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Respiratory education and training issues
P88 The Aintree Hospital Pleural Disease Training Programme: achieving competency in intercostal drain insertion and in management of pleural problems on the ‘acute take’
  1. B Chakrabarti,
  2. L G Spencer,
  3. A Kwok,
  4. P Albert,
  5. C J Warburton,
  6. J E Earis
  1. Aintree Chest Centre, University Hospital Aintree, Liverpool, UK

Abstract

A key recommendation from the NPSA Rapid Response Report is that intercostal drains should only be inserted by staff who have received appropriate training. Aintree Hospitals NHS Trust has developed an educational programme to improve the management of pleural problems presenting on the ‘Acute Take’ which complies with this NPSA directive. This study evaluates this programme together with ‘prior knowledge’ from the BTS Education Hub e-learning programme (Pleural Aspiration and Insertion of a Seldinger Chest Drain).

The programme, introduced in 2009, is a 4 h ‘hands on’ course consisting of:

  1. Lectures covering the indications, technique and pitfalls of drain insertion coupled with real case histories focusing on common ‘out of hours’ scenarios.

  2. ‘Hands on’ experience of ‘Seldinger’ and ‘Blunt dissection’ drain insertion using porcine ribcages fixed to resin torso models giving a ‘lifelike’ feel.

  3. Practical management of underwater seals and suction. Candidates had to demonstrate competence in drain insertion to a Faculty member before receiving certificates of course completion.

Programme evaluation COPD, chronic obstructive pulmonary disease, TIA, transient ischemic attack, ACS, acute coronary syndrome (angina, unstable angina, non-ST elevation myocardial infarction and myocardial infarction), ABG, arterial blood gas. 19 candidates were provided with an individual licence to use the BTS module (£75 per licence) and were instructed to undertake the programme and on-line assessment before attending the practical session. Evaluation was with a VAS ranging from 5 (‘very much’) to 1 (‘not at all’). All found the course and e-module high quality, the correct level, easy to use and felt it gave them confidence to safely perform pleural procedures and drain insertion (17 gave rating of 5 or 4). 18 gave 5 or 4 for the course fulfilling its objectives. Despite instructions to complete the e-assessment only 10 (53%) did so. Of these the mean test score was 64% (SD 21 range 11–91%).

Conclusion A programme combining e-learning, assessments, lectures and ‘hands on’ experience in intercostal drain insertion using animal models represents an effective means of training for the acute take. The BTS e-learning module proved to be a very useful prior knowledge resource but in future, satisfactory performance for the online test will be a pre-requisite to undertaking the clinical skills session.

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