End of life care training in Birmingham
CME Medical is helping healthcare professionals to gain confidence in caring for patients at the end of their lives. Managing end of life care is a challenge for all health staff, as it often involves dealing with complex and emotional communication with patients and relatives and managing patient symptoms. But now highly sophisticated mannequins – which can talk and simulate signs and symptoms of advanced illness – are being used in a pioneering and unique training programme in Birmingham.
The Hollier Simulation Centre, based at Good Hope Hospital, uses high fidelity mannequins, along with actors and trained staff, to simulate end of life situations, in order to help train doctors, nurses and care workers from hospices, among other healthcare professionals.
Nurses from the Heart of England NHS Trust at an end of life care training day
Dr Lisa Boulstridge, Consultant in Palliative Medicine at Heart of England NHS Trust, who runs the courses, said: “As far as we are aware, we are the only simulation centre in the UK which has developed such a range of training courses in end of life and palliative care.”
The courses include the use of CME Medical’s T34TM Ambulatory Syringe Pump, which is commonly used during palliative care in patients’ homes, care homes, hospices and hospitals across the country.
Lisa said: “The use of syringe drivers is an important aspect of palliative care as it enables medication to be given continuously via the subcutaneous route to maintain a patient’s symptom control. Patients approaching the end of their lives are usually unable to take medications by mouth and this delivery system enables a combination of medications to be given.”
Lisa explains: “Within the simulated training scenarios the T34TM is set up and attached to the patient mannequin as it would be in real life. In one of the scenarios we deliberately detach the pump from the patient to simulate it having been pulled out by the patient who is agitated. Within the scenario we are hoping that the participating clinician will consider the possibility of the pump being displaced as a reason for the patient’s symptoms becoming more severe and makes appropriate checks of the T34TM.
“The pump can be used for patients in any setting. It is important that all doctors and nurses who look after patients at the end of life are aware of how a syringe driver works and the potential problems which can occur. The T34TM Ambulatory Syringe Pump is the syringe driver which is now used for palliative care patients within our hospital and our local hospice. It is also increasingly being used by district nurses within the community setting as it offers more safety features than the one which was previously used.”
The T34 will be used to demonstrate patient management techniques alongside I-STAN – the high fidelity mannequin, which is able to talk, thanks to role play provided via a microphone by a member of the simulation centre team. He can also simulate a number of signs and symptoms which typically occur in palliative care patients including: pain, agitation, nausea and vomiting, fits, upper respiratory secretions, abnormal chest sounds, bleeding from tumours, alterations in pulse, blood pressure or temperature and respiratory rate.
The centre also uses professional actors and team members to role-play distressed and angry relatives as appropriate.
Lisa said: “Simulation training enables clinicians to develop their skills in a safe clinical environment which is appropriate to their usual place of work. The scenarios are versatile and can be adapted in real time to the skill level of the individual so that they can be challenged but not overwhelmed by the experience.
“Debriefs facilitated by specialists in palliative care supplement the learning and introduce participants to the impact of human factors within multi-disciplinary teams as well as communication and technical skills,” she added.
History of the centre
The Hollier Centre was set up in 2008 after the hospital received a legacy donation for medical education from the late Mr and Mrs Harry Hollier. All lead clinicians within the hospital were invited to assess how the high fidelity simulation facilities might be used for training within each speciality area.
Lisa said: “I already had a keen interest in education and was excited by the possibility of developing something brand new. In collaboration with the Hollier team, the hospital palliative care team took on the challenge to develop innovative training in end of life care.”
High Fidelity Simulation Training has its origins within the aviation industry where flight simulation has been used extensively to train pilots in order to improve safety . Within healthcare this type of training is increasingly utilised to reproduce clinical situations and teach technical skills and to accommodate human factors. The innovative model developed at the Hollier Centre facilitates experiential learning in life-like scenarios which enable clinicians to develop their skills in a realistic but safe environment.
The centre is now running one end of life care training course a month, on average, for a range of trainees including hospital nurses, hospice and palliative care staff and GP trainees. The team recently presented two academic posters at the European Association of Palliative Care Conference 2013, outlining the success of the courses achieved so far:
“Simulation training offers an innovative education model. Participants learn by experience and via facilitated discussion with colleagues. Scenarios can be adapted for the participants’ skill level, discipline and working environment. Feedback from participants indicates that it can provide a powerful learning experience and increase clinical confidence.
Lisa said: “The feedback we have received from nurses and doctors who have participated in the training is that it provides a powerful experiential learning opportunity. We undertake a survey before and after the course for each participant and the results show that on average participants feel more confident about undertaking all aspects of end of life care after the course.”
What the delegates say:
“Excellent training course that should be offered to all nursing staff.”
“Simulation was quite scary but very useful to me for future care.”
“The simulations allowed us to focus on questions we get asked as nurses but are afraid to answer.”
The Hollier Centre is continuing to evaluate the success of its courses and is hoping to expand the range on offer in the future to include training for district nurses, nursing homes, surgical trainees and the ambulance service.