Guide to the Anglia Ruskin Paramedic Science Practice Assessment Document Valid for Academic Year 2016/7 www.anglia.ac.uk Page 1
Purpose of this document This document is to give you, and your mentor a guide of what is required to pass the Practice Assessment Document (PAD), what can and can t be simulated, and how to use discussions for sign off. Each element of practice is listed in this document along explanation of what you need to be exposed to for this to be signed off, and is intended to be used with the PAD. This document will also outline the role of alternative assessment process, such as simulations and facilitated discussions, when these can be undertaken and how. This document does not replace the descriptors in the PAD, and is designed to be used to provide further information. Simulations Simulations may be undertaken for certain elements of practice that the student has not been exposed to during their time out on placement. For a student to be given a simulation, non-exposure must be recorded by the mentor in the comment area of the element of practice in question, without this simulation will not be offered. Each element of practice below, sets out whether or not simulation will be facilitated, simulation will only be provided for elements the students may not reasonably be exposed to over the course of their placement. Simulations are only to be provided by the Anglia Ruskin University teaching team and should not take place within the Trust by mentors. Appropriate time has been pre-arranged in the timetable by the module team for completion of simulations or other form of assessments if necessary. Each student will be given two simulations only. Discussions Discussions can be used to demonstrate knowledge after attending an incident which may relate to an element of practice in the PAD but that doesn t meet the full descriptor requirements, examples of this are provided in each section. These examples are not definitive, and discussion can be used if the student is in part exposed to an element, and further clarity is needed by the mentor. Elements of Practice The elements of practice are all listed below, and provides further information and clarity about what is necessary to get an element signed off, these have been generated partly in response to questions raised from mentors in previous years. These descriptors are to complement those found in the PAD, and the two are to be used together to help www.anglia.ac.uk Page 2
understand what exposure is required. The descriptors in the PAD provide examples of things required but are not a comprehensive list. Each also contains information regarding any discussion or simulation options, and an example of the type of situation where discussion may be beneficial. If an element of practice has been signed off at an appropriate grade formatively, and the student receives no further exposure, a mentor is encouraged to consider moving this to a summative assessment. The University is unable to make the assumption that an appropriate sign off at the formative can automatically be moved to the summative. An incident which has been attended can be used for the completion of more than one element of practice. Please note - For an element of practice to be completed it requires the appropriate grade, as well as being signed, and dated by the mentor. Who Can Sign Elements Off? The following table gives guidance as to who can sign off the Practice Assessment Document when on ambulance placements. This is mandated in part by the HCPC, and is not a comment on the clinical abilities of non-registered clinicians. Clinician Practice Educator Course Completed? Formatives n Registered Cannot sign off any Clinician elements. n Registered Can sign off any Clinician within their scope of practice. Paramedic Can sign off any within their scope of practice. Paramedic Can sign off any within their scope of practice. Summative Cannot sign off any elements. Cannot sign off any elements. Cannot sign off any elements. Can sign off any within their scope of practice. www.anglia.ac.uk Page 3
Newly Qualified Paramedics (NQP) Please note that this guidance currently only applies to those in the London Ambulance Service. Guidance for East of England will be released shortly. Growing as an educator is an important part of any clinican s career, below stipulates how Newly Qualified Paramedics can act as mentors to Anglia Ruskin students. Clinician Practice Educator Course Completed? Take Students on Shifts? Formative Sign Offs NQP1 Cannot sign off any elements. NQP1 Cannot sign off any elements. NQP2 Cannot sign off any elements. NQP2 Can sign off any within their scope of practice. Summative Sign Offs Cannot sign off any elements. Cannot sign off any elements. Cannot sign off any elements. Cannot sign off any elements. The above grid outlines which NQPs can take students out on shift, but this should only be done as a last resort, and students should not have an NQP as a named mentor. Trust policy takes precedence over anything contained in this document. Answers to any further queries, and a contact for the University can be found at www.anglia.ac.uk/mentors. www.anglia.ac.uk Page 4
Contents List of Elements of Practice Skill Page 1 Communication (and technologies) 6 2 Moving and Handling: 6 3a H&S Scene Safety 6 3b H&S-Scene Safety (HAZMAT) 7 4 H&S PPE 7 5 Infection Protection Control (cross-infection) 7 6 Patient Safety 8 7 Patient Involvement and Wellbeing 8 8 Consent 8 9 Confidentiality 9 10 Capacity including refusal of care, treatment and or transportation 9 11 Patient records 9 12 Vulnerable Adults/Children 10 13 Monitoring, Recording and Interpreting Observations (Adults) 10 14 Monitoring, Recording and Interpreting Observations (Paediatrics) 10 15a 4 and 12 Lead ECG Analysis 11 15b 4 and 12 Lead ECG Analysis (Interpretation) 11 16 History Taking Use of FE (Adults and Children) 11 17 History taking Mental Health 11 18a Primary Survey 12 18b Primary survey (Trauma) 12 19 Time Critical Patients 12 20 Respiratory System Examination and Management (Adults) 13 21 Cardiovascular System Examination and Management (Adults) 13 22a Nervous System Examination and Management (Adults) 13 22b Nervous System Examination and Management (Adults)(cranial nerves) 14 23 Gastrointestinal and Genitourinary System Examination and Management (Adults) 14 24 Musculoskeletal System Examination and Management (Adults) 14 25 Obstetric and Gynaecological Presentations and Management 15 26 Respiratory System Examination and Management (Paediatrics) 15 27 Cardiovascular System Examination and Management (Paediatrics) 15 28 Nervous System Examination and Management (Paediatrics) 16 29 Gastrointestinal and Genitourinary System Examination and Management (Paediatrics) 16 30 Musculoskeletal System Examination and Management (Paediatrics) 17 31 Multiple Casualties and Resource Management 17 32a Recognition, Assessment and Management of Cardiac Arrest (All Ages) (BLS) 17 www.anglia.ac.uk Page 5
32b Recognition, Assessment and Management of Cardiac Arrest (All Ages) (ALS) 18 www.anglia.ac.uk Page 6
Skill Page 33 Basic Airway Management (Adults) 18 34 Advanced Airway Management (Adults)Level 4 18 34a Advanced Airway Management (Adults) (Supraglottic) Level 5 18 34b Advanced Airway Management (Adults) (Intubation) Level 5 19 34 Advanced Airway Management (Adults) Level 6 19 35 Patient Ventilation (Adult) 19 36 Basic Airway Management (Paediatrics) 19 37 Advanced Airway Management (Paediatrics) 20 38 Patient Ventilation (Paediatric) 20 39a Medicine Management (Adults) 20 39b Medicine Management (Adults) 20 40a Medicine Management (Paediatrics) 21 40b Medicine Management (Paediatrics) 21 41 Intramuscular Injection 21 42 Intravenous Cannulation 21 43 Intravenous Infusion 22 44 Wound Care and Dressings 22 45 Cervical Spinal Care and Immobilisation 23 46 Fractures Including Splinting and Traction 23 47 Patient Transportation and Positioning 23 48 Clinical Decision Making 24 49 Treatment Centre/Destination 24 50 Patient Handover 24 51 Maintain Fitness to Practice/Professional Standards 25 52 Multidisciplinary Working and Collaboration 25 www.anglia.ac.uk Page 7
Elements of Practice Element of Practice 1 Communication (and technologies) Discussion? What makes a sign off? To achieve this sign off the student needs to demonstrate principles of communication, talking to a variety of people, and having a variation in discussions. t all of the subjects listed in the descriptor need to be used, they may be a variety of these, or something else entirely. Students may also wish to demonstrate communication with EOC, by use of radios, Mobile Data Terminals etc. Element of Practice 2 Moving and Handling Discussion? What makes a sign off? For this element of practice students need to demonstrate they can safely apply moving and handling skills to patients, and to equipment. Students do not need to undertake every element that is named in the descriptor in the PAD to make a sign off, nor is it mandatory to use a carry chair. Element of Practice 3a H&S Scene Safety Discussion?, discussion may be used at a variety of scenes to demonstrate understanding of potential hazards, and how they can be overcome. What makes a sign off? Scene safety can consist of seeing and managing hazards, any dangers that may present to the crew, patients or bystanders, and acting to minimise those risks. Discussions may be used to display knowledge of where hazards could present from, and how to minimise them. www.anglia.ac.uk Page 8
Element of Practice 3b H&S Scene Safety (HAZMAT) Discussion?, discussion may be used to demonstrate understanding of potential hazards, as well as resolutions. What makes a sign off? This element is focused more around scene safety that may not be within the immediate control of the crew, and to think about areas such as STEP 1, 2, 3, and larger elements of HAZMAT scene safety. Element of Practice 4 H&S PPE Discussion? What makes a sign off? This element requires students to demonstrate the appropriate use of PPE, wearing of hi-visibility clothing, gloves, deciding when to wear them, and making sure they re used appropriately. This may be something that students see and do regularly, and signing off using multiple demonstrations is acceptable. Element of Practice 5 Infection Protection Control (cross-infection) Discussion? What makes a sign off? For this element students need to appropriately act to prevent the spread of infection. This is explained in the descriptor in the PAD, but not all of the elements discussed need to be demonstrated to achieve sign off. www.anglia.ac.uk Page 9
Element of Practice 6 Patient Safety Discussion?, patients may be vulnerable and require assistance, but much/many of the things they require may be in place, discussion to show understanding about what makes them vulnerable and requiring assistance is acceptable. What makes a sign off? This element is to ensure that patient safety is considered by the students, it can apply to vulnerable patients, and to non-vulnerable patients who may be at risk. Students should be aware of any issues these patients might need to have dealt with, such as needing support in self-care, and can signpost them to the most appropriate service, referrals do not have to be undertaken for this to be signed off. This may be further demonstrated in history taking, where students ask appropriate questions to show they are considering this. Element of Practice 7 Patient Involvement and Wellbeing Discussion? What makes a sign off? This element of practice may be signed off after seeing a wide range of patients, and acting on their behalf as an advocate. It can also be shown by involving patients in decisions made about their care. Element of Practice 8 Consent Discussion? What makes a sign off? To achieve this element it needs to be demonstrated that students gain appropriate patient consent when undertaking practice. This means that the element may be signed off after having seen a number of patients, and gaining appropriate consent, for various procedures. www.anglia.ac.uk Page 10
Element of Practice 9 Confidentiality Discussion? What makes a sign off? Confidentiality must be maintained at all times, and this element may be signed off after several patient encounters, where good consistent behaviour is demonstrated. Element of Practice 10 Capacity Discussion?, patients may retain capacity to make decisions presented to them, but discussion can be used to show understanding of the extent of their capacity, and what decisions the patient can and cannot make. What makes a sign off? Assessing capacity of patients, and reaching the decision that they have capacity is of as much importance as identifying patients who are lacking capacity, and the students demonstrating an appropriate assessment is of the most importance, and making appropriate conclusions. Element of Practice 11 Patient Care Records Discussion? What makes a sign off? Passing this element necessitates the completion of patient care records appropriately. The PAD descriptor outlines some of the options for completing this. Like some other elements, this may be something that is demonstrated continually, and over multiple occasions. www.anglia.ac.uk Page 11
Element of Practice 12 Vulnerable Adults/Children Discussion?, discussion may include patients who are borderline vulnerable, or discussing if their care and living standards are appropriate for them. What makes a sign off? This element is based around identifying patients who may be vulnerable, and helping to minimise their vulnerability. This may include identifying those who need further support and offering it, even if it is not accepted. A vulnerable adult form does not need to be completed for this element. Element of Practice 13 Monitoring, Recording and Interpreting Observations (Adults) Discussion? What makes a sign off? Appropriately undertaking observations and relating them to the patient, the PAD descriptor lists some of the observations students may do, but this list is again, not comprehensive. Element of Practice 14 Monitoring, Recording and Interpreting Observations (Paediatrics) Discussion? What makes a sign off? Appropriately undertaking observations and relating them to the patient, the PAD descriptor lists some of the observations students may do, but this list is again, not comprehensive. www.anglia.ac.uk Page 12
Element of Practice 15a 4 and 12 lead ECG analysis Discussion? What makes a sign off? This element is about the appropriate placement of an ECG, and use of the equipment to conduct one, analysis of the 12 lead is not required for this element. Element of Practice 15b 4 and 12 lead ECG analysis Discussion? What makes a sign off? For element 15b students are required to analyse ECGs, and appropriately implement their findings to clinical practice. This may include identification of STEMIs, but is not limited to this, and the element concerns more appropriate identification and application of the ECG findings to the patient. Element of Practice 16 History Taking Use Of FE (Adults and Children) Discussion? What makes a sign off? Students need to demonstrate fluid and systematic taking of a history, please refer to the PAD for further information around this. Element of Practice 17 History Taking Mental Health Discussion? What makes a sign off? Taking of a mental health history does not need to follow a given model, but may follow for example an adapted OPQRSTA. www.anglia.ac.uk Page 13
Element of Practice 18a Primary Survey Discussion? What makes a sign off? Students need to demonstrate appropriately undertaking a primary survey on patients, the patient does not need to fail a primary survey for this skill to be signed off. Students may demonstrate this in a variety of ways, either from verbalising, in post job debrief, or by undertaking interventions, this list is not exhaustive. Element of Practice 18b Primary Survey (Trauma) Discussion?, discussion may be used to identify when patients require a medical primary survey, but have trauma presentations. What makes a sign off? This sign off does not have to be on time critical trauma patients, and may instead focus on patients with either minor trauma presentations, or presentations involving a level of trauma, such as a fall. Element of Practice 19 Time Critical Patients Discussion? What makes a sign off? Managing patients in a time critical state does not have to be limited to patients being pre-alerted, nor do the patients have to remain time critical for the duration of the call. Identification of and management of an acute asthma that resolves with nebulisers for example, may be appropriate. www.anglia.ac.uk Page 14
Element of Practice 20 Respiratory System Examination and Management (Adults) Discussion? What makes a sign off? This element is the appropriate system examination and management of the respiratory system. This may follow a hands up style assessment, or could be based around any relevant OSCE sheets. Element of Practice 21 Cardiovascular System Examination and Management (Adults) Discussion? What makes a sign off? Element 21 is the appropriate system examination and management of the cardiovascular system. This may follow a hands up style assessment, or could be based around any relevant OSCE sheets. Element of Practice 22a Nervous System Examination and Management - Adults Discussion? What makes a sign off? This element is for students to demonstrate their ability to undertake the FAST test, a full neurological exam is not required, please refer to the student s physical examination briefs for what they have been taught to date. The patient does not need to be FAST positive for this element to be signed off. www.anglia.ac.uk Page 15
Element of Practice 22b Nervous System Examination and Management - Adults Discussion? What makes a sign off? This element covers a more in depth neurological examination, and referring to the OSCE sheets may provide a useful insight of what has been taught to date. Element of Practice 23 Gastrointestinal and Genitourinary System Examination and Management (Adults) Discussion? What makes a sign off? For this students are required to undertake an appropriate examination and management of the gastrointesintal and genitourinary system and conditions. Guidance for what may be appropriate can be found on any relevant OSCE sheet, or from key texts. Element of Practice 24 Musculoskeletal System Examination and Management (Adults) Discussion? What makes a sign off? Element 24 requires students to assess and manage the musculoskeletal system, outline assessments may be found in modules involving assessment and management, or by using any relevant OSCE sheets. www.anglia.ac.uk Page 16
Element of Practice 25 Obstetric and Gyanecological System Examination and Management (Adults) Discussion?, discussions around potential management of obs and gynae presentations, may help elicit student knowledge, and could be used. What makes a sign off? Obstetric and gynaecological examination and management does not need to be limited to the management of a birth. Any condition presenting to a relevant system may be considered. Element of Practice 26 Respiratory System Examination and Management (Paediatrics) Discussion? What makes a sign off? For assessment of the Paediatric respiratory system, students should demonstrate appropriate assessment and management of a respiratory complaint, such as croup, URTI, or wheeze. Element of Practice 27 Cardiovascular System Examination and Management (Paediatrics) Discussion? Given the presentation of many paediatric patients, it may be appropriate to discuss how their presentation may be related to the cardiovascular system, and how this would be managed. What makes a sign off? For assessment of the Paediatric cardiovascular system, students should demonstrate appropriate assessment and management of a cardiovascular complaint. www.anglia.ac.uk Page 17
Element of Practice 28 Nervous System Examination and Management (Paediatrics) Discussion? Given the presentation of many paediatric patients, it may be appropriate to discuss how their presentation may be related to the nervous system. What makes a sign off? For assessment of the Paediatric nervous system, students should demonstrate appropriate assessment and management of an appropriate complaint, such as febrile convulsions or an injury involving that system such as a head injury. Acute management of this condition is not required for sign off. Element of Practice 29 Gastrointestinal and Genitourinary System Examination and Management (Paediatrics) Discussion? Given the presentation of many paediatric patients, it may be appropriate to discuss how their presentation may be related to the GI and GU system. What makes a sign off? For assessment of the Paediatric gastrointestinal and genitourinary system, students should demonstrate appropriate assessment and management of an appropriate complaint. www.anglia.ac.uk Page 18
Element of Practice 30 Musculoskeletal System Examination and Management (Paediatrics) Discussion? Given the presentation of many paediatric patients, it may be appropriate to discuss how their presentation may be related to the musculoskeletal system. What makes a sign off? For assessment of the Paediatric musculoskeletal system, students should demonstrate appropriate assessment and management of an appropriate complaint, such as head injury. Element of Practice 31 Multiple Casualties Discussion? What makes a sign off? Triaging in some form is required for this sign off, it does not have to be a large scale major incident involving triage sieve and sort, and can be a scene requiring the management of multiple patients. Element of Practice 32a Recognition, Assessment and Management of Cardiac Arrest (BLS All Ages) Discussion? What makes a sign off? Students require exposure to a cardiac arrest, either one where active resuscitation elements are being undertaken, or appropriately applying recognition of life extinct. BLS at this level may also include use of the AED, and appropriate rhythm recognition. www.anglia.ac.uk Page 19
Element of Practice 32b Recognition, Assessment and Management of Cardiac Arrest (ALS All Ages) Discussion? What makes a sign off? For advanced life support, the student does not necessarily need to lead the cardiac arrest, suitable participation is acceptable for sign off. Return of spontaneous circulation is not required for the sign off. Element of Practice 33 Basic Airway Management Adults Discussion? What makes a sign off? Students need to appropriately manage a patient s airway, this does not need to be in the context of a cardiac arrest. Element of Practice 34 Advanced Airway Management Adult (Level 4) Discussion? What makes a sign off? Students do not need to insert an advanced airway for this element, they can assist with managing one. Their exposure does not have to be limited to the context of a cardiac arrest, but use of capnography alone is not suitable for this sign off. Element of Practice 34a Advanced Airway Management Adult (Supraglottic) (Level 5) Discussion? What makes a sign off? For this element students can use supraglottic airways, this may be either LMAs or igels. www.anglia.ac.uk Page 20
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Element of Practice 34b Advanced Airway Management Adult (Intubation) (Level 5) Discussion? What makes a sign off? A number of advanced airway manoeuvres are acceptable for this element, however intubation may be the most commonly practiced, if this is not routine practice for your trust, it will be done in simulation. Element of Practice 34 Advanced Airway Management Adult (Level 6) Discussion? What makes a sign off? Any use of an advanced airway is acceptable, supraglottic or intubation. Element of Practice 35 Patient Ventilation Discussion? What makes a sign off? Ventilation of a patient is not limited to the use of a ventilator, and only requires appropriate ventilation. Element of Practice 36 Basic Airway Management Paediatrics Discussion? What makes a sign off? For this students need to demonstrate appropriate basic airway management in paediatrics. www.anglia.ac.uk Page 22
Element of Practice 37 Advanced Airway Management Paediatrics Discussion? What makes a sign off? Any use of an advanced airway is acceptable, supraglottic or intubation. Element of Practice 38 Patient Ventilation - Paediatrics Discussion? What makes a sign off? Ventilation of a patient is not limited to the use of a ventilator, and only requires appropriate ventilation. Element of Practice 39 Medicine Management Adults (For level 5 both a and b apply here) Discussion?, discussion can be used to help clarify when patients fall short of the requirements for medication, or why they may not be able to take it. For example a patient needing analgesia, who s taken their own pain relief, discussion may allow a student to display knowledge of why they are indicated, but should not be given it. What makes a sign off? This element is to do with the student identifying appropriate drug selection, and administering where possible. Displaying accurate and safe knowledge of when drugs are indicated, and contraindicated. www.anglia.ac.uk Page 23
Element of Practice 40 Medicine Management Paediatrics (For level 5, both a and b apply here) Discussion?, discussion can be used to help clarify when patients fall slightly short of the requirements for medication, or why they may not be able to take it. For example a patient needing analgesia, who s taken their own pain relief, discussion may allow a student to display knowledge of why they are indicated, but should not be given it. What makes a sign off? This element is to do with the student identifying appropriate drug selection, and administering where possible. Displaying accurate and safe knowledge of when drugs are indicated, and contraindicated Element of Practice 41 Intramuscular Injection Discussion? What makes a sign off? To achieve completion students need to appropriately, and safely undertake an intramuscular injection, as cited in the PAD. Element of Practice 42 Intravenous Cannulation Discussion?, identification of why not to cannulate some patients, or how it may be adopted for different situations is acceptable. What makes a sign off? Appropriate and safe cannulation needs to be undertaken for this element to be completed. www.anglia.ac.uk Page 24
Element of Practice 43 Intravenous Infusion Discussion? What makes a sign off? The student needs to be able to demonstrate the appropriate set up of an intravenous infusion, they do not need to calculate things such as drip rates. Whilst not labelled for simulation, this does not need to be done with a patient, as the skill is the preparation of an infusion, it can be assessed without being patient facing. Element of Practice 44 Wound Care and Dressings Discussion?, if students are exposed to wounds, and they require further management by the hospital, the student can discuss definitive management. Identification of wounds that don t need management, and what would change that, would also be a worthwhile discussion. What makes a sign off? Students need to appropriately manage wounds and use a suitable dressing, this does not have to be a permanent management of the wound, patients may still be conveyed after. www.anglia.ac.uk Page 25
Element of Practice 45 Cervical Spinal Care and Immobilisation Discussion?, discussion may be warranted around patients who have potential to require management of their cervical spine, but fall short of intervention, which may have required immobilisation. What makes a sign off? The student needs to be exposed to either the decision making around when to immobilise, or the process of spinal immobilisation. The decision not to immobilise can be just as important as the immobilisation. Element of Practice 46 Fractures Including Splinting and Traction Discussion?, if a patient has an injury that may not be fractured, but has still warranted assessment, discussion may help the student show they understand the difference between soft tissue injury and fracture. What makes a sign off? Assessment of limbs and deciding what requires management as a fracture, is just as important as the physical management of a limb. Ensuring students can appropriately assess a limb as well as suitably manage any fractures are acceptable for sign off. Element of Practice 47 Patient Transport and Positioning Discussion? What makes a sign off? Alongside all elements listed in the PAD, this may include the use of alternative transport options, such as the use of taxis, or alternative transport, including patient s own. This is something normally considered on www.anglia.ac.uk Page 26
every job, a decision that transport by ambulance is appropriate is still a decision on patient transport. Element of Practice 48 Clinical Decision Making Discussion?, discussion could be used to allow students to demonstrate their decision making process on calls. What makes a sign off? This is a process that s involved in every call, for the sign off students will make a decision about the appropriate location of treatment for every patient. This includes the decision for the patient to be seen and treated in the emergency department, as well as necessary treatments about intervention. This could also be shown by the student s conclusions on differential diagnoses. Element of Practice 49 Treatment Centre/Destination Discussion? What makes a sign off? This is similar to the clinical decision making processes, and students need to demonstrate the ability to appropriately decide on a patient outcome. This can be demonstrated in primary or acute care, with HASU, PPCI, or GP surgeries, as well as patient self-care. Element of Practice 50 Patient Handover Discussion? What makes a sign off? For this sign off, the student needs to undertake a handover, this can be to any other healthcare professional. This may be over the phone, or in person. www.anglia.ac.uk Page 27
Element of Practice 51 Maintain Fitness to Practice Discussion? What makes a sign off? Maintaining fitness to practice is something the student may demonstrate over time, and is not necessarily shown in a single shift or a single job. It can be demonstrated through students continuing advancement of their practice, and through maintaining improvements in practice. Element of Practice 52 Multidisciplinary Working and Collaboration Discussion? What makes a sign off? Students will demonstrate this frequently by their involvement as part of a multidisciplinary team, through working with those at an emergency department such as nurses and doctors. This extends to working with any healthcare professional either within or beyond the ambulance service, and the student making appropriate use of them. www.anglia.ac.uk Page 28