as required. However issues with regard to a student s engagement along with other problems of attitude/behaviour would trigger the PEd to complete a Development Action Plan in the first instance, followed by a discussion with the Link Lecturer and if the behaviour continued then a Cause for Concern form would be completed and submitted to the UEA for further support and action. Table 1 shows how the two taxonomies are aligned along with the grading used within the PAD

3 Grade University of East Anglia Anglia Ruskin University Grade 1 Dependent Exposure (formative assessment only) Grade 2 Assisted Participation Grade 3 Minimal Supervision Identification Grade 4 Independent Internalisation Grade 0 Table 1 Levels of Competence Disengagement (Cause for Concern) In order to allow the Paramedic Educator to identify swiftly the necessary Elements of Practice that a student has to pass at the final assessment whilst in placement or in the case of the UEA, by the end of each year, a traffic light system has been devised and is presented on the next page. Any area in red indicates that a student has not yet had the theory or skills sessions within the University but may be exposed to the skill whilst on placement (See table 2 below). These Elements will not require any summative assessment however the student should ideally capture these experiences (exposure) and record this within the formative section (Learning log) of the PAD. Those Elements of Practice highlighted in Amber and Green will have a specific level that the student must achieve whilst in clinical placement, or for UEA during that year, and will form part of the final or summative assessment within the PAD. Grade University of East Anglia Anglia Ruskin University Traffic Light System Grade 1 Dependent Exposure Red Grade 2 Assisted Participation Amber Grade 3 Minimal Supervision Identification Amber Grade 4 Independent Internalisation Green Grade 0 Disengagement Cause for Concern Table 2 Alignment of Traffic Light System

4 BSc (Hons) Paramedic Science Key Traffic Light Scope of Practice No Theory or Skills sessions have been delivered. Student should be exposed to these skills without an expectation to practice. The student is not expected to be knowledgeable at this stage however if the PEd undertakes this skill, and assistance is required, it MAY be appropriate for the student to participate in part of the activity, under the direct supervision of the PEd. Exposure only at this level is expected. Relevant Theory and Skills session have now been undertaken Student must now practice these skills Exposure and relevant theory underpinning the skill enables the student to assist or aid the lead clinician in the application of an intervention but independent practice is not within their current scope. The student may lead on patient care however this is under the direct supervision of the PEd. As such the clinical decision to implement and the responsibility of the intervention, procedure or skill remains the primacy of the PEd. Participation and Identification is expected at this level Relevant Theory gained and Skills practice has taken place. Student must now develop Independence in their practice. The student has developed the required level of skills and knowledge and falls within this scope of practice and is capable of independent practice. However, experiential learning is still taking place, as such advice and guidance may still be sought from the PEd. Internalisation or Independence is expected at this level. Subject to satisfactory completion of manual handling training which the HEI/Ambulance Trust deems appropriate for employees to be able to participate in manual handling tasks. Subject to satisfactory evidence of competency achieved during hospital placement (or passing practical skill in skills lab summative). Important note: The Paramedic Educator, registered practitioner or lead clinician continues to maintain primacy of care of the patient and is ultimately responsible for all documentation, although where appropriate the student may take the active lead.

5 The traffic light scope of practice is intended to be a quick reference guide and communication tool for the PEd, associate PEd or supervising clinician. It highlights whether the student has received any formal training for a particular element at any given time on the programme and how much support or training the PEd is likely to be expected to provide. Obviously as the student progresses through the programme and is assessed in practice by their PEd, decisions on the delegation of skills will be based on this assessment and any action plans in place. However as the student will be moving between ambulance and non-ambulance placements this traffic light document will provide a quick reference in situations of uncertainty thus not impeding the learning opportunities by lengthy searches through the PAD in order to clarify what the student should and should not be able to do at any particular time in the programme. This document considers a progressive practice journey from red (Exposure or assisted) to green (Internalisation or independent). It is written with due consideration of the UK ambulance service clinical practice guidelines (JRCALC, 2013) and considers patient assessment skills that meet the standards of this. The next few pages present the elements of practice colour coded using the traffic light system NB Those areas in red (exposure or dependent) do not require summative assessments, those in amber (participation and identification or assisted and minimal supervision) will require summative assessments but only to grades 2 and 3 with green being assessed at grade 4 (internalisation or Independent)

6 Weeks (ARU) Tri 2 / 3 (ARU) Tri 1 / 2 (ARU)Tri 3 (ARU) tri 1 / 2 Grading Grade 1/2 Grade 1/2/3 Grade2/3/4 Grade 4 1 Communication (and technologies) Breaking bad news Radio base and Tetra handsets Mobile Data Terminal (MDT) Blue calls/pre alert calls (mobilising) 2 H&S - Moving and Handling Ergonomics, risk assessment, TILE Use of carry chair (not lifting) Lifting carry chair with patients Small handling aids Use of trolley bed (not lifting) Lifting trolley bed with patients Use of Manger-Elk inflatable cushion 3 H&S - Scene Safety Safety of scene CBRN/HAZMAT Step 1, 2, 3 De-fusing and resolving conflict 4 H&S - PPE Wears high visibility jackets/helmets appropriately Wears gloves, aprons, eye protection appropriately 5 Infection Prevention Control (Cross Infection) Hand hygiene and gloves Cleaning Sharps management Using appropriate cleaning mediums

7 Vehicle and equipment hygiene 5 (Cont) Aseptic technique Reporting HSE issues and RIDDOR 6 Patient Safety Slips, trips and falls Walking equipment and personal alarms 7 Patient involvement and wellbeing dignity, respect advocacy 8 Consent Obtain consent to assess and examine Valid, written, verbal and implied Best interests DNA-CPR orders Advanced Decisions (Living Wills) 9 Confidentiality Verbal PRF/ePCR documentation 10 Capacity Assess capacity; understand, retain, weigh-up, communicate Assess capacity in patients with MH, dementia Assess capacity in patients under influence of alcohol or recreational drugs

8 11 Patient Records of clinical records PRF/ePCR completion Capacity forms Other; NHS leave at home leaflets 12 Vulnerable Adults/Children Falls referal Vulnerable adult/child referal 13 Monitoring, Recording and Interpreting Obs (Adults) Pulse rate Respiratory rate Blood pressure SpO2 monitoring Peripheral blood glucose testing Temperature AVPU Glasgow Coma Scale (GCS) Peak Expiratory Flow Pupils Capillary refill Pain score 14 Monitoring, Recording and Interpreting Obs (Paed's) Pulse rate Respiratory rate Blood pressure SpO2 monitoring

9 Peripheral blood glucose testing Temperature AVPU Glasgow Coma Scale (GCS) Peak Expiratory Flow Pupils Capillary refill Pain score 15 4 and 12 Lead ECG Analysis Identify anatomical landmarks for ECG dot placement 15 (Cont) Correctly use equipment (Zoll) Apply systematic approach Normal ECG ACS including STEMI Arrhythmias Blocks 16 History Taking Adult Children Mental Health patients 17 Mental Health - History Taking and Assessment Communication skills Risk assessment tools/challenging conversations 18 Primary Survey Medical: ABCDE

10 Trauma: CAcBCDE 19 Time Critical Patients Manage time-critical patients 20 Respiratory System Exam and (Adults) Expose, inspect, palpate, auscultate, percuss 21 Cardiovascular System Exam and Manage (Adults) OPQRSTA/SOCRATES, oedema, JVD/JVP, clubbing 22 Nervous System Examination and Manage (Adults) FAST 22 (Cont) Follow H, peripheral vision, pupil accomodation, muscle strength/tone, sensory and sensation 12 cranial nerve assessment 23 Gastrointestinal/Genitourinary Exam (Adults) Expose, inspect, auscultate, percuss, palpate 24 Musculoskeletal System Exam and Manage (Adults) Look, feel, move, neurovascular compromise, TAM (tetanus, allergies, medications)

11 25 Obstetric and Gynaelogical Presentations/Manage Three stages of labour Normal delivery Obstetric emergencies; Prolapsed umbilical cord, PPH, AP and placental abruption, multiple births, shoulder dystocia, eclampsia Miscarriage/ectopic Care of the newborn 26 Respiratory System Exam and (Paed's) Expose, inspect, palpate, auscultate, percuss 27 Cardiovascular System Exam and Manage (Paed's) OPQRSTA/SOCRATES 28 Nervous System Examination and Manage (Paed's) Assessment specific to paediatric presentation i.e. Seizure 29 Gastrointestinal/Genitourinary Exam (Paeds) Expose, inspect, auscultate, percuss, palpate 30 Musculoskeletal System Exam and Manage (Paed's)

12 Look, feel, move, neurovascular compromise, TAM (tetanus, allergies, medications) 31 Multiple Casualties and Resource Sieve and Sort Designated role in major incident 32 Recognition/Assessment of Cardiac Arrest (All Ages) Basic life support adult Basic life support child Intermediate life support adult Intermediate life support child Advanced life support adult advanced life support child Defibrillation (manual) 33 Basic Airway (Adults) Head tilt, chin lift 33 (Cont) Jaw thrust C-Spine control Oropharangeal airway Nasopharangeal airway Suction BVM 34 Advanced Airway (Adults) I-gel

13 Intubation (inc assisted and laryngoscopy) Needle Cricothyroidotomy Tracheotomy care Capnography Needle chest thoracocentesis 35 Patient Ventilation (Adults) IPPV - mechanical ventilator 36 Basic Airway (Paediatrics) Head tilt, chin lift Jaw thrust C-Spine control Oropharangeal airway Suction BVM 37 Advanced Airway (Paediatrics) I-gel Intubation (inc assisted and laryngoscopy) Needle Cricothyroidotomy 37 (Cont) Tracheotomy care Capnography Needle chest thoracocentesis 38 Patient Ventilation (Paediatrics) IPPV - mechanical ventilator (age appropriate) 39 Medicine (Adults) Safe practice; check medicine to be given

14 Inhaled medicines Oral medicines Sublingual medicines IM medicines Per-rectum medicines IV/IO medicines Controlled medicines (assistance only) 40 Medicine (Paediatrics) Safe practice; check medicine to be given Inhaled medicines Oral medicines Sublingual medicines IM medicines Per-rectum medicines IV/IO medicines Controlled medicines (assistance only) 41 IM Injection Site selection Aseptic technique 41 (Cont) Correct needle chosen for given site/person IM injection technique 42 IV Cannulation Site selection Aseptic technique Correct cannula chosen for site, person and drug IV cannulation techique

15 43 IV infusion Prime giving set with correct fluid Attach giving set to cannula/three-way tap Attach three-way tap Secure line Run fluid according to best practice 44 Wound Care and Dressings Dressings (all) Non-invasive burns care 45 Cervical Spinal Care and Immobilisation Manual immobilisation Collar Kendrick Extrication Device Rapid take-down Crash helmet removal Orthopaedic stretcher (not lifting) Rescue board (not lifting) Orthopaedic stretcher (lifting) Rescue board (lifting) 45 (Cont) Standard extrication Rapid extrication 46 Fractures - Including Spinting and Traction Traction and Sager Splint Box splint Triangular bandages Frac straps SAM splint (pelvic fractures)

16 47 Patient Transportation and Poistioning Positions and transports a wide range of patients 48 Clinical Decision Making - Including Trust Pathways STEMI Stroke TIA Sepsis AAA Trauma NOF Safety netting 49 Treatment Centre/Destination General - identifying destination 50 Patient Handover Physical patient handover Clinical patient handover ASHICE 50 (Cont) ATMISTER 51 Maintain Fitness to Practice/Professional Standards Adhere to HCPC standards 52 Multidisciplinary Working and Collaboration Work with a wide range of HCP's

17 Other Vehicles VDI (ambulance equipment) These students are NOT able to drive ANY service vehicle under ANY circumstances. They have not had any training in the use of driving related functions. Important Note: The registered practitioner or lead clinician continues to maintain primacy of care of the patient and is ultimately responsible for all documentation, although where appropriate the student may take the active lead.