Care of the Critically Ill Surgical Patient CCrISP

Care of the Critically Ill Surgical Patient CCrISP Guide to regional delivery Information for potential new centres A course developed and quality assured by The Royal College of Surgeons of England Updated 29 April 2014

Contents 1.0 Care of the Critically Ill Surgical Patient... 1 1.1 Course objectives... 1 1.2 Target audience and suitability... 1 2.0 Becoming an Approved RCS Regional Centre... 1 2.1 Centre approval... 2 2.2 Approved faculty... 2 3.0 Course Requirements... 2 3.1 Centre requirements... 2 3.2 Course administrator... 3 3.3 Faculty... 3 3.4 Facilities and equipment... 3 4.0 Course Programme... 4 4.1 Course format... 4 4.2 Class size... 4 4.3 Course materials... 4 4.4 Pre-course preparation... 4 4.5 Assessment... 4 4.6 Sample course programme... 5 5.0 Quality Assurance... 8 6.0 Promotional Support... 8 7.0 Course Fees... 8 7.1 RCS fee charged to regional centre... 8 7.2 Fee charged by regional centre to delegates... 8 7.3 Set up and running costs... 8 8.0 Contact Us... 9 Appendix: Course Equipment Requirements... 10 Updated 1 September 2014

1.0 Care of the Critically Ill Surgical Patient This informative and interactive course combines a variety of teaching and learning techniques to advance the practical, theoretical and personal skills necessary for the care of critically ill surgical patients. This is an assessed course and certificates will only be awarded upon successful completion of the entire course. Intending participants should be aware that this course will cover basic principles which are transferable to all specialties; however, the worked examples will all be taken from general surgical patients. 1.1 Course objectives By the end of the course participants will: Develop the theoretical basis and practical skills necessary to manage the critically ill surgical patient Be able to assess critically ill patients accurately and appreciate the value of a system of assessment for the critically ill Understand the subtlety and variety of presentation of critical illness and the methods available for improving detection Understand the importance of a plan of action in order to achieve clinical progress, accurate diagnosis and early definitive treatment, and be able to formulate a plan of action and involve appropriate assistance in a timely manner. Appreciate that complications tend to occur in a cascade and realise that prevention of complications is fundamental to successful outcome Be aware of the support facilities available and interact with nursing staff, other surgeons, intensivists and anaesthetists, being aware in particular of the surgeon s role in the delivery of multidisciplinary care to the critically ill Understand the requirements of the patients and their relatives during critical illness and be able to inform and support both appropriately 1.2 Target audience and suitability CCrISP is usually taken in CT1 or early in CT2 and it is strongly recommended that participants have had six months general surgery training. More senior trainees may also benefit from attending a CCrISP course, should they wish to do so. This course is also suitable for SAS Grades. This course is not suitable for FY trainees who are not eligible to attend. FY trainees are recommended to attend the START surgery course. 2.0 Becoming an Approved RCS Regional Centre The RCS is an independent professional body committed to promoting and advancing the highest standards of surgical care for patients. RCS Education work with over 140 regional centres across the UK, delivering RCS courses to 7,500 8,000 regional delegates each year. There are a number of regulations set in place by the College in order to ensure the agreed teaching standards are maintained for all of our regional courses. Our aim is to ensure participants receive the same high quality educational experience and standard of teaching, wherever they attend an RCS course. Royal College of Surgeons of England 2014. All rights reserved. 1 P a g e

2.1 Centre approval A regional centre will be approved to deliver an RCS course if it can demonstrate that it can meet the course requirements as described in Section 3. 2.2 Approved faculty In order for a centre to deliver the CCrISP course on a regular basis, the centre will need the support of a local Course Director and eligible faculty. The number and type of faculty required are detailed in Section 3.3. Below is a brief outline of the essential requirements to become a CCrISP Course Director and a CCrISP Instructor. A more detailed role specification for course directors and faculty is available from https://www.rcseng.ac.uk/courses/course-search/regional-courses/regional-centres-1/ccrispinformation-for-regional-centres. A Course Director must meet the following criteria: Be in a substantive Consultant or SAS post managing potentially unwell surgical patients as part of routine clinical practice; and Have taught regularly on at least 5 CCrISP courses in the last 5 years; and Have gained RCS approval as a Course Director Instructor faculty must meet the following criteria: Be an established consultant, SAS doctor or ST5+ managing potentially unwell surgical patients as part of routine clinical practice; and Have attended the CCrISP instructor course; or Have attended or observed a CCrISP course, completed a comparable recognised teaching course such as Training the Trainers in the last 5 years, and be approved by as faculty by a Course Director after acting as a faculty observer on a CCrISP course (i.e. being observed teaching part of the course). The centre should first identify their Course Director. It is essential that a proposed Course Director is an experienced member of the CCrISP faculty and is able to attract potential faculty from surgery, anaesthesia and intensive care. If most of the proposed faculty are experienced CCrISP Instructors, it is likely that a centre can go ahead with running their first course and will be quality assured by the presence of an external senior member of CCrISP faculty. Alternatively, centres with several new potential members of faculty should liaise with the College to get faculty trained on a CCrISP Instructor course which are currently held at the College. 3.0 Course Requirements 3.1 Centre requirements The regional centre is responsible for the organisation of the course including arranging the faculty, booking facilities and catering, advertising the course, taking bookings and processing payments. A regional centre must be either a legal entity or part of one. Royal College of Surgeons of England 2014. All rights reserved. 2 P a g e

3.2 Course administrator The regional centre should nominate a course administrator who will manage applications for the course and deal with any pre- and post-course queries. The courses administrator will also work closely with RCS Education to ensure that the course requirements are met. In addition, adequate support needs to be provided throughout the course by the course administrator and/or technician to set up the teaching stations and to ensure the general smooth running of the course. The course administrator and/or technician will need to have observed a CCrISP course being delivered at another centre before the course can be run locally. 3.3 Faculty The Course Director takes responsibility for the running of the course and may be assisted by a Codirector. The Course Director need not be a surgeon, but where the Course Director is a nonsurgeon, a surgeon should be identified as the Co-director. The faculty requirements to run a course are: Courses should run with a minimum of 8 faculty on days 1 & 2 and 10 faculty on day 3 (this includes the Course Director). The Course Director will be present throughout the delivery of the course. At least three of the faculty should be anaesthetists and at least three of the faculty should be surgeons. All faculty and Course Director(s) must be qualified CCrISP instructors. See Section 2.2 for a brief outline of the essential requirements to become a CCrISP Course Director and CCrISP Instructor. 3.4 Facilities and equipment In order for a regional centre to be given approval to run this course, it must meet the requirements outlined below. The facilities and equipment required are: 1 seminar room with seating for at least 25 for lecturing with standard audio visual (AV) equipment of laptop and data projector A skills area large enough to accommodate: o 4 moulage stations for the Simulated Patient Scenarios o an area to demonstrate a Patient Scenario to the delegates o plus additional space to run the 4 Skills Rotations Stations* 1 room for faculty meetings Actors are needed for the communication skills stations run on day 2 and for the final scenarios run on the morning of day 3 Equipment as detailed in the Appendix * You can run most of the Skills Rotation Stations in seminar rooms if available. See Section 4.6 for more information. Royal College of Surgeons of England 2014. All rights reserved. 3 P a g e

4.0 Course Programme 4.1 Course format CCrISP is a two and a half day* course designed to advance the practical, theoretical and personal skills necessary for the care of the critically ill surgical patients. The course includes: s and demonstrations Simulated patient scenarios (actors are required on days 2 and 3) Case-based skill stations Interactive small group discussions Pre and post course MCQ tests and scenario-based assessment *A two day version of the course will be available from late 2015 as part of the 4th edition course updates. 4.2 Class size The maximum class size is 16 participants and up to 4 observers. 4.3 Course materials Course manuals should be ordered from RCS Education 3 months before the course to allow you time to distribute them to the participants at least one month before the course. Participants are required to read the course manual and complete an MCQ test before the course. 4.4 Pre-course preparation Although the MCQs are not part of the formal assessment, candidates receive the MCQ test and the course handbook prior to the course to encourage them to revise core knowledge. 4.5 Assessment This is an assessed course and a certificate of completion will only be awarded to successful participants. Assessment is conducted by all faculty members and is discussed at faculty meetings held during the course. Royal College of Surgeons of England 2014. All rights reserved. 4 P a g e

4.6 Sample course programme Delivery of the course should follow the standard programme format and must include all the sessions and cover the learning outcomes listed. Day One Day/Date Time Topic Room(s) 1200-1230 Participant Registration & Lunch 1200-1230 Faculty Meeting & Working Lunch Faculty room 1230-1310 1310-1330 1330-1430 1430-1510 Introduction to CCrISP and Assessment of the Critically Ill Surgical Patient Demonstration Assessment of the Critically Ill Surgical Patient Simulated Patient Scenarios Small Group Sessions: Assessment of the Critically Ill Surgical Patient (participants break in to four rotations) Patient A Patient B Patient C Patient D Perioperative Respiratory Complications Seminar room Skills area Skills area Seminar room 1510-1525 Refreshments Refreshment area 1525-1605 1605-1725 Shock and Haemorrhage Skills Rotations Small Group Sessions: (participants break in to four rotations) Airway Management Tracheostomy Management Wounds Stomas Seminar room Skills area* 1725-1800 : Cardiac Disorders in Surgical Critical Care Seminar room 1930 Faculty & Participants Course Dinner * The Airway and Tracheostomy Management Skills Rotations should be held in the Skills area as equipment is required, but you can run the Wounds and Stomas Skills Rotations in separate seminar rooms if available. See the Appendix for a full list of Course Equipment Requirements. Royal College of Surgeons of England 2014. All rights reserved. 5 P a g e

Day Two Day/Date Time Topic Room(s) 0800-0840 0840-0915 0915-0945 0945-1300 (refreshments at 1030) Sepsis Renal Dysfunction in Surgical Critical Care Communication A Vital Skill in Critical Care Skills Rotations Small Group Sessions: (participants break in to four rotations) Cardiovascular Manipulation in Shock Communication and Organisational Skills in Surgical Care 1 (Actor) Perioperative Cardiac Disorders Renal Scenarios Seminar room Skills area/seminar room* 1300-1345 Lunch Refreshment area 1345-1415 1415-1445 1415-1445 1445-1800 (refreshments at 1615) Nutrition Workshop Nutrition Scenarios Groups A & B Workshop Nutrition Scenarios Groups C & D Skills Rotations Small Group Sessions: (participants break in to four rotations) Sepsis Scenarios Communication and Organisational Skills in Surgical Care 2 (Actor) Invasive Cardiovascular Monitoring Chest Radiology and Respiratory Care Seminar room Skills area # Seminar room # Skills area/seminar room* 1800 Faculty Meeting Faculty room * Only the Communication and Organisational Skills in Surgical Care 1 and 2 Skills Rotations require equipment. These sessions can be quite noisy and are best held in a separate room if you can accommodate this. All other Skills Rotations only require a laptop and can be run in the Skills area or in separate seminar rooms if available. See the Appendix for a full list of Course Equipment Requirements. # Delegates split into 2 groups for the Nutrition workshops. These only require a laptop and can be run the Skills area and seminar room or in 2 seminar rooms if available. Royal College of Surgeons of England 2014. All rights reserved. 6 P a g e

Day Three Day/Date Time Topic Room(s) 0800-0850 0850-0940 0940-1000 1000-1300 (refreshments at 1115 & 1130) Demonstration Practical Management of the Critically Ill Surgical Patient Pain Management Course Summary Simulated Patient Scenarios (Assessment) Practical Management of the Critically Ill Surgical Patient (participants break in to four rotations) Patient A Scenario 4 (Actor) Patient B Scenario 4 (Actor) Patient C Scenario 5 (Actor) Patient D Scenario 5 (Actor) Skills area Seminar room Skills area The Surgical Ward Round Seminar room 1300-1330 Faculty Meeting & Working Lunch Faculty room 1300-1330 Participant Lunch Refreshment area 1330-1400 Closing Remarks and Feedback Seminar room 1400 Course Close Royal College of Surgeons of England 2014. All rights reserved. 7 P a g e

5.0 Quality Assurance We aim to ensure participants receive the same high quality educational experience, wherever they attend an RCS course. The Surgical Course Participant Evaluation (SCOPE) is an essential part of maintaining the high quality of our courses and directing the future development of courses. It is an essential requirement for participants as certificates are only issued free of charge to those participants who complete SCOPE within the agreed timeframe after the course. Faculty are also asked to complete the online evaluation to ensure a full review of the course from both the participants and faculty viewpoints. After the event, we will send you feedback on how your course was evaluated. 6.0 Promotional Support Most regional courses are run as open courses, i.e. they are open to any delegate who meets the criteria and courses are advertised by the regional centre. If you plan to run CCrISP as an open course we can provide promotional support with the details of your course appearing on the College website. CCrISP may also be delivered as a closed course, i.e. only invited delegates may attend. Closed courses are not advertised on the College website. 7.0 Course Fees 7.1 RCS fee charged to regional centre The fee payable to RCS is 125 per participant. For this fee we provide: CCrISP course manual Course administration Promotional support Quality assurance including feedback on the course Participant certificates The fee to observe a course is 40 and this includes a copy of the CCrISP course manual. 7.2 Fee charged by regional centre to delegates If you plan to run your course as on open course (see Section 6) and are charging a fee per delegate, you may charge a fee ranging from between 590 to 990 per delegate (this is 200+/- the fee for a CCrISP course held at the RCS Education Centre, currently 790). If you plan to run your course as a closed course (see Section 6) for invited delegates only, you may choose not to charge delegates to attend, or charge a nominal administration fee only. 7.3 Set up and running costs In terms of set up, you will need to take into account the following one off costs: The purchase of any equipment as listed in the Appendix A one off fee of 850 for the CCrISP new centre materials box Purchase of a CCrISP faculty handbook for the centre for 25 each Royal College of Surgeons of England 2014. All rights reserved. 8 P a g e

Running costs include: Fees for the actors on days 2 and 3 Room hire, AV costs, catering, technician costs to set up the rooms/scenarios Faculty dinner on first evening (inviting participants to the dinner is optional) Travel and accommodation costs for the faculty, some of whom my not be local Note: a new edition of CCrISP is due to be released in September 2015. 8.0 Contact Us Please contact the Regional Education team if you have any questions or would like to discuss how we can work together to deliver CCrISP in your area. E: education@rcseng.ac.uk T: 020 7869 6300 www.rcseng.ac.uk/courses All information is correct as at September 2014, but may be subject to change. Royal College of Surgeons of England 2014. All rights reserved. 9 P a g e

Appendix: Course Equipment Requirements The Centre must be able to provide the following equipment. Simulated Patient Scenario Stations (days 1 and 3): Equipment need not be sterile and can be re-used on successive courses. Remove all sharps. Equipment is listed for the following Skills Rotation Stations (days 1 and 2): Airways station (day 1 skills rotation) Tracheostomy station (day 1 skills rotation) Stomas (day 1 skills rotation) Communication and Organisational Skills in Surgical Care (day 2 skills rotation) Workshop: Nutrition Scenarios Groups (day 2 skills rotation) Equipment Requirements for CCrISP: * on list indicates kit needed for both airways and patient stations # on list indicates kit also needed for both tracheostomy and patient stations ^ on list indicates instruments and kit for the demo station as well For all simulated patient scenarios (day 1 and day 3) Patient scenario stations Per station Total for course Bed with sheets and pillows 1 4 Drip-stand 1 4 Table 1 4 Chairs 4 16 Actor for playing patient 1 4 For each patient scenario station On the table Total for course X-ray box 1 4 Laryngoscope with batteries 1 5 * Miller laryngoscope blades large & small 1 of each 5 of each* Mackintosh laryngoscope blades large & small 1 of each 5 of each* Psygmanomometer / blood pressure cuff 1 4 Ambu- bag/ bag valve mask 1 5* ECG monitor or simulated monitor 1 4 Oxygen masks: - Reservoir mask 1 5* - Ward type variable concentration mask 1 5* - Nasal O2 tubing 1 5* Suction tubing with yankuer tip 1 5* Oral Guedel airways- two adult sizes 1 of each 10* Endo-trachial tubes 2 sizes 1 of each 10* Nasopharyngeal airway 2 sizes 1 of each 10* Tracheostomy tube size 8 1 5# Stethoscope 1 4 Chest drain 1 4 Royal College of Surgeons of England 2014. All rights reserved. 10 P a g e

On the table Chest drain tubing and bottle 1 4 Pulse oxymeter 1 4 Nasogastric / Ryles tube 1 4 10ml and 20 ml syringes 1 of each 12*# Arterial blood gas syringe (Pulsator) 1 4 Blood sample tubes 3 12 IV cannulae 1 4 Total for course 16G (grey) venflons (sharps removed) 1 + spares at least 4 20G (pink) venflons (sharps removed) 1 + spares at least 4 IV giving sets 2 8 Fluid bags 500ml - can be saline, but labelled as: - Saline 1 4 - Dextrose 1 4 - Colloid solution 1 4 Micropore tape - 50mm, 25mm, and 12mm rolls plus spares 1 of each 4 of each Epidural catheter 1 4 Opaque stoma bag 1 5^ Foley urinary catheter 1 4 Bedside Urine bag with meter 1 4 Simple patient make-up and wash-kit: - Wash bag 1 4 - Blue make-up for pallor (cyanosys) 1 4 - ear buds for applying makeup 1 box 4 box - 33%glycerol mixture for perspiration 1 4 - Shower gel 1 4 - Baby wipes 1 pack 4 packs - Patient hospital gown (optional) 1 4 PPE Plastic aprons Examination gloves (small, medium & large) 2 packs 2 box of each Central table for patient scenarios On the table Total for course Blood bags (saline bag with 10ml food colouring or ink to simulate blood) Fake urine (cold weak tea in a container) 1 4 2 litres Adhesive Mepore dressings (9 x 20 cm) 1 + spares 1 box Central venous catheter set 1 Paper for patient information/ notes Desktop telephones 1 4 Multi-lumen IV catheter 1 + extras at least 4 You may find it useful to keep a stopwatch and bell handy for timing and announcing rotations. Royal College of Surgeons of England 2014. All rights reserved. 11 P a g e

Airways station (day 1 skills rotation) * on list indicates kit needed for both airways and patient stations Skills station Per station Total for course Table 1 Chairs 4 Laerdal Airway Management trainer (or similar airways trainer) 1 Ambu- bag / bag valve mask 1 5* Oxygen masks: - Reservoir mask 1 5* - Ward type variable concentration mask 1 5* - Nasal O2 tubing 1 5* Oral Guedel airways- two adult sizes 1 of each 10* Nasopharyngeal airway 2 sizes 1 of each 10* Suction tubing with yankuer tip 1 5* 10ml an 20 ml syringes 1 of each 12* Endo-trachial tubes 2 sizes 1 of each 10* Laryngeal mask airway (LMA) 2 sizes 1 of each 2 Tracheostomy station (day 1 skills rotation) # on list indicates kit needed for both tracheostomy and patient stations Skills station Per station Total for course Table 1 Chairs 4 Tracheostomy tubes: - Portex cuffed 1 1 - Portex uncuffed 1 1 - Fenestrated Shirley 1 1 - Minitrach 1 1 - Tracheostomy tube size 8 1 5# - Trachy mask ; administration of oxygen 1 1 Stomas (day 1 skills rotation) Skills station Per station Total for course Laptop 1 at least 4 Selection of stoma appliances / bags (optional): - Opaque 1 1 - Flushable 1 1 - Flanged 1 1 - Tube of stoma adhesive paste 1 1 Royal College of Surgeons of England 2014. All rights reserved. 12 P a g e

Communication & Organisational Skills in Surgical Care (day 2 skills rotation) Skills station Per station Total for course Patient couch with sheets and a pillow 1 1 Actor for playing patient 1 1 Nutrition and nutritional interventions (day 2 lecture & workshop), 2 stations No equipment required as it can be run from a laptop. However it is useful to have two boxes with examples of patient nutrition and feeding tubes. Workshop (optional) Per station Total for course Ryles tube 1 2 PEG tube 1 2 Trans-nasal feeding tube 1 2 Small range of nutritional products for example: - Complan sachets 2 1 box - Forticreme pots 2 4 - Fortisip bottles 2 4 All other skills rotations can be run from course DVD using laptops Wounds (day 1 rotation) Shock (day 2 rotation) Perioperative cardiac disorders (day 2 rotation) Renal (day 2 rotation) Sepsis (day 2 rotation) Invasive cardiovascular monitoring (day 2 rotation) Chest radiology (day 2 rotation) Royal College of Surgeons of England 2014. All rights reserved. 13 P a g e