Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 100
UNIT 13: Management of self-injury by autonomous practitioners in a minor injuries
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 101
pain management
treatment of wounds
initial psychological assessment
aftercare advice
referral to:
o
mental health services
opolice
o
social services
oother agencies.
LO 2 – LO 5 Evidence must be given for a minimum of three cases.
If not specifically stated in the assessment information, a plural statement in any assessment criteria means a minimum of two.
For Health and Social Care, Clinical Care, early years Care and the care of Children and Young People:
To meet standards for clinical governance, organisational liability, professional and regulatory requirements, all new units containing assessments that are competence based and are for learners who are employed in, or volunteering in, health and social care, clinical care or childcare settings:
learners must have completed any mandatory H&S training or education required for their job role
context-specific health and safety must be explicitly stated WITHIN individual units.
Other Mappings:
Code 2015.
RCEM CC12, CC6, CC3.4, CC1, CC2, CC3, CAP23, CC16, CC4, CC5, CC17, CC18, CC19, CC21, CC24, PAP6, PAP15, CAP30.
Assessor Requirements:
Registered practitioners with a minimum of two years experience of working in minor injuries settings as:
an emergency nurse/paramedic/advanced care practitioner
Consultant nurse or
Consultants in emergency medicine.
© 2016 Agored Cymru
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 102
Self Mutilation [Mental health] [RCEM CAP30]
The EP will be able to evaluate the patient who presents following self-mutilation, assess risk and formulate appropriate management plan
Knowledge Assessment
Methods
NMC:
Outline the risk factors for a suicidal attempt C, Mi, PE, A
Know the national guidelines for self harm
Outline the powers that enable assessment and treatment of patients following self harm or suicidal ideation as defined in the Mental Health Act
C, Mi, PE,A
Skills
Take a psychiatric assessment supported by scoring tool to assess risk of further harm (Becks scale for suicidal inventory, SAD PERSONS, Australian Mental Health Triage Scale)
D, Mi, C PE, A
Behaviour
Liaise promptly with psychiatric services as appropriate C PE, A
Show compassion and patience in the assessment and management of those who have suicidal intent
C, M PE, A
Anaphylaxis [RCEM CMP1]
The EP will be able to identify patients with anaphylactic shock, assess their clinical state, initiate immediate resuscitation and refer in a timely manner
Knowledge Assessment
Methods
NMC
Identify physiological perturbations causing anaphylactic shock C, Mi, PS,
A
Recognise clinical manifestations of anaphylactic shock C, Mi, PS,A
Elucidate causes of anaphylactic shock C, Mi, PS,A
Know anaphylaxis guidelines C, Mi, PS A
Skills
Recognise clinical consequences of acute anaphylaxis Mi, C, PS, A
Perform immediate physical assessment (laryngeal oedema, bronchospasm, hypotension)
Mi, C, D, PS, A
Institute resuscitation (adrenaline/Epinephrine), oxygen, IV access, fluids) Mi, C, D, PS, A
Refer in an appropriate timely manner PE, A
Be an ILS/ ALS provider PE, A
Behaviour
Exhibit a calm and methodical approach C, Mi, PE, A
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 103 Septic Shocked Patient (combined RCEM CMP4 & CMP 5)
The EP will be able to identify a shocked patient, who may present with Severe Sepsis or Major Trauma and assess their clinical state, prioritise, seek urgent help /referral to appropriate centre and understand the requirement for
resuscitation.
Knowledge Assessment
Methods
NMC
Recalls the pathophysiology of shock for sepsis and hypovolaemia C, Mi, PE, A Identify physiological perturbations that define shock and understand the
patho-physiology of its cause
C, Mi, PE, A
Recalls the sepsis 6 bundle PE, A
Skills
Perform immediate (physical) assessment (A,B,C) Mi, D, PS, PE, A
Recognise the need for immediate referral PS, PE, A
Recognise immediate resuscitation measures required and initiate/refer (oxygen, iv access, fluid resuscitation)
Mi, D, PS, PE, A
Arrange simple monitoring of vital signs (BP, pulse & respiratory rate, temp, urine output) & initiate investigations &life saving measures whilst waiting e.g.
oxygen therapy, iv access and fluids
Mi, D, PS, PE, A
Behaviour
Exhibit calm and methodical approach to assessing the critically ill/injured patient
C, Mi PS, PE, A
Calls for prompt assistance as appropriate from : ED team, WAST 999 ambulance, colleagues, critical care outreach services
PS, PE, A
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 104
Assessment Documents
Consultation Assessment Proforma (mini-cex)
This provides a structure for the learner to have their consultation skills assessed. The guidance for what should be considered during the assessment & assessing the performance can be found in the overarching clinical consultation competency.
Case details: Presenting Complaint: Male / Female Age:
Please tick one column for each statement & rationalise score. If a section does not apply, please mark it N/A (non applicable)
Not yet competent Competent
Rationale for Score Given
1 Demonstrates ability to quickly build a therapeutic relationship with the patient:
a Introduces self b Good eye contact c Speaks at a volume that
the patient can hear d Speaks with tone & speed
of speech that demonstrates a empathetic, interested and non-judgemental approach
e Explains necessary information in language that the patient understands f Checks patient
understanding g Gives the patient an
opportunity to ask questions
2 Elicits relevant history for a specific problem in a
structured way, giving patients time to answer questions posed.
3 Demonstrates an ability to use a systematic/ structured approach to physical examination of the patient a Appropriate vital signs
b Look
c Listen d Feel
e Move
4 Identifies those patients requiring analgesia and administers appropriate pain relief
5 Demonstrates an ability to interpret findings from history
± clinical examination and obtains relevant investigative studies
6 Documents data accurately in an organised and succinct format
7 Demonstrates clinical decision
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 105 making skills
8 Formulates diagnosis based on logical progression of data 9 Offers sound rationale for
clinical decisions to both the patient and assessor 10 Develops and implements a
timely therapeutic
management plan consistent with
a physical need b psychological need c age & developmental
changes
d family considerations e referral to other health
care professionals f community resources g appropriate follow up 11 Demonstrates safe
management of the patient regardless of the outcome 12 Demonstrates independence
in clinical decision making
13 Identified strong areas of consultation
14 Suggested areas for improvement for next consultation
15 other comments
OVERALL ASSESSMENT AND RATIONAL Overall assessment
not yet competent / competent Rationale
Assessor Name: Signature Designation Date:
Trainee’s Signature
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 106
Case Reviews Guidance Note
Patient records can be used in professional portfolio as long as they are completely anonymised.
Anonymising the record can be achieved by:
1. photocopying the record,
2. covering the necessary data using sticky labels or tippex 3. re-photocopying and placing this copy in the portfolio
4. shredding the original photocopy or placing in confidential waste.
The record should be anonymised of the following data:
1. all health board, hospital, department or unit identification data including consultant name 2. date and time of arrival and any other timings in the record
3. patient’s name, date of birth, address, GP details & next of kin
4. details of any other including family members or friend’s names which have documented in the record 5. all names and signatures apart from own
Whilst removing this data, is it useful to ensure a note is made of the patient’s age and sex. And if an x-ray has been taken, what the report showed and if this was at variance to you or your clinical supervisor.
The review or reflection should comment on the following findings as per medical model:
Documentation of:
1. own name ~ both printed and signed
2. time consultation completed and if delivered by self, time treatment completed and patient discharged Documentation with reference to presence and quality of information recorded, some should be referenced to latest literature (e.g. NICE head injury guidance) or departmental guidelines:
1. age, sex and who patient was accompanied by 2. Presenting Complaint (PC)
3. History of presenting complaint (HPC) with context and mechanism of injury e.g. tripped, FOSH 4. Past medical history
5. Drug history 6. Allergies
7. Clinical examination: on examination using as appropriate:
a. Look b. Listen c. Feel d. Move
8. Investigations including how this concurs with the report 9. Diagnosis
10. Treatment
11. Plan/after care advice
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 107
DEMONSTRATION OF PROCEDURAL SKILLS (DOPS) /VERIFICATION OF KNOWLEDGE
This proformas facilitates the mentor being able to assess and document the knowledge base of the individual and the practical skills required to enable management of the patient’s injuries e.g. insertion of local anaesthetics, wound closure, removal of foreign bodies and interpretation of assessments such as x-ray, reflex testing.
Communication with patient
• Awareness of cultural and ethical factors
• Ability to perform clinical examination or procedural skill
• Consideration of patient and professionalism demonstrated
Name & Qualifications
Skill or knowledge being assessed:
please indicate achievement
needs further development competent excellent
Give rationale for & evidence to support decision
Assessors name (print) Designation & Qualifications Assessing Qualification Signed
Date
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 108
ENP DOCUMENTATION ASSESSMENT AUDIT
In the curriculum, the learner is expected to undertake at least 1 audit of their own work using one of the audit proformas. These proformas have also been found useful for mentors to assess the documentation and be able to detail the number of cases have reviewed providing robust evidence of assessments undertaken.
For all uses, the proforma provides standardisation, enable excellence to be recognised and for any deficits an action plan for improvement developed.
The following audit forms have been developed to enable the practitioner to evaluate their record keeping:,
“ The quality of your record keeping is a reflection of the standard of your professional practice. Good record keeping is a mark of the skilled and safe practitioner, whilst careless or incomplete record keeping often highlights wider problems with the individual’s practice” (2005) .
Hand and wrist
Elbow
Shoulder
Knee
Ankle & foot (below knee)
Facial injury which includes nasal injury
Head injury
Eye injury
Wounds
The following are still to be developed: neck injury, back injury, truncal injury.
Each proforma has been developed to meet the requirement of the most common injuries, it is recognised that not all components are required for each case e.g. a patient who sustains a direct blow to their hand would not normally require an assessment from their SCJ to fingertip, but standard practice would indicate that they require an
assessment from joint above to joint below; therefore the individual using the form has to determine what is necessary and be able to rationalise why other components were not used.
Anecdotally it has been reported by the mentors that these work well in practice and that these also act as a
reminder for their own record keeping.
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 109
HAND/WRIST
1 2 3 4 5 6 7 8 9 10ENP Initials
Printed Name
Signature
Date
Time
PC Clear
HPC Context
MOI
Time Since Injury
Hand Dominance
Occupation
Pain Score & Analgesia
PMH
DH
Allergies
Tetanus
HITS /Protection Assessment
Examination: Look Diagram
Deformity
Bruising
Swelling
Wounds
Infection
Lymphangitis
Cascade Of Fingers
Examination: Feel
Radial Pulse / CRT
Sensation Radial, Median, Ulna
Axillary Nerve
Bony Tenderness Phalanges
Metacarpals
Scaphoid, ST & Telescoping
Other Carpals
Distal Radius/Ulna Inc Styloids
Shaft Radius & Ulna
Elbow 4 Points
Humeral Head Neck & Shaft
SCJ, ACJ, Scapula
Examination: Move
Phalanges: F/E/Fist/FDS/FDP/
Extensors
2 To 5 MCPJ: F/E/Abd/Ad
1st MCPJ:F/E/Abd/Add/Opp
Tip & Base Little Finger
IPJ Thumb: F/E
Finkelstein Test
Pincer Grip
Wrist: DF/PF/UD/RD
Elbow: F/E/S/P
Shoulder: F/E/Abd/Ad/H- Abd/
H-Add/IR/ER/ Apley Scratch
Impression
Appropriate X-Ray
Clear Interpretation Of X-Ray
Diagnosis Made
Appropriate Treatment
Appropriate After Care: Follow Up
Verbal
Patient Information Leaflet
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 110
ELBOW
1 2 3 4 5 6 7 8 9 10ENP Initials
Printed Name
Signature
Date
Time
PC Clear
HPC Context
MOI
Time Since Injury
Hand Dominance
Pain Score & Analgesia
PMH
DH
Allergies
Tetanus
HITS/Protection Assessment
Examination: Look Diagram
Deformity
Bruising
Swelling
Wounds
Infection
Lymphangitis
Examination: Feel
Radial Pulse
Sensation Radial, Median, Ulna
Bony Tenderness Metacarpals
Scaphoid, ST & Telescoping
Distal Radius/Ulna Inc Styloids
Shaft Radius & Ulna
Medial Epicondyle
Lateral Epicondyle
Olecranon
Radial Head
Humeral Head Neck & Shaft
SCJ, ACJ, Scapula
Examination: Move
Elbow: F/E/S/P
Wrist: DF/PF/UD/RD
Shoulder: F/E/Abd/Add/ H-
Abd/H-Ad/IR/ER/ Apley Scratch
Impression
Appropriate X-Ray
Clear Interpretation Of X-Ray
Positive X-Ray Finding
Diagnosis Made
Appropriate Treatment
Appropriate After Care: Follow Up
Verbal
Patient Information Leaflet
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 111
SHOULDER INJURY
1 2 3 4 5 6 7 8 9 10ENP Initials
Printed Name
Signature
Date
Time
PC Clear
HPC Context
MOI
Time Since Injury
Hand Dominance
Pain Score & Analgesia
PMH
DH
Allergies
safeguarding Assessment
Examination: Look Diagram
Deformity
Bruising
Swelling
Wounds
Examination: Feel
Radial Pulse
Sensation Radial, Median, Ulna
Regimental Badge
Bony Tenderness
SCJ, ACJ & Clavicle
Scapula
C/Spine
Humeral: Head / Neck
Humeral Shaft
4 Points Elbow
Scaphoid, ST & Telescoping
Length Radius/Ulna Inc Styloids
Carpal Bones
Metacarpals
Examination: Move
Shoulder :F/E/Abd/Ad/ H-abd/Had/IR
/ER/ Apley Scratch
C/Spine: F & L Flexion, Ext, Rotation >
45
Elbow X 4
Impression
X-ray Justified
X-ray Interpreted
Diagnosis Made
Appropriate Treatment
Appropriate After Care: Follow Up
Verbal
Patient Information Leaflet
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 112
ANKLE / FOOT / BELOW KNEE
1 2 3 4 5 6 7 8 9 10ENP Initials
Printed Name
Signature
Date
Time
PC Clear
HPC Context
MOI
Time Since Injury
Pain Score & Analgesia
PMH
DH
Allergies
Tetanus
Safeguarding Assessment
Examination: Look Diagram
Deformity
Bruising
Swelling
Wounds
Infection
Lymphangitis
Examination: Feel
Pulses Dorsalis Pedis
Posterior Tibialis
Sensation
Bony Tenderness MTs 1 - 5 Inc 5th Styloid
Tarsal Bones X 7
Ankle: MM & LM
Tibia & Fibula IncShaft &
Head/Neck Fib
Calf/Achilles Tenderness
Examination: Move
Flexion
Extension
Inversion
Eversion
Ant Drawer/Tilt Test
Symonds Test
Mantles
Impression
Appropriate X-Ray Meets Ottawa Rules
X-ray Interpreted
Diagnosis Made
Appropriate Treatment
Appropriate After Care: Follow Up
Verbal
Patient Information Leaflet
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 113
KNEE INJURY
1 2 3 4 5 6 7 8 9 10ENP Initials
Printed Name
Signature
Date
Time
Age > 55 Female
PC Clear
HPC Context (consider hip inj/complaint)
MOI
Time Since Injury
Locking Before / After Injury
Giving Way Before/ After Injury
Pain Score & Analgesia
PMH
Previous Knee Injury
DH
Allergies
Tetanus
Safeguarding Assessment
Examination: Look Diagram
Deformity
Bruising
Swelling
Onset of swelling
Effusion
Onset of effusion
Wounds
Infection/Lymphangitis
Examination: Feel
Pulses Dorsalis Pedis
Posterior Tibialis
Sensation
Bony Tenderness Patella
Joint Margin
Femoral Condyles
Tibial Plateau
Tibial Tuberosity
Fibula Head & Neck
Shaft Tibia / Fibula & Femur
Other Feel Anterior Joint
Posterior Joint
Patella Tendon
Ligament/Other Testing MCL / LCL @ 0 & 30°
ACL/PCL Lachman & Drawer
Grinding Test
Examination: Move SLR
Flexion
Extension
Rotation of hip @ 90 flexion
Impression
Appropriate X-Ray Meets Ottawa Rules
Clear XR Interpretation
Diagnosis Made
Treatment Appropriate
Appropriate After Care: Follow Up
Verbal advice
Patient Information Leaflet
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 114
FACIAL/HEAD INJURY
1 2 3 4 5 6 7 8 9 10Printed Name
Signature
Date
Time
PC Clear
HPC Context
MOI
Time Since Injury
Loss Of Consciousness
Otorrhoea
Rhinorrhoea
Seizures
Headache
Vomiting
Amnesia Pre Injury
Bite Affected
Paraesthesia
Vision affected: Diplopia/
blurred Neck pain
Pain Score & Analgesia
PMH / DH / Allergies Coagulation state
Safeguarding Assessment
Examination: GCS
Pupil Reaction
Spo2
Vital Signs
Examination: Look Diagram
Panda Eyes
Battles Sign
Deformity
Swelling
Septal Haematoma
Gingival Haemorrhage
Haemotympanium
Wounds
C/Spine Central
Shoulders In Alignment
Examination: Feel: sensation
Bilateral: forehead, cheek,
mandible, bottom lip
Bony Tenderness Skull Boggy swelling
Cervical Spine
Orbits
Maxilla
Mandible
Zygoma
Nasal Bones
Cranial Nerves II - XII
Examination: Move Rotation L & R (>45°)
Forward Flexion
Lateral Flexion L & R
Extension
Eyes: H movement
Impression / Diagnosis
Appropriate Treatment
Appropriate After Care: Follow Up
Verbal
Head injury PIL given
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 115
EYE INJURY
1 2 3 4 5 6 7 8 9 10ENP
Printed Name Signature Date Time Age Sex Occupation PC
HPC: Context Of Injury
Time Since Injury Mechanism Of Injury Blurred Vision Double Vision Pain Score & Analgesia
PMH DH Allergies Tetanus
SH: Accompanied By
Safeguarding Assessment O/E:
Visual Acuity Eye Washout pH
Look: Picture:
External Eye Sub-Tarsal
Conjunctiva & Sclera Limbus
Iris Cornea
Pupils: Size Contour Move: Movements Of Eye 'H'
Fluorescein Stain & Findings Eye Washout (If Appropriate) Impression / Diagnosis Appropriate Treatment
Plan:
Discharge
Patient Information Leaflet
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 116
WOUND
1 2 3 4 5 6 7 8 9 10Printed Name
Signature
Date
Time
PC Clear
HPC Context
MOI
Time Since Injury
PMH
DH
Allergies
Tetanus
Pain Score
Safeguarding Assessment
Examination:
Look Diagram
Size
Site
Lay eg Transverse
Active Bleeding
Dermis Breached
Base Of Wound Visible, no
deep structures involved
Bruising
Signs Of Infection
Lymphangitis
Examination:
Feel
Vascular
Status Distal To Wound / CRT
Sensation Deficit Distal To Wound
Examination:
Move Distal To Wound
Ligaments Stressed
Tendons Intact
Impression
Appropriate X-Ray
Clear Interpretation Of X-Ray
Diagnosis Made
Treatment Wound Cleaning Solution
Local Anaesthetic
Wound Closure Method
End Result e.g. good opposition
Primary Dressing
Secondary Dressing
Method For Securing
Sling If Appropriate
Appropriate After Care:
Follow Up
Verbal - Sepsis & Wound
Management
Patient Information Leaflet
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 117
CHEST INJURY
1 2 3 4 5 6 7 8 9 10ENP Initials
Printed Name
Signature
Date
Time
PC Clear
HPC Context
MOI
Time Since Injury
Pain Score & Analgesia
PMH
DH
Allergies
Tetanus
Safeguarding assessment
Full vital signs: temperature, pulse, resps, BP, oxygen sats,
Examination: Look Diagram
Deformity
Bruising
Swelling
Bilateral equal expansion Trachea central Flail segment
Wounds/abrasions
Examination: Feel (bony
tenderness and crepitus) SCJ, Clavicle, ACJ
Sternum Ribs (posterior,
anterior and lateral)
Bilateral equal
expansion
Stress rib cage lateral
& AP
Thoracic spine
Abdo: tender & rigid
Breath sounds Equal air entry
wheeze
crackles
Impression
Appropriate X-Ray (if able to
request)
X-ray Interpreted (if
appropriate)
Diagnosis made
Appropriate Treatment
Appropriate After Care: Follow Up
Verbal
Patient Information
Leaflet