Alcohol IBA e-learning programme developed by Public Health England and Health Education England e-Learning for Healthcare.

We often think of alcohol misuse in terms of dependence and the conditions associated with heavy drinking like liver disease and pancreatitis. But, as last year’s Chief Medical Officers’ new guidance indicated, lower levels of alcohol misuse can contribute to a wide range of conditions not so readily associated with alcohol. Is it therefore worth considering how alcohol could be affecting the health of a wider range of patients and not just heavy drinkers?

The guidance indicates that regular consumption of more than 14 units of alcohol a week significantly raises the risk of ill health for adults. In fact, the risk of some cancers, including breast cancer, starts to increase with regular consumption of any alcohol.

Obviously, most people don’t knowingly want to take risks with their long-term health. The majority of patients who regularly drink over 14 units are probably unaware of the level of risk from their alcohol consumption. But, there are quick, effective screening tools available to health professionals to assess a patients risk from alcohol use and strong evidence that spending less than five minutes making people aware of that risk can persuade them to drink less.

Identifying those at risk and alerting them to the risk, known as alcohol identification and brief advice (IBA), has been researched extensively over the last 35 years. The overwhelming conclusion is that the practice can reduce weekly drinking across the patient cohort by up to 34% (between 3 to 9 units per week). This will reduce relative risk of alcohol-related conditions by c14%, and absolute risk of lifetime alcohol-related death by c20%.”. IBA can take less than 5 minutes and surveys have found that patients expect and are accepting of health practitioners asking about their alcohol use. NICE guidance recommends that all health professionals carry out IBA as an integral part of routine practice.

NICE guidance also recommends alcohol screening and advice for hypertensive patients – 35% of hypertension cases among men and 15% among women are alcohol-related[i]. Reducing alcohol consumption reduces the blood pressure of hypertensive people and alcohol-induced hypertension resolves within two to four weeks of abstinence (or substantial reduction)[ii].

IBA might be done at key opportunities with all patients, or targeted at particular at-risk groups. There are numerous opportunities to address alcohol consumption, such as when patients register with a GP or when reviewing medication. The NHS Health Check also includes an alcohol risk assessment and advice to those at risk and, in 2017-19, a CQUIN scheme will incentivise alcohol IBA and very brief advice on smoking for all inpatients in secondary care.

Health Education England e-Learning for Healthcare (HEE e-LfH) has therefore worked with Public Health England to produce e-learning sessions to support delivery of IBA. Courses take less than an hour to complete and give health staff understanding of the tools and techniques for delivering effective IBA.

For more information about e-LfH visit www.e-lfh.org.uk.

Professor Sir Ian Gilmore MD, DL, FRCP

Chairman, Alcohol Health Alliance UK

University of Liverpool.

Health Education England Funded: Breaking Down the Barriers

Camden and Islington NHS Foundation Trust empowering teams through training and transforming physical health checks for people with mental health needs

People with serious mental illness (SMI) are at greatest risk of poor overall health and premature mortality. Figures show that people with SMI on average die 15 to 20 years earlier than the general population due to preventable physical health problems. Premature and avoidable deaths in people with SMI could be significantly reduced if their physical health needs were identified much earlier and effectively managed.

People with SMI often do not access healthcare in the same way as the general population.  For a long time this group of people have struggled to get appropriate, timely information, advice and support for their physical health needs on subjects including diabetes, chronic obstructive pulmonary disease (COPD), and how to quit smoking. Effective communication and collaboration across primary and secondary healthcare settings in closing the care and quality gaps in physical health and the management of care in people with severe mental health illness needs to be number one priority across the NHS.

Addressing the problem

Camden and Islington NHS Foundation Trust’s (C&I) innovative approach focuses on the coordination and treatment of physical and mental health needs of people with psychosis and bipolar disorders, providing particular health treatment for COPD and diabetes. This is through physical health tests undertaken at special health and wellbeing clinics, use of a specially-designed physical health screening tool for tighter assessment and a programme of physical health training options for mental health staff.

The project’s key targets are:

  • reducing the suicide rate among psychosis patients by 20% by 2022
  • cutting the percentage of those smoking by 2% per year by 2020
  • widespread screening for diabetes to determine full prevalence up to 2020, before then reducing to stabilise at 18% or lower by 2022, reversing the national trend.

How is C&I transforming the way physical health checks are carried out amongst patients with SMI and related needs?

C&I set up a five-year programme known as the Integrated Practice Unit for Psychosis (IPU), working in partnership with Camden and Islington Clinical Commissioning Groups, local authorities, GPs, acute trusts and community health services. It is targeting 18 specific improvement outcomes addressing both mental and physical health, as well as wellbeing and quality of life.

Training

Breaking Down the Barriers (BDtB) programme, funded by Health Education England, North, Central and East London and supported by UCLPartners has facilitated the delivery of training sessions at the Trust on Physical Health Checks, who does what? including the National Audit of Schizophrenia health check, Lester tool and Health Improvement Profile (HIPs). The programme aims to raise awareness of the importance of and significant positive health outcomes that early and timely physical health checks could have on people with SMIs.

Refining the physical health checks approach

C&I has a comprehensive Physical Health Screening Tool (PHST) in place and flow chart which describes the process staff should follow. This is supported by staff training, in addition, C&I has recently audited its medical equipment to ensure that staff working in the service have the right equipment in place. The Trust’s approach to ensuring staff are skilled in physical health assessment and intervention is based on the use of physical health skills self-assessment and training passport. This builds on existing skills and learning is through formal training, use of a simulation suite and in-team training with the practice development team.

Anthony Jemmott, a Community Nurse Manager with the Trust’s Integrated Practice Unit (IPU) in Camden, attended one of the BDtB training sessions in 2016. He said: “The BDtB training supported the development of the IPU and the physical health and wellbeing clinics within C&I. It has raised staff awareness and gave them the confidence to address the physical health and wellbeing needs of our service users with SMI. The research shows that people with serious mental illness die younger than the normal population – not from the mental health problems, but from a preventable long-term physical health condition. By carrying out physical health screening on this client group we would detect early symptoms of preventable long term physical health conditions like diabetes and COPD, also make interventions in smoking cessation, and therefore reduce the prevalence of these diseases and mortality rates.”

Seeing results

Susan Cummins, Community Physical Health Matron, said: “The BDtB modules on COPD and diabetes are very informative and highly relevant to mental health staff working with service users who are more at risk of these conditions. The material is accessible to all staff, using plain and simple language. It is evidence- based and highlights the day to day challenges of treating and managing these long-term conditions. Participants are signposted to lots of other helpful resources for professionals. The sessions have been very well attended by a very broad range of disciplines and are highly engaging.”

Ronke Adejolu, Breaking Down the Barriers, UCLPartners, said: “NHS mental health professionals and the multidisciplinary workforce play a pivotal role and have exclusive opportunities to help people in their care to improve their physical health alongside mental health.”

Breaking Down the Barriers’ free physical health awareness training materials aim to increase awareness, skills and knowledge across the NHS workforce to help in the early identification of key risk factors that are known to adversely affect the physical health of people with mental health needs, including subsequent management of care and timely referrals to appropriate services.

Access Breaking Down the Barriers physical health checks training resources

Training resources can be accessed via e-learning for Healthcare http://www.e-lfh.org.uk/programmes/breaking-down-the-barriers/

Further information

Please visit bit.ly/UCLPBreakingBarriers

Tweet us @UCLPartners #UCLPartnersBreakingBarriers

Call us direct +44 (0)20 3108 2319 or contact the Project Support Officer ellen.nelson@uclpartners.com

There is nothing more powerful than when the NHS health and social care workforce and community comes together to share ideas, stories and hope. UCLPartners makes this happen by bringing people and organisations together to transform the health and wellbeing of the population.

Get in Touch www.uclpartners.com or contact@uclpartners.com

Laith’s story- a radiographer’s journey

Laith Hasan, Radiographer and SoR Union Learning Representative, City Hospitals Sunderland NHS Foundation Trust.Originally from Iraq, I came to the UK in June 2007 after going through multiple traumatic events which prevented me from completing my secondary school education. My biggest mission when I first arrived was to learn the language from scratch before starting my education journey again. I have always known that I wanted to work in healthcare but was not sure which job was best for me and because of the limited English I had, I thought it was impossible for me to work in this field.

Therefore, I studied IT for two years whilst at the same time working hard to improve my English then decided to change my education route and applied for an Access course to get me into university. After reading about the different health careers available and gaining work experience in radiography in multiple hospitals, I had come to conclusion that radiography is the right career for me.

In September 2013, I started my degree at the University of Cumbria studying BSc (Hons) Diagnostic Radiography, with my hard work and dedication I have managed to complete my degree successfully and become a Radiographer. During my time at the university, I had a few favourite experiences including being a student ambassador, which has been one of the best highlights and one that I will always remember, as it helped strengthen my communication and presentation skills, organisational as well as team working skills. I have also been a successful Student Representative for my cohort. Whilst I was at the university, I attended multiple student conferences including: SoR Annual Student Conference and GCU Inter-University Radiography Conference. I have also attended few internal and external CPD activities in Image Interpretation, Spine Imaging and Surgery Planning, CT Head Scanning and Interpretation, and Mentor Training Course.

I am currently working at Sunderland Royal Hospital as a Radiographer since August 2016. One month later, I was nominated to be one of the Union Learning Representatives in my department and since then we have been running some very successful in-house CPD activities such as talks and practical sessions about facial bones (techniques and image interpretation); CT Heads – Indications for scanning and pathology; Moyamoya disease and cerebral angiography; Basic Interpretation of the Chest X-ray; Shoulder imaging and modified techniques; e-LfH Image Interpretation programme; and An introduction to CPD Now. We use e-LfH sessions to support our CPD programme by identifying sessions that staff can complete prior to the timetabled CPD learning session. This is to enrich the learning further. Following the CPD sessions we support staff to reflect on their learning and how it will impact on their practice.

In the future, I am hoping to specialise in plain-film reporting whilst at the same time mentoring students and promoting learning across the department.

Laith Hasan,

Radiographer and SoR Union Learning Representative,

City Hospitals Sunderland NHS Foundation Trust.

How “Prescribe” came to be

The ‘Prescribe: Clinical pharmacology and prescribing’ e-learning programme has recently been launched for which I am an author and senior editor.

I became involved in healthcare education in my role as consultant pharmacist in academic pharmacy practice at a UK teaching hospital.  In conjunction with a nurse colleague, I developed an accredited course for pharmacist and nurse prescribers for a higher education institution in 2004.  I also contributed to the development of a competence framework for non-medical prescribers and trained as an independent prescriber myself.  Experienced practitioners began to question whether there was an equivalent course and competence framework for medical prescribers since all prescribers should work to the same standards of practice.

I conducted an audit of prescribing quality by doctors within the hospital against the local standards for good prescribing.  This looked at practical aspects of prescribing such as:

  • clear and legible writing of prescriptions;
  • the use of inappropriate abbreviations of drug names and dose units;
  • bioequivalent dosage of drugs prescribed by multiple routes of administration;
  • provision of legible prescriber details including name and contact number;
  • the correct method of cancelling and amending prescriptions.

The outcomes of this audit linked with the investigation of prescribing errors reported to the medication safety committee led to collaboration with the local medical school and the subsequent setting up of a prescribing course for final year medical students.  Students were required to demonstrate practical prescribing by writing a range of ‘student’ drug charts for patients they had encountered (based on real drug charts but altered so they couldn’t be used for drug administration to the patient).  This included the prescribing of high-risk drugs including insulins and treatment anticoagulation.  There was also an open-book summative examination looking at other practical aspects of prescribing such as calculation skills and interpretation of information found in the British National Formulary (BNF).  A formative drug chart assessment continues to this day, although the examination has been replaced by the national Prescribing Skills Assessment (PSA).

In 2012 I was approached about authoring several topics for ‘Prescribe’ in conjunction with Professor Simon Maxwell.  I wrote several sessions on topics such as how to write a hospital drug chart, calculation skills, intravenous fluid therapy and how to use the BNF.  Unforeseen problems delayed publication and launch of the course at that time.  In April 2016 I was approached to see if I was interested in working with the course team again.  This great team of people all collaborated to achieving the goal of launching the course at the British Pharmaceutical Society (BPS) conference in December.   I was able to update my original sessions and contribute to the editing of many more.  It was amazing just how much practice had moved on during the intervening years.  For example, we now have the electronic BNF (e-BNF) and electronic prescribing, both of which impact dramatically on prescribing practice.

‘Prescribe’ should help medical students to prepare for the PSA.  It is a resource that will support both medical students and junior doctors as they prepare for and gain experience in practical prescribing.

I feel very privileged to have had the opportunity to contribute to this initiative.  It has the potential to impact significantly on patient care and reduce the risk of harm arising from prescribing errors.

We will continue to review, update and develop the course.  We would love to hear your feedback – whether you found the course useful, any ideas you may have for new topics and, of course, any suggestions for improving what is already available.

To access the e-learning programme click here.

Alison G Eggleton
Consultant Pharmacist in Academic Pharmacy Practice
alison.g.eggleton@btopenworld.com

A Spare 20 minutes – End of Life Care for All (e-ELCA)

I was recently told that my blog, published in September for the European Association of Palliative Care (EAPC), was number eight in ‘most viewed in 2016’ list.  Why was this I wonder?

Did the informal style draw potential users in? Waiting for a meeting?  Travelling on a train?  A spare 20 minutes before lunch? Why not open an e-ELCA e-learning session and learn something new?

Of course, members of the EAPC will think end of life care important, but was it the information about accessing on-line learning that was of prime interest to them especially those in Europe who can access the amazing content of over 160 sessions through purchase via e-Integrity?

Was it the Twitter sphere? @Cmf_elca doesn’t have a great following but those that follow me have a huge network across health and social care communities.  Did those six retweets make a difference I wonder?

I’m not sure whether these were the key factors but I do know that the value of e-ELCA to teachers and learners seems to be increasing and the launch and completion of session data has shown dramatic rises in the past 18 months.  Two factors are very definitely key to this.  Firstly support from e-LFH on developing a targeted marketing and communications plan.   This has included attending many national and regional conferences, handing out leaflets contributions to workshops and poster presentations.

We have also helped users navigate the programme to find the sessions that support their learning needs.  Unlike some other programmes e-ELCA is not targeted at a single audience or a single curriculum.  It has content that is designed to address the core competences required by the health and social care workforce in providing high quality end of life care, but what a care worker needs to know is quite different to what a GP trainee may need.  Our learning paths have become an important feature to help users find the sessions they need and these continue to develop.  Some learning paths are to support individual Trusts (for example the United Lincolnshire Hospitals Trust (ULHT) learning paths for doctors, end of life care facilitators and for other healthcare professionals) some are focused on staff groups (for example priorities for care of the dying person for nurses) and some support defined curriculum such as the NVQ levels 2,3 & 5

Many specialists in palliative care are using the sessions within their teaching. For example for a course about advance care planning (ACP) Introduction to Principles of Advance Care Planning may be used to bring course participants to a common level before attending a study day. This ACP course might also make use of  e-ELCA material for discussion within a group (for example How to Negotiate Decisions Which May be Difficult to Implement)  and perhaps as a way to consolidate or further learning (for example Developing Your Practice: Clinical Supervision and Further Reading).

There are tips about how e-ELCA can motivate and engage learners on the e-ELCA website.  My newest venture to help learners and educators make best use of this amazing, free resource is a YouTube channel (a work in progress!)

The e-ELCA session that is my personal favorite is Spirituality and Philosophy of End of Life Care.  It’s a session that makes me think and reflect even after over 25 years of supporting people who are dying. The importance of the holistic approach to people in finding themselves, is so beautifully articulated through a patient video.  A good way to spend those 20 minutes!

Professor Christina Faull
Consultant in Palliative Medicine
LOROS Hospice, Leicester, UK
Association for Palliative Medicine National Clinical Lead for e-ELCA
@cmf_elca
YouTube e-ELCA

Learning resources promoting integration of physical and mental health launched

Health Education England has worked with UCLPartners and NHS mental and physical health experts to develop a suite of educational material for use across primary and secondary NHS health settings.

“Breaking Down the Barriers” aims to support education across the NHS workforce by providing the training materials to enhance existing skills, increase knowledge for early recognition, assessment, management and signposting of mental and physical health needs of patients.

A key aim of this work is to facilitate and encourage collaborative working and the sharing of resources and training delivery arrangement between NHS Trusts. The education and training materials cover the following areas:

  • Mental Health awareness in emergency and urgent care settings
  • Physical Health awareness in mental health settings
  • Child and Adolescent mental health awareness training for GP practices in primary care
  • Child and Adolescent learning disabilities awareness training for GP practices in primary care

The resources are a combination of classroom training, videos, simulation training, presentations, case based scenarios, case studies, tutorials and quizzes.

Breaking Down the Barriers awareness training packages and associated materials are available as a free downloadable resource from HEE e-Learning for Healthcare for use across primary and secondary care settings.

To access the resources please click here.

Award win for NHS e-learning programme

learning-pool-award-240x160Health Education England’s e-Learning for Healthcare (HEE e-LfH) programme picked up the “Best Adapt Project” award at the Learning Pool 2016 awards.

Adapt is an open source authoring tool for creating fully responsive, multi-device, HTML5 e-learning content and Learning Pool are one of the organisations behind the open source project. The award was given in recognition of the way the authoring tool has been used in HEE e-LfH’s MindEd for Families e-learning resource.

The “Best Adapt Project” judges were looking for evidence that the project is innovative and original and that the interactivity is used to reinforce learning. e-LfH certainly achieved this; pushing the limits of what can be done with Adapt and creating a comprehensive, graphically rich suite of resources of the highest quality. The team also used an innovative co-authoring model where parents and clinicians collaborated on each session along with e-LfH’s instructional designers.

HEE e-LfH’s MindEd for Families programme is aimed at parents and carers of children and young people who suffer from poor mental health. It was developed in partnership with a consortium to ensure this sensitive subject was handled appropriately and accurately, including the Royal College of Paediatrics and Child Health, the Royal College of Psychiatrists, the Royal College of General Practitioners, Young Minds, the National Children’s Bureau, the Royal College of Nursing and the British Association for Counselling and Psychotherapy. It also put parents at the heart of the authoring process to ensure that their views were represented and the output was right for them as the ultimate users of the content.

Commenting on HEE e-LfH’s recent win, Martin Sinclair, e-LfH Programme Lead, said: “HEE e-LfH is delighted to receive a Learning Pool award for the MindEd for Families programme. As e-learning professionals it is great to see that our good work has been recognised by the industry and we are all very proud of MindEd for Families. It is an important and necessary resource for people in very difficult situations and we hope that we can make a positive difference.”

For more information about HEE e-LfH’s programme please visit www.e-lfh.org.uk

Attached photograph shows from L to R:

•             Sam Barbee – Sales and Marketing Director, Learning Pool

•             Martin Sinclair – Programme Lead, e-Learning for Healthcare

•             Wendy Lowe – Instructional Designer, e-Learning for Healthcare

•             Deborah Limb – Chief Operations Officer, Learning Pool.

New MRI safety training – volunteers required

The author of a new MRI safety course, which has been developed in partnership with Health Education England e-Learning for Healthcare (HEE e-LfH), which could prevent injuries and save lives by reducing adverse incidents, is calling for volunteers to take part in a pilot of ‘Managing Patients Undergoing Anaesthesia in the MRI Unit’.

Barbara Nugent, a team leader at the Royal Hospital for Sick Children in Edinburgh and a project lead for MRI safety at NHS Education for Scotland, has been actively trying to create a global database of MRI adverse events. The evidence compiled supports the need for introducing minimum levels of safety education to the MRI workforce. To satisfy this requirement some of this data has been used to reinforce the need for e-learning modules for MRI staff at the frontline of MRI safety: including radiographers, radiologists, physicists and clinical scientists.

Developed in collaboration with Health Education England’s e-Learning for Healthcare (HEE e-LfH) programme and with the support of other professional bodies and organisations across the UK (SCoR, BAMRR, MRAG, IPEM (MRSIG), MHRA, BIR, RCR, HFS, AAGBI and ISMRM) the first module of the MRI safety course is now ready to be tested.

Once this first module has been evaluated, it is intended to be one of a suite of online MRI Safety Programme learning modules designed to share fundamental MRI safety knowledge while also developing professional expertise in the areas of:

  • MRI safety hazards and risk management
  • MRI safety guidelines and legislation
  • MRI adverse incident management and reporting

For more information about the MRI Safety e-learning session and to evaluate the pilot please click here.

Widening the access of HEE e-LfH resources

Health Education England e-Learning for Healthcare (HEE e-LfH) has added the e-LfH Hub and its thousands of e-learning sessions to the list of OpenAthens resources to make it easier for certain groups of the health and social care workforce to access e-LfH’s e-learning.

HEE e-LfH works in partnership with the NHS and professional bodies to support patient care by providing e-learning to educate and train the health and social care workforce.

HEE e-LfH’s programmes cover subjects from audiology to anaesthesia, dentistry to dermatology, electronic fetal monitoring to end of life care, primary care to prescribing, safeguarding children to statutory and mandatory training. All content is nationally quality-assured and available 24/7. The online training sessions enhance traditional learning, support existing teaching methods and provide a valuable reference point.

OpenAthens is a service that allows people to access a series of online resources free of charge with just a single OpenAthens account.

The OpenAthens eligibility criteria, which are managed by NICE, cover anyone working directly with NHS patients and anyone working directly on the development and/or delivery of training materials for either NHS staff or NHS patients within an organisation that provides NHS-commissioned care or commissions care for NHS patients in England. This includes charities, voluntary organisations, local authorities, arm’s length bodies and healthcare students.

For more detailed information on the eligibility criteria please visit: www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases/openathens/openathens-eligibility

To register for an OpenAthens account please visit: https://openathens.nice.org.uk/ or for more information about accessing e-LfH resources via OpenAthens visit: http://support.e-lfh.org.uk/get-started/openathens/

End of Life Care for All e-learning (e-ELCA)

Waiting for a meeting?  Travelling on a train?  A spare 20 minutes before lunch? Why not open an End of Life Care for All (e-ELCA) e-learning session and learn something new?  Created in 2010 and completely updated in 2015, e-ELCA is an e-learning programme aimed at enhancing the training and education of all those involved in providing end-of-life care. It is managed by Health Education England’s e-Learning for Healthcare programme in partnership with the Association for Palliative Medicine of Great Britain and Ireland (APM).

e-ELCA has over 160 e-learning sessions written by specialists in the field of palliative care in the UK and Ireland. The sessions are grouped into subject specific modules about advance care planning, symptom management, assessment, communication skills and bereavement, two modules that focus on learning for social care, spiritual care and a module that uses case scenarios to help integrate learning.  More information about the background and detail of the content can be found in our recent EJPC article – please see below.

You can register for e-ELCA or if you are not eligible you can purchase it. Thirteen sessions are free to access.  Additionally Recognising the Last Months and Days of Life is available as a sample session.   This is a very important session to help doctors and nurses address the significant issues that recent reports about the quality of end of life care have highlighted.

You can see further how e-ELCA sessions can support the competences required to meet the Priorities of Care of the Dying Person report by you or your trainees, students or colleagues completing a Training Needs Analysis.   NICE has indicated that e-ELCA sessions are a good way of supporting implementation of the Guideline for Care of Dying Adults in the Last Days of Life.

Many specialists in palliative care are using the sessions within their teaching. For example for a course about advance care planning (ACP) Introduction to Principles of Advance Care Planning may be used to bring course participants to a common level before attending a study day. This ACP course may also make use of e-ELCA material for discussion within a group (for example How to Negotiate Decisions Which May be Difficult to Implement) and perhaps as a way to consolidate or further learning (for example  Developing Your Practice: Clinical Supervision and Further Reading.  There are tips about how e-ELCA can motivate and engage learners and suggested learning paths or collections of sessions to support staff groups.  In addition e-ELCA sessions have been mapped to the end of life care qualification, especially useful for social care workers.  Mapping to the Association for Palliative Medicine of Great Britain and Ireland Undergraduate Medical Student Curriculum is underway.  Keep in touch through the e-ELCA website

My personal favourite session is Spirituality and Philosophy of End of Life Care.  It’s a session that makes me think and reflect even after over 25 years of supporting people who are dying. The importance of the holistic approach to people in finding themselves, is so beautifully articulated through a patient video.  A good way to spend those 20 minutes!

European Journal for Palliative Care July 2016

Professor Christina Faull
Consultant in Palliative Medicine
LOROS hospice, Leicester UK
APM National Clinical Lead for e-ELCA
@cmfaull