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					                               UH
            Faculty of Health and Human
                      Sciences
    School of Paramedic Sciences, Physiotherapy &
                    Radiography

                         Certificate in Professional Studies
                           (Emergency Care Practitioner)


                               PRACTICE PORTFOLIO

  Module 4: Therapeutic Interventions in Primary Care
                      3AHP0020

     To be completed by the STUDENT and the PRACTICE ASSESSOR
 Student Name:                   Submission Date:
 Cohort:                         Module Leader:
 Link Lecturer:                  Practice Assessor:
 Contact Details:                Contact Details:




 Personal Tutor:                         Placement Name:



 Academic Level                          3
            nd
Revised 2        August 2005
            University of Hertfordshire – Module 4 ECP Practice Portfolio (Level 3)
MODULE 4 OVERVIEW
This Level 3 Module will develop your ability to apply your analysis on clinical
pharmacology to prescribe and administer medicines from an agreed list, such
as a Patient Group Direction (PGD). It will also assist you to evaluate non-
pharmacological treatment options thus providing an appropriate level of care
in a health care setting. This module is not recognised by the Nursing &
Midwifery Council (NMC) and therefore does NOT give nurses ‘prescriber’
status.


Therefore the aims of this Module are to:


    •   Use evidence based guidelines to safely, legally and ethically to prescribe
        and administer an agreed list of medicines




LEARNING OUTCOMES
The Module learning outcomes are defined under the following areas:


Knowledge & understanding
   •    Understand the principles of pharmacodynamics and pharmacokinetics as applied
        to clinical interventions
   •    Evaluate the effect the individual differences on physiology and drug responses
   •    Evaluate adverse drug and interactions and implement the reporting procedures
        associated with these
   •    Appraise the impact of co-morbidities on prescribing and patient management
        choices
   •    Explore the legal and ethical basis of prescribing, supplying and administering
        medicines
   •    Examine the clinical, psychological and cultural factors influencing prescribing
        decisions



Skills & Attributes
   •    Apply their analysis of clinical pharmacology to safely, legally and ethically
        prescribe and administer medicines from an agreed list
   •    Evaluate pharmacological and non-pharmacological treatment options, choosing the
        most appropriate for the patient
   •    Accurately document and communicate prescribing decisions using appropriate
        terminology, format and technology




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               University of Hertfordshire – Module 4 ECP Practice Portfolio (Level 3)


    CORE COMPETENCIES

    The following 11 primary competencies are the basic requirement for all ECPs.


    1. Demonstrate an understanding of the four key assessment skills of inspection,
        palpation, percussion and auscultation, and recognise the importance of history
        taking as a key component in any patient assessment situation
    2. Demonstrate knowledge of the relevant applied anatomy and physiology pertaining
        to the body systems covered within the course, including variations across the
        lifespan
    3. Develop and apply history taking skills, and the four key assessment skills in order
        to undertake a comprehensive patient assessment, or the assessment of a
        particular body system
    4. Identify and articulate ‘normal’ and ‘deviation from normal’ in the physical
        assessment of patients, including variation in normality across the lifespan
    5. Demonstrate sensitivity to patients, professional colleagues and peers in
        undertaking physical examination, and maintain respect for privacy, dignity and
        confidentiality at all times
    6. Demonstrate accurate and effective documentation of findings from the history
        taking and physical assessment process in such a way that this can be understood by
        all members of the multi-disciplinary team
    7. Understand the legal, professional and ethical issues pertaining to emergency care
        and to Emergency Care Practitioners (ECPs)
    8. Understand the expanding scope of ECP practice in the arena of physical
        assessment, and the impact of these new roles to professional practice
    9. Reflect upon the contribution which the acquisition of these new skills will make to
        their holistic care delivery, and recognise the importance of carrying out these
        skills in the context of evidence-based practice
    10. Develop skills and confidence in being able to challenge the rationales behind
        current emergency practice and explore alternatives using the best available
        evidence
    11. Develop an understanding of the processes required to change practice

In addition to these learning outcomes, students are required to have gained confidence
and competence with regard to the learning outcomes in the following courses:

•   Advanced Life Support (ALS)
•   Paediatric Advanced Life Support (PALS)
•   Pre-Hospital Trauma Life Support (PHTLS)/Pre-Hospital Emergency care (PHEC) or
    Pre-Hospital Trauma Course (PHTC)




                                                                                         -3-
           University of Hertfordshire – Module 4 ECP Practice Portfolio (Level 3)
ASSESSMENT
This Module is assessed using the following criteria:


 30% Laboratory Report
 40% Practice Portfolio
 30% Unseen written examination



LABORATORY     REPORT
You are required to complete a Laboratory Report as part of the Module
assessment. The Report will take the form of an essay, which is 2,000 words in
length (+/- 10%), whereby you select a medication of your choice from the
supplied Patient Group Directions* (PGDs). During your clinical placement,
select a patient who has been prescribed, or you feel would have been
prescribed, this particular medication if you had been managing the patient
autonomously as a qualified ECP. The essay should include:

   •   A brief description of the patient using the accepted approach e.g. PC,
       HPC, PMH etc
   •   Your clinical examination and findings
   •   Your provisional and differential diagnosis
   •   You suggested management plan, including the medication of your choice
       with formulation, dosage, frequency, duration and quantity supplied
   •   The rationale for your selection, including reference to potential
       adverse reactions, indications and, contraindications
   •   Your suggested clinical pathway and any advice given



PRACTICE PORTFOLIO/SKILLS SCHEDULE
A detailed Skills Schedule is also provided in order for you to document
specific skills that you achieve on the placement. Please fill this in to provide
yourself and us with a record of your clinical activities.


UNSEEN WRITTEN         EXAMINATION
This will be undertaken in the final assessment week.


(*Bedfordshire & Hertfordshire Ambulance & Paramedic Service NHS Trust [BHAPS]
Proposed Patient Group Directions for ECPs, July 2005)




                                                                                     -4-
             University of Hertfordshire – Module 4 ECP Practice Portfolio (Level 3)
GRADING SCHEDULE
You are expected to achieve a grade of Acceptable or above in all the practice
learning outcomes.

Outstanding                     O         An exceptional level of ability; constantly shows
                                          highly developed knowledge, skills and attitudes.
                                          Demonstrates a focused approach to care.
Very Good                       VG        A consistently high level of ability; applies a
                                          developed understanding of skills and knowledge
                                          to practice.
Good                             G        Overall a good level of ability; demonstrates an
                                          understanding on appropriate concepts and
                                          principles and normally applies them in practice.
Acceptable                       A        Overall, an acceptable safe standard has been
                                          achieved. Demonstrates acceptable knowledge
                                          and application to practice.
Fail                       Refer/Fail     Performance has been below the appropriate
                                          standard for Level 3. There appear to be
                                          serious gaps in knowledge and/or competence.




                                                                                       -5-
         University of Hertfordshire – Module 4 ECP Practice Portfolio (Level 3)
YOUR PRACTICE PORTFOLIO

  1. As a student you will be required to:

     a) Complete all relevant sections of this document in black ink
     b) Complete the Preliminary Interview with their Practice Assessor
     c) Discuss and plan how to achieve the practice learning outcomes and
        agree an action plan with your Practice Assessor
     d) Achieve a grade of ‘acceptable’ or above in all the learning outcomes
     e) Ensure all the relevant details are completed and signed prior to
        submitting the Practice Portfolio at the designated time (this
        includes the Placement Attendance Record)
     f) Keep a copy of the Learning Outcomes and Attendance Record for
        your Professional Portfolio

  2. The Practice Assessor will be required to:

     a) Interview the student at the required times, review the practice
        learning outcomes and discuss the placement learning opportunities
        with the student in order to achieve the outcomes
     b) Assess and grade the student’s achievement of the learning
        outcomes
     c) Discuss the student’s progress and identify his/her learning needs
     d) Assess the student’s practice competence using the Grading
        Schedule and sign when the student has achieved the learning
        outcomes
     e) Sign the Practice Portfolio prior to the student leaving the
        placement
     f) Contact the Course Team promptly if you have any concerns
        regarding the students’ progress

  3. The course team will be required to:

     a) Give guidance to the students on completing each aspect of the
        Portfolio
     b) Ensure the Practice Assessors and Link Lecturer are familiar with
        the documentation
     c) Review/assess the content of the Portfolio and award a grade
     d) Discuss the Portfolio, where appropriate with the student and Link
        Lecturer
     e) Forward completed and graded Portfolio to the Course Coordinator
        via the submission box



                                                                                   -6-
         University of Hertfordshire – Module 4 ECP Practice Portfolio (Level 3)
PRELIMINARY INTERVIEW (complete within first 2 days in practice)
                                                       Please tick when completed
Orientation programme completed – to include
the following;
• Familiarisation with practice area
• Knowledge of team structure and function
• Fire Procedure
• Emergencies Procedure
• Incidents & Accidents
       o Policies & Protocols for:
       o Storage if valuables
       o Safety of self & others
       o Other relevant local policies
• Procedures for student sickness/absence
Discussion of student developmental needs
Discussion of placement learning opportunities to
enable achievement of practice learning outcomes
Discussion of skills to be achieved during the
placement as identified in the Skills Schedule
Agreed Action Plan (include how you intend to achieve your learning outcomes)




Signatures to agree Action Plan



Practice Assessor:                             Date:



Student:                                       Date:
Contact with Link Lecturer:




                                                                                    -7-
                                                University of Hertfordshire – Module 4 ECP Practice Portfolio

                                                              SPECIFIC COMPETENCIES

Therapeutic Interventions                                                                  Date                 Grade    Student       Practice
                                                                                         achieved                       Signature     Assessors
                                                                                                                                      Signature
General
Demonstrate an understanding of evidence-based medicine relating to
therapeutic interventions
Demonstrate     a    basic    understanding   of   the     pharmacology      and
pharmacodynamics of drugs commonly used in emergency/unscheduled care
Demonstrate knowledge of commonly used and misused drugs/substances, and
their physical manifestations
Demonstrate the ability to objectively assess the patient in pain across all age
ranges using assessment tools and administer analgesia using pharmacological
and non-pharmacological methods
Describe the principles of safe prescribing and mechanisms for reporting
adverse drug reactions

Specific Conditions
Demonstrate a broad based understanding of drugs commonly used in the
routine management of medical conditions, and the ability to refer to
appropriate information sources for further information (see Skills Schedule)
Describe and explain the indications for thrombolysis in both hospital and out-
of-hospital settings, the various agents involved and the associated risks
Interpret 12 lead ECGs and react in a timely manner in relation to findings
Demonstrate an understanding of the effects of common disease processes
such as renal failure, and the dynamics of age have on drug effectiveness and
the necessary precautions to avoid patient harm




                                                                                                                                -8-
                                               University of Hertfordshire – Module 3 ECP Practice Portfolio



Learning Outcomes
                                                                                          Date                 Grade    Student     Practice
                                                                                        achieved                       Signature   Assessors
                                                                                                                                   Signature
Law & Ethics
Demonstrate an understanding of the principles and practice underpinning the
use of Patient Group Directions (PGDs) including their legal status
Demonstrate a clear understanding of the legal and prescribing rules associated
with the prescribing, administration and supply of medicines
Understand and explain what is meant by the terms consent, capacity,
confidentiality and disclosure, and their application in emergency/unscheduled
care settings to patients across the lifespan
Demonstrate understanding of the correct handling and stewardship of
confidential patient information, and familiarity with the Data Protection Act
and the role of the Caldicott guardian

Arriving safely
Demonstrate familiarity with current ambulance service best practice
regarding driving (e.g. Institute of Health Care Development (IHCD))
Demonstrate awareness of guidance on parking upon arrival at incident scenes
Demonstrate understanding of the principles of scene safety and scene
protection
Describe and explain HAZCHEM codes and the importance of the UN number




                                                                                                                                   -9-
                                                 University of Hertfordshire – Module 3 ECP Practice Portfolio



                                         SKILLS SCHEDULE* – THERAPEUTIC INTERVENTIONS IN PRIMARY CARE

  Area of Examination                                  Normal                Normal               Abnormal 1              Abnormal 2   Paediatric 1



    Gastrointestinal
                                      Problem

e.g. IBS, Chron’s Disease,
                                          Date
       constipation
                                        Grade
                                     Assessor



  Area of Examination                                  Normal                Normal               Abnormal 1              Abnormal 2   Paediatric 1



       Respiratory
                                      Problem

   e.g. COPD, chronic
                                          Date
   bronchitis, asthma
                                        Grade
                                     Assessor


  * This Skills Schedule is NOT exhaustive just suggestive – please feel free to amend/add as your clinical practice allows




                                                                                                                                           - 10 -
                                          University of Hertfordshire – Module 3 ECP Practice Portfolio



  Area of Examination                           Normal                Normal               Abnormal 1     Abnormal 2   Paediatric 1



         Cardiac
                               Problem

e.g. Post MI, heart failure,
                                  Date
           angina
                                 Grade

                               Assessor




  Area of Examination                           Normal                Normal               Abnormal 1     Abnormal 2   Paediatric 1



         Diabetes              Problem

      e.g. Type 1 & 2             Date
                                 Grade

                               Assessor




                                                                                                                           - 11 -
                                  University of Hertfordshire – Module 3 ECP Practice Portfolio

 Area of Examination                      Normal                Normal               Abnormal 1   Abnormal 2    Paediatric 1



    Gynaecological         Problem
                                                                                                                May not be
 e.g. PID, endometriosis      Date                                                                              appropriate
                             Grade

                           Assessor




Area of Examination                      Normal               Normal               Abnormal 1     Abnormal 2   Paediatric 1



   Mental Health            Problem
    e.g. depression,
                                                                                                               May not be
schizophrenia, anxiety         Date
                                                                                                               appropriate
       disorders
                              Grade
                           Assessor




                                                                                                                   - 12 -
                                            University of Hertfordshire – Module 3 ECP Practice Portfolio

   Area of Examination                            Normal                Normal               Abnormal 1     Abnormal 2   Paediatric




        Neurological             Problem
e.g. Parkinson’s & Alzheimer’s
                                    Date                                                                                 May not be
           disease
                                                                                                                         appropriate
                                   Grade

                                 Assessor



   Area of Examination                            Normal                Normal               Abnormal 1     Abnormal 2   Paediatric




           Other                 Problem

                                    Date
                                   Grade

                                 Assessor




                                                                                                                            - 13 -
               University of Hertfordshire – Module 4 ECP Practice Portfolio

PRACTICE ASSESSOR SIGNATORIES

Your identified Practice Assessor or a suitably qualified and competent
health care practitioner can assess and sign your competencies and/or
Skills Schedule. The following table allows for you and us to be able to
identify these individuals. Please ask them to fill in their details.

Name (print)         Position               Employing              Sample Signature
                                            Trust




                                                                               - 14 -
              University of Hertfordshire – Module 4 ECP Practice Portfolio (Level 3)

PLACEMENT EVALUATION

As part of our continuous monitoring of the quality of practice experience we would
appreciate your feedback on the following:

Placement:…………………..……………………….                 Clinical Area: ………………………………………….……….

Name of Service/Trust: ………….…………         Dates of Experience: …………………………………...
                                                                   Yes    No
      1. Placement preparation was appropriate and informative.


      2. The placement was aware of my allocation to the area.


      3. I had a named Practice Assessor throughout the placement.


      4. My orientation and interviews were conducted appropriately


      5. The amount of supervision was appropriate for the course


      6. I was given support to complete the learning outcomes


      7. I had the opportunity to develop my communication skills


      8. I knew who my Link Lecturer was, and knew how to contact
        them when required


If you have answered ‘No’ to any question please give further details:
…………………………………………………………………………………………………..………………………………………….……..

..…………………………………………..……………………………………………………..…………………………………………..……

Please make two positive comments about the experience:
1.     …………………………………………………………………………………………………………………………………………………………

2.
     ……………..……………………………………………………………………………………………………………………………………………....

(To be completed and submitted with your Attendance Record)




                                                                                        - 15 -
                 University of Hertfordshire – Module 4 ECP Practice Portfolio (Level 3)

ATTENDANCE RECORD

Module: Therapeutic Interventions                       Module Leader:…………………………………………..

Practice Assessor:………………………………………………………………………………………..…………….……………..

Name of Placement: ……………..………..……….………..                                Dates: …………………………..…………

Student's Name: …………………………………….…………                                     Cohort:………………………….…………..
(Please print)
                                                                           (Signatures to agree hours)
Date       Start           Finish Time     Total Hours            Practice       Student
           Time                            (Excl. breaks)         Assessor




Total number of days:             Days Signature of Practice Assessor

           In placement
                   Sick
                 Absent



  All sickness/absence must be reported to the Link Lecturer/Module Leader
       .



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