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  • Training nurses using non-invasive ventilation in ward areas


    • UK
    • Interviews and reflections
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    • Health and care staff

    Summary

    Kat Dalton, Critical Care Outreach Sister in Brighton and Sussex University Hospitals NHS Trust, reflects on her experience training nurses using non-invasive ventilation (NIV) in ward areas.

    The Trust’s NIV steering group reviewed how they could improve NIV care and keep up with current national recommendations. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD)’s report ‘Acute Non-invasive Ventilation: Inspiring Change’, published in 2017, highlighted 21 recommendations for acute NIV care, including that: “All staff who …make changes to acute non-invasive ventilation treatment must have the required level of competency as stated in their hospital operational policy.  A list of competent staff should be maintained.” With this in mind, and as part of the NIV steering group, Kat volunteered to take on training nurses using NIV in ward areas.

    Content

    Q: Why was the training needed?

    A: A trust audit found that mortality for NIV was higher than the national average. We looked at previous training for nurses and there was no clear record for most ward areas using NIV. Some nurses had training, but this was several years old. The trust had also upgraded all the NIV machines as the previous machines were no longer serviceable. This gave a great opportunity to ‘rebrand’ NIV and provide current and appropriate training for all those using NIV.

    Q: What inspired you to take on this project?

    A: I work in an amazing team of highly skilled and resourceful nurses. We each have areas or ‘projects’ that we work on, looking to develop knowledge and skills among other nurses and to support unwell or deteriorating patients in ward areas. Since joining the critical care outreach team, I have been inspired by my colleagues to look at situations with the aim of ‘how can we improve this?’ and look at practical solutions to issues that may arise. Training ward nurses is an excellent way of passing on knowledge and skills, increasing safety and improving patient care.

    Q: What did you do?

    A: I began by gathering current training records and speaking to ward nurses about how they practice currently and the NIV care given. I found that many nurses did not have an up to date record of training, had gaps in their knowledge and lacked confidence in using NIV. We asked the reps supplying the new machines to carry out machine updates, including how to operate the machine, cleaning, storage and maintenance. I then planned a pilot training day for nurses working in the acute medical unit, which included indications for starting NIV, assessing and recognising a deteriorating patient, analysing arterial blood gases and using the machines in practice.

    From the pilot training day and the feedback from the nurses, I adapted the training to include more simulation and patient scenario training, as well as a troubleshooting workshop for everyone to have a chance to use the machine.

    Following this I set up monthly study days, working with the practical development nurses in the areas using NIV, and invited all nurses from these areas to sign up and attend the day, whether they had previous NIV experience or not. Ten nurses attend each of these days and an up-to-date database is kept for the whole trust. I gathered information at each day, asking the candidates to score their confidence out of 10 before and after training. 

    I also worked with the NIV steering group during this time to update the trust NIV policy to reflect the most recent British Thoracic Society standards for NIV care in acute wards.

    Q: You work full-time, how did you find the time to complete the project?

    A: A lot of the initial background work, planning teaching sessions and administrating the study days was done in my own time. My manager has been very supportive from the beginning and since the first few months I have had some protected management time to continue planning, administrating and improving the training.

    Q: What challenges did you face?

    A: The administration has been really challenging: booking rooms, updating the online booking form, contacting candidates and managers about non-attendees or issues that arise. It has also been a huge undertaking, we have identified 230 nurses that need training, some of whom only work nights! There has been a varied response from ward areas, some being very supportive and others taking a lot longer to engage with the training. Nurses attend who have no prior experience of NIV right through to those who have been using NIV for over 10 years, this can be difficult to pitch the training at the right level.

    Q: How did you overcome these challenges?

    A: I have now got a more robust system for administration, this mainly involves a lot of forward planning, organisation and writing everything down! I have kept going and kept going with trying to engage all ward areas and managers, we are getting there – but it remains a work in progress. I have had to develop the teaching from scratch and have learnt as I’ve gone along! Feedback from the candidates after each day has been invaluable to ensuring the training is relevant and interesting for everyone there. I have also used the KSS e-learning NIV package to provide some pre-reading, especially for those with no prior experience.

    Q: Has the project made a difference?

    A: Yes! We asked candidates to score their confidence before and after training, with on average this improving from 3/10 to 8/10 following training. We have improved nursing training records from unrecorded to 49% across the trust and competency from unrecorded to 20% in just over a year of training sessions. We are aiming for 80% so we have a bit more work to do. We are currently doing the national NIV audit in the trust and I hope this will reflect some of the improvements in training to patient care and outcomes.

    Q: How have you ensured that this project is sustainable?

    A: We have recently asked some senior nurses on the wards using NIV to take on additional responsibility as ‘link nurses’ for NIV. They will help to deliver bedside support on clinical shifts and assess competency for nurses in their ward areas. I have completed a standardised template for the days, so in theory any one of my critical care outreach team colleagues could pick up the training folder and run a training day. I am also looking at working with the senior respiratory physios to deliver ‘update training’ for nurses who have attended training to keep up with any recent policy changes and have a chance to refresh their NIV knowledge if needed.

    Q: Do you have any advice for anyone starting a quality improvement project? Or top tips?

    A: Evidence is essential. Have a clear standard that you are working towards, make sure you have gathered some evidence as to why your project is needed, and have a measure that you can look at to show how you are improving things. Not only does this help continued motivation and interest in your project, but it also helps with securing more support from managers and those you are trying to engage with.

    Look at sustainability right from the beginning. It’s easier to start something first time then have to go back and re-do things later down the line.

    Stay positive!  It’s easy to feel disheartened in an under-resourced and challenging environment, sometimes it feels like no one else is aware of what you are doing and the difference it can make, but keep talking about it, and keep being positive, and eventually others will get on board!

    Q: What are your future plans?

    I will continue the training until we reach our goal of 80% competency. I am working with physio colleagues to develop ‘update sessions’ so that competency can be maintained. I will continue to inform and update ward leaders and managers to keep the momentum going.

    As a team we have used the database structure I created to help track other areas of competency such as tracheostomy training. I have created a poster to represent the work I have done over the last 12 months and will look to do this yearly to show how far we have come.

    Please contact me if you are planning or implementing a similar project, I would love to hear about it and share resources and ideas.

    About the Author

    Kat studied adult nursing at the University of East Anglia, Norwich, and then worked in Accident and Emergency for 3 years before working in Intensive Care for 5 years. She has been part of the critical care outreach team in Brighton and Sussex University Hospitals Trust for over 2 years and has a special interest in NIV. 

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