This is a discussion I had with Liz Staveacre (@lizzys39) who is Senior Critical Care Outreach Clinical Nurse Specialist at Northwick Park Hospital. Her Masters’ dissertation looked at the factors that influence whether nurses will escalate the patient when it is necessary. From the discussion, it would seem that there is still some work to be done.
It certainly gives us some food for thought and hopefully will provide some refocus on the important problems.
Click here for: Interview Questions for Critical Care Practitioners
Welcome to the Critical Care Practitioner Website. Lets Network and Learn Together
Here you can find;
My objective with this site and the other resources connected with it is to help myself and therefore others to become better practitioners.
I also want us all to connect and engage with one another to help us move our professions forward and improve patient care!
Do you need to be able to demonstrate the ability to undertake clinical examination of your patient?
NEW- Advanced Critical Care Practitioners- CPD and Appraisal Pathway
Advanced Critical Care Practitioners- CPD and Appraisal Pathway- This is an important piece of work by the Faculty of Intensive Care Medicine (FICM) and I have summarised some of the key points below for reference. This will ensure that the practitioner keeps up to date, provides evidence for their employer and allows a standardisation of practice when moving between jobs. We are all then singing from the same hymn sheet I hope.
The document has copies of all the paperwork needed to complete the full 3 yearly appraisal, and I suggest that it is something that should be worked on consistently rather than at the end of each 3 year cycle.
Nursing and Medical Appraiser
“It is envisaged that in order to adequately represent both the nursing and medical aspects of the ACCP appraisal process, the appraisal meeting itself should be a tripartite discussion, between the ACCP and two appraisers. The first appraiser should be an NMC approved member of nursing staff (usually the line-manager) and the second appraiser should be the local ACCP Clinical Lead or deputy.”
Continuous Professional Development
“Personal learning and CPD should be organised and undertaken as part of your personal development. It is an essential part of an ACCP’s career. CPD should be linked to the domains and attributes of the NMC Revalidation Code and the Good Medical Practice Framework. For ACCPs registered with the Health Care Professional Council [HCPC] the requirements of the CPD and Registration HCPC document will be met by this document.”
“In order to fulfil the agreed requirements of FICM ACCP AG ACCPs should be undertaking 100 hours of CPD, 50 hours of which need to be participatory, within each 3 year Revalidation Cycle.”
“Within each 3 year revalidation cycle, you must record at least 5 pieces of formal written reflection that explain how this CPD and/or Quality Improvement activity demonstrates that you are meeting the needs of the NMC Revalidation Process, HCPC CPD guide and Good Medical Practice”
“Within this section you must demonstrate that you regularly participate in activities that review and evaluate the quality of your work, both as an individual or as part of the Critical Care Team”
“Quality improvement activities for an ACCP can take many forms and examples include;
Clinical audit – evidence of effective participation in clinical audit or an equivalent quality improvement exercise
Improvement project using plan, do, study, act cycles QI methodology
Review of clinical outcomes – where robust, attributable and validated data are available. This could include morbidity and mortality statistics and meetings or Clinical review meetings you should seek to present and discuss
Performance data and complication rates where these are routinely recorded for local or national reports. Critical Care has in place several robust and validated quality measures that include ICNARC, SICSAG, and SCTS Blue Book Data etc. You should submit any such data that is applicable to your Critical care Unit.
Case review or discussion – a documented account of interesting or challenging cases that an ACCP has discussed with a peer, another specialist or within a multidisciplinary team.”
There are also some more examples in this category.
Non Medical Prescribing
“As ACCP non-medical prescribers your appraisal / PDP process must involve a review of your prescribing activity.”
Practice Related Feedback
“It is a formal requirement of NMC Revalidation process that you must obtain at least five pieces of practice-related feedback over the three years prior to the renewal of your registration. This would be considered good practice for AHP ACCPs. At least two of these pieces must be of Multi Source Feedback variety, one of which should be sourced from patients/ relatives and one from professional colleagues”
Multi Source Patient and Colleague Feedback
“Feedback from colleagues and patients will usually be collected using standard MSF questionnaires that comply with NMC/HCPC/ GMC guidance and it is expected that any questionnaire will be administered independently of the ACCP and the appraiser.”
“We recommend a minimum of 15 complete responses for each colleague MSF undertaken and up to 10 complete responses for patient or relative feedback every 3 years in order to meet revalidation requirements.”
Feedback: review of compliments and complaints
“Feedback is often provided by patients and others by way of complaints and compliments which should also be reviewed as part of the appraisal process.
Complaints should be seen as another type of feedback, allowing ACCPs and organisations to review and further develop their practice and to make patient-centred improvements.
Complaints may potentially act as an indicator of performance and the way in which you use your professional and clinical skills. Complaints can thus be utilised in order to highlight areas for further learning, which should then be included in your personal development plan”
Scope of work – completed
Yearly : evidence of completion of mandatory training
Review of learning objectives from the previous appraisal period with evidence of how these have been met.
Five piece of reflective accounts per three year period. It is expected each yearly appraisal will include at least one piece of reflective writing to effectively meet this requirement.
Quality Improvement activity as agreed with your appraiser
Personal good character and probity review
MSF Achievement ,challenges and aspirations
PDP objectives for the next appraisal period
Professional indemnity check
Significant event discussion
Colleague: we recommend a minimum of 15 complete responses for each colleague MSF each year
Patient and relative: a minimum of 15 complete responses for patient or relative feedback every three years.
Feedback – review of compliments / complaints.
All Workplace based assessments undertaken
Current job plan
Courses attended & certificates
Personal development plan for the next year
Summary of appraisal discussion
Welcome to this website. This is a resource for critical and emergency care practitioners and anyone else involved in the care of this type of patient.
My name is Jonathan Downham. I work as an advanced clinical practitioner in emergency medicine at band 8a and have been in this post since September 2014. Prior to this role I worked as an advanced practitioner in critical care for 4 years. I also teach Clinical Examination skills and diagnostics at Warwick University at Masters level and am responsible for setting up and running a degree level course via Stafford University on the same subject area.
I am a nurse with more than 25 years experience, most of that in the intensive care environment. I finished my nurse training in 1990 and after a short spell in medical and surgical wards and an even shorter spell in Saudi Arabia I made the move into intensive care in 1995. I did my ITU course at Harefield Hospital, Middlesex, then moved to the cardiac ITU at Queen Elizabeth Hospital, Birmingham. Another short spell at Glenfield Hospital, Leicester (cardiac again) before finally settling down at Heartlands Hospital, Birmingham.
I worked up to senior charge nurse then in 2005 started a two and a half year post graduate degree with Birmingham University in Anaesthetic Practice, qualifying in 2007 as a Physicians Assistant (Anaesthesia). Shortly after this I moved into the Critical Care Outreach team and finished my dissertation to earn my Masters degree in Anaesthetic Practice. I also completed my non-medical prescribing course.
The Critical Care Practitioner will;
Have advanced knowledge and skills in critical care and provide a direct contribution to the assessment, treatment and planning of care, and evaluation of the outcomes of patients with critical illness.
This statement is the reason for the website you are looking at now. It is hoped that it can become a useful resource for Critical Care Practitioners and enable them to be well informed and up to date with current practice.
The headings in the menu above are based on some of the competencies identified in the Department of Health document, “The national education and competence framework for advanced critical care practitioners”.
The Advanced Critical Care Practitioner role is a new way of working for health professionals working in critical care. It is acknowledged that the role described crosses the professional boundaries of many functions within critical care, including medicine, nursing, technical, physiotherapy and clinical pharmacology. The role is designed to ensure that patients receive timely and effective care. The role will deliver some elements of medical practice and may provide a method of closing the knowledge and skills gap likely to result from the reduction in trainee numbers due to shortened training time; it will also provide a highly proficient supporting role to the senior medical team.