Connecting staff to corporate knowledge and best practice
Angela Hall describes how the Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) Library Service is utilising clinicalskills.net to connect its workforce to corporate knowledge and best practice.
Health Education England is committed to developing NHS library services that are proactive and focused on the knowledge needs of the NHS and its workforce.1 Trusts need to identify opportunities to achieve productivity, realise efﬁciency savings and improve the quality of care.2 Librarians and knowledge specialists have a pivotal role to play through mobilising knowledge and evidence effectively while transforming the way we deliver library and knowledge services.3
Building on their earlier success helping to develop the Royal Liverpool Emergency Medicine Handbook App), the library team have once again boosted their involvement in organisational knowledge management activities, ensuring that the service is fully embedded in the business of the organisation, ‘making the provision of knowledge and evidence a business-critical healthcare intervention’.4
In 2016, the RLBUHT Library subscribed to clinicalskills.net including all procedures and test assessments, not realising that it would create an additional, significant role for library staff within the organisation. Clinicalskills.net contains over 300 fully illustrated step-by-step guidelines on clinical skills covering Adult Nursing, Children’s Nursing, Primary Care, Moving & Handling and Healthcare Assistants. With each procedure comes a test assessment. The library agreed to fund the resource. As we had few resources to offer clinical skills or Bands 2-4, we thought the subscription would, in the long term, be more beneficial to staff (and ultimately patient care) than the purchase of additional textbooks.
We initially promoted the resource to our Clinical Skills & Simulation Department, who began using it as pre-training material for bands 3 & 4 HCA workforce, before commencing the ‘practicals’ in the laboratory, helping them to bridge the knowledge-practice gap. Pre-course tests allowed them to significantly shorten training sessions. Health care assistants, for example, could complete the relevant module and assessment at their own pace; and only those staff who had passed the test were allowed to attend the training. Reference to the e-learning modules has been embedded into the RLB programme – an in-house training programme for registered nurses, dental nurses, allied health professionals, assistant practitioners, healthcare assistants and volunteers.
We knew that the resource was popular, with 384,460 page views within our account in the last 12 months. We also knew that it was customisable, with administrators able to:
add new users and teams
edit existing question banks or devise question banks from scratch
add organisational notes to each procedure, for example direct links to Trust policies
allocate tests and procedures to individuals or teams
view all candidates’ progress/scores.
What we didn’t fully appreciate was how it could be used as a highly flexible e-learning tool, allowing the RLBUHT Library Service to play a vital role in improved patient care and at the same time delivering significant time and cost savings for the Trust as demonstrated below.
The Head of Clinical & Practice Development and a Consultant in Diabetes then asked me if we could use clinicalskills.net to host ‘Use Insulin, Save Lives’, an e-learning module written by the Consultant, which is part of our Trust’s Clinical Core Skills Programme. ‘Use Insulin’ had been previously hosted on our existing Electronic Staff Record (ESR), but some users were unable to access it despite apparently having the correct software (e.g. Java).
As a result, few people had completed the module online.
‘Use Insulin’ was in the form of an interactive PowerPoint show and a question bank of 105 questions. The Consultant sent us the PPT, the introduction to the module and the question bank and we decided to try putting it on clinicalskills.net. While the ESR cannot currently be accessed off-site, clinicalskills.net can, using Athens authentication.
The first step was to create and name the assessment ‘RLBUHT – Use Insulin, Save Lives’. We added our own Trust logo to the template, highlighting to our users that this assessment was linked to our organisation. We set the desired percentage pass rate at 90 per cent and the number of allowed attempts to unlimited. The Consultant wanted learners to be able to view feedback on the answers and have the ability to download a certificate.
Next, we created the question banks. All 105 questions were split into five sections or chapters, so that we could ‘cherry pick’ seven questions from each section, forming a test of 35 randomised questions in all. We were able to load all the questions, using the question types available on clinicalskills.net: True/False, Multiple answers: only one is correct, Multiple answers: several can be correct or Free text.
We promoted it to managers and clinicians involved in prescribing or administering insulin, explaining that staff could access it with their Athens accounts. On logging in via Athens for the first time, users have to complete first-name and last-name fields and agree to the terms and conditions. This ensures that the learner’s name appears on the certificate of test completion. Library contact details were added to address any queries.
The test has been successful: during the two years that the ‘Use Insulin, Save Lives’ test was hosted on the ESR, only 75 staff completed it, but in the six months since it has been available on clinicalskills.net, 204 staff have passed the module. At present, the scores are exported and forwarded to the Learning & Development Department monthly, for them to upload to the ESR.
As the resource is SCORM-compliant with any Learning Management System (LMS) via SSO (single sign-on), it will in my view be essential to integrate clinicalskills.net into our ESR (using employee ID/Assignment number) so that we can automatically record users’ scores.
The Gastroenterology Nurse Consultant also asked whether clinicalskills.net could provide a solution to the dwindling numbers of doctors attending the face-to-face training on ‘Safe placement of Nasogastric Tubes’, which is part of the Trust’s ‘Essential Skills’ Training Programme.
A Patient Safety Alert5 issued in July 2016 stated that, despite the guidance from the National Patient Safety Agency (NPSA), issued in 2011 and aimed at reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants, there have since been 95 incidents reported to the National Reporting & Learning System (NRLS) where fluids or medication were introduced into the respiratory tract via a misplaced nasogastric tube.
A study by NHS Improvement found that the most common type of error was misinterpretation of X-rays by medical staff who had not received the required competency-based training. Clinicalskills.net lent itself well to this type of test, involving interpretation of chest X-rays images can be incorporated with each question.
The Trust’s ‘Clinical Core Skills Programme’ (CCSP) had been delivered via ‘face to face’ at induction and as part of mandatory training. A senior-level decision was made to convert the CCSP to e-learning to make training more accessible to all clinical staff enabling them to access the programmes anywhere, at any time and at their own pace, without the need to release staff from the ward or department. Hosting the programme on clinicalskills.net seemed an appropriate solution.
The Head of Clinical & Practice Development established a working group of subject matter experts to agree e-learning content for the CCSP and a template was devised to gather information in
I met with the subject specialists to complete a template for uploading content onto clinical skills.net. The fields for completion were:
title of course
lead and contributors
frequency of training
method of delivery
assessment of learning
brief overview of content
The content was received in PowerPoint format, and I had to make the presentations professional and consistent, using the Trust PPT template. I also created the assessments, making them as interactive as possible, and creating test accounts to ensure all answers were correct. I then shared them with the subject specialists for final approval.
The training programme
The whole Clinical Core Skills training programme now sits on www.clinicalskills.net – this includes the e-learning modules and test assessments tailored to the needs of our organisation to include our own local policies and standards of practice. The subject areas above form part of either the ‘Clinical Core Skills Programme’ or ‘Essential Skills Training Programme’ – to be further developed. It was formally launched at the August 2017 induction and was very well received.
Everyone who has an individual account on clinicalskills.net can view a record of their performance: which assessments they have taken, the pass mark, their score, and, if they have started an assessment there is a link to allow them to continue with it.
Managers can see who has started or completed their assessment, whether they have passed and at what mark, and how many times a user has taken an assessment. They can also see what answers users gave to the most recently taken.
Nurses can record their CPD activity online.
In addition, reflective accounts in preparation for revalidation can automatically be generated within the Nursing and Midwifery Council-approved form, which also adds up the hours automatically.
Sue Lacey Bryant et al commented in Update recently that "the challenge is to flex to meet priorities, design and deliver services that make a positive impact on patient care and give value for money, managing electronic and physical resources to optimum effect".
This challenging project has called on
the library team at the Royal to do just that – as well as reflecting HEE’s Knowledge for Healthcare strategic development framework, which advocates library staff to be "flexible, multi-skilled knowledge specialists, able to work at pace and deliver under pressure, taking opportunities to enhance their skills in leadership, networking, partnership working, problem solving and in many other areas as they deliver projects".
1 Health Education England. The NHS Library and Knowledge Services in England Policy.
2 Lord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: -unwarranted variations: an independent report for the Department of Health.
3 HEE. Knowledge for Healthcare: a development framework for NHS Library and Knowledge Services.
4 Bryant, S. L., Stewart, D., & Young, G. Knowledge for Healthcare – workforce planning and development. CILIP Update. Dec/Jan 2016 pp. 33-35.
5 NHS Improvement. Patient Safety Alert NHS/PSA/RE/2016/006 – Nasogastric tube misplacement.