paediatric intensive care foundation course...picu education team 23/12/15 v 1.1.5 (updated 15/7/16)...
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1 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
PAEDIATRIC INTENSIVE CARE FOUNDATION COURSE
PORTFOLIO OF LEARNING
Name:..…………………………………… Cohort:…………………………………... Mentor: …………………………………. …………………………………. Support Group:………………………… Kingdom:………………………………..
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Overview of your learning portfolio:
Welcome to our PICU Team. You are joining our PICU Foundation programme, we hope you will enjoy it and it be the basis of your PICU career. All the resources for this programme, including timetable changes can be found at www.bch.moodle.org. This is a brief overview of assessment tools that are used throughout the programme to help you, your mentor and the clinical skills facilitators to identify any outstanding training needs. The tools will also be reviewed by the PICU Education Team during your interviews to assess your progress. Support and Feedback will be given throughout and following the course via: Personal Development Interviews: You will have interviews during weeks 1, 4, 6, 8, 26 (6 months) and 36 (9 months) of the course. These will enable the Education Team to monitor your progress and to allow for additional support/learning on an individual need basis. You should also arrange to meet with your support group leader during the course for additional feedback. At 6 months if you are achieving your targets you will be permitted to work bank shifts. At 9 months you should arrange an appraisal with your support group leader. Once your appraisal is completed confirming your yearly targets are met and you have successfully completed the programme you will go through your Foundation gateway and receive your increment at one year. Using your completed competencies towards the appraisal process: Once you have completed the course you will have yearly reviews with your support group leader as part of the appraisal process. While the competences and learning outcomes of the foundation course outline the specific skills and knowledge required to work on the paediatric intensive care unit (PICU), the NHS appraisal is a broad and generic focusing on the application of your knowledge and skills. If you successfully complete the Foundation course you should meet all of the dimensions in the Band 5 staff nurse job outline. Further information about the appraisal process and what is expected from you can be obtained from your support group leader and the PICU Education team. For nurses joining PICU with previous experience you should keep your same appraisal date to ensure you get your increments. Please liaise with the PICU education team regarding who can do this for you.
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Learning Outcomes
At the end of the course participants should be able to:
1. To be safe and competent in caring for a critically ill child.
2. Demonstrate knowledge of normal paediatric anatomy and physiology.
3. Be able to recognise abnormal physiology and link to clinical practice.
4. Demonstrate a sustained contribution to team work.
5. Demonstrate effective communication with the child and family on PICU.
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Methods of Assessment
The course is summatively assessed via:
Multiple Choice Exam
Total Patient Assessment (clinical assessment) To assist your development and support you with the summative assessment, the following formative assessments are included within the course:
Skills Passport
Trust Requirements
Topic Teaching Tasks
Clinical Support Shifts Multiple Choice Exam: Questions devised directly from Topic Teaching Tasks. Therefore the Information Sheets which you have produced in the Topic Teaching Tasks and have been provided with by your peers should become your revision tools and resources for the exam.
You will be allowed 1 hour to complete the exam carried out in exam conditions.
There will be 50 questions with a choice of answers.
Questions may state that there are one or more correct answers.
You will have a question paper and an answer sheet.
Pass mark is 35/50. On passing the exam your mark will be calculated into a percentage out of 100% (pass mark as a percentage = 70%). You will be able to see your marked answer paper with correct answers indicated so you may review the question paper to increase your understanding and ask for clarification if needed from the education team. P. 30 Total Patient Assessment: To be undertaken at week 9-10. The aim of this assessment is to ensure you have gained the appropriate level of knowledge and skills to enable you to provide safe and effective care for the child and family requiring Level 2 PICU intervention. Pass/Fail P. 11 Skills Passport: The skills passport is a list of clinical skills that has been development to enable you to have a planned skill acquisition. It will also be used as a tool to enable mentors to monitor progress and individual learning needs. P. 21 Trust Requirements: There are mandatory trust clinical competencies and study requirements which require completion. A complete list of trust and PICU requirements is included to aid your completion.
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P. 73 Topic Teaching Tasks: Within Action Learning Sets (ALS, groups within cohort) you will be given topics to; research, create information sheets and teach. You will then formatively assess your peer’s contribution to team work, clarity of communication and quality of feedback. These topics will align with the Multiple Choice Exam and the formative feedback on communication and team work will inform us of your development in these areas over the course duration. P. 35 Clinical Support Shifts: Members of the PICU Education Team will work with you clinically once a month until course completion. These will help inform you of your skills development and provide written feedback on performance utilising the shift reflections sheets. Your mentors and Clinical Skills Facilitators (CSF’s) will also complete these shift reflections if asked.
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Guidelines for Sickness and Absence Reporting within PICU. Within PICU we have a strict sickness policy that all members of staff need to adhere to. Please make yourself familiar with the sickness policy but we have given an outline below. Please contact the band 7 nurse in charge on 0121 333 9653 when needing to phone in sick. It is every member of staff responsibility to contact the unit themselves to report sickness as soon as possible. Below are suggested times for contacting the unit to report sickness.
Early shift – Contact unit before 6am on day of shift
Late shift – Contact unit before 10am on day of shift
Night shift – Contact unit before 2pm on day of shift
Please give a reason for sickness and inform Nurse in charge of when you are next due on shift. For short term sickness, you must contact the unit on a daily basis to inform nurse in charge of your progress. On your first shift/study day back at work you must complete a yellow back to work form. These are located in the A/B side coffee room. Please complete the front of the form and attend the off duty clinic on that day to complete the rest of the form with the Band 7. Trigger Points. A stage one sickness review will be commenced if you have either of the following as sickness:
3 separate episodes in a continuous 6 month period
10 days in a continuous 12 month period.
Patterns of sickness will also be noted.
You are not able to do any bank shifts within the trust for 2 weeks following any single period of sickness and are unable to do bank for 3 months while on a stage 1 review. If you are absent for over 7 days you require a medical certificate from your GP. The certificate must be posted into the unit as soon as it has been issued and not kept until your return to work. Please address it to Yvonne Heward or Joanna Durham while on the foundation course. Please be aware that if you are off with Diarrhoea and vomiting you must still follow sickness policy but will be required to be absent for 48 hours from last symptom. The Band 7 remind you of this when you contact the unit.
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Guidelines for signing Skills Passport for the PICU Foundation Programme
There have been recent changes to the PICU Foundation Programme. This document outlines the changes, which have been made as a result of feedback and evaluation. 1. Alteration to the supernumery structure.
Weeks 1-5: One to One supervision with an assigned mentor.
Weeks 6-10: Two to One supervision with Clinical Skills Facilitator (CSF).
The Skills Passport reflects these changes in supervision. The skills passport list is divided into completion dates of:
Before 6 weeks (supernumery period)
Before 10 weeks (CSF period)
Before 6 months
Before 9 months.
Assessment of skills
The list of skills is for your mentors, CSF’s or any staff nurse who has already
completed the foundation course to sign when you are competent.
This should allow you to prompt your mentors for learning opportunities if there
are skills that you have not yet experienced or feel competent in.
During your first 6 months of employment with the trust all new staff
members will undertake a probationary period. During this time we want to
ensure that you feel supported, listened to and developed at BCH. The
probationary period is a supportive process with a structured approach that
enable us to do this. It also ensures that you are clear about your role, what is
expected of you and your responsibilities. During the probationary period you
will be required to complete four weekly progress meetings. We will utilise
bedside shift reflections from your mentors along with 3 monthly reviews with
the education team. It is important that you complete the following review
points in order to comply with your contract. Your 6 and 10 week interviews
with your mentors and CSF’s will allow you to set and review learning
objectives as part of the review dates.
There are also shift reflections within this portfolio of learning so that you can
receive feedback on your performance each shift. It is an essential
requirement to complete the shift feedback after every supported shift. Both
the interviews and shift reflections will act as an aid to improve your learning
and development within PICU, by identifying together, areas for further
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learning. Please present the interviews and shift reflections to mentors and
CSF’s to ensure they are completed.
Probationary Responsibilities.
KEY RESULT AREAS (breakdown further if necessary) to be achieved in the first 6 months
Performance of duties: Complete 10 week supernumery period and enter nursing numbers within the allocated timeframe. Successfully Pass Total Patient Assessment during allocated shift. Ensure all policies are adhered to and work within your own clinical capabilites. Complete all set moodle and clinical competancies in set timeframe.
Attitude/Behaviour: Please remember you are a representative of BCH and ensure professional behaviours and attitudes are maintained at all times. Ensure a positive attitude to learning is maintained throughout the Foundation programme.
Integration into ward/department: To work effectively within your Dizney team by ensureing you promote good teamworking attributes and skills.
Relationships with co-workers and manager: maintain good communication with mentors, CSF’s, Education team and Band 7 regarding progress, worries and anxieties.
Values/Standards: Ensure trust standards and values are maintained and promoted at all times. Demonstrate PICU values during all shifts
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Students Interview / Learning Contract Mentor phase (week 1)
Initial interview: This interview is designed to focus both foundation member and mentor on the important learning objectives within the 1:1 supernumerary clinical environment. The PICU Education Team has the common learning outcome (below) as a requirement for everyone however there is space for you to add your own personalised ones as well after you have had a discussion with your mentor. Agreed Learning outcomes:
To achieve the skills in the section within the skills passport entitled, “complete before 6
weeks” (supernumerary period).
Complete BCH clinical competency – Administration of Medicines
Complete BCH clinical competency – Arterial/Central blood sampling
Complete Medical Gas Training on trust moodle. Date completed………………..
Complete Waste Management training on trust moodle. Date completed……………..
Complete PEWS training on trust moodle. Date completed……………….
Complete PEWS Neuro training on trust moodle. Date completed………………
Complete PEWS Recognition of the sick child on trust moodle. Date completed……,…
Mentor Comments:
Foundation Member Comments: Foundation Member: Mentor: Print name…………………………….. Print name…………………………….. Sign…………………………………..… Sign…………………………………….. Date…………………………………….. Date…………………………………..… Foundation Member: Print name………………………………………. Sign……………………………. Date………………
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Students Interview / Performance Review Month 1 Mentor phase (week 4)
Week 4, Progress interview: The purpose is to review the progress of the foundation member so far and to recognise skills achieved, but more importantly those outstanding. Outstanding skills should then become a priority to learn in the final 1:1 mentor week, this list can be reviewed by the CSF’s so they can develop these skills further once they also start mentoring them. If you have concerns that there may be insufficient time to achieve these skills in the set time, please email the PICU Education Team ([email protected]) Agreed Learning outcomes:
Outstanding Skills from section entitled, “complete before 6 weeks” in skills passport. Mentor Comments: Is the Foundation member meeting everything set in probationary responsibilities? Yes No Please make any comments needed. Foundation Member Comments: Foundation Member: Mentor: Print name…………………………….. Print name…………………………….. Sign…………………………………..… Sign…………………………………….. Date…………………………………….. Date…………………………………..…
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Interview / Learning Contract CSF phase (week 6)
Week 6, Initial Interview with CSF: The purpose of this interview is to review the progress and to review the skills passport achievements in the “complete before 6 weeks". Outstanding skills should become a priority in the CSF time. There are common learning outcome below, there is space for you to add your own personalised outcomes as well with discussion with your mentor. Agreed Learning outcomes:
To achieve any remaining skills in section within skills passport entitled, “complete before 6 weeks” in skills passport.
To achieve the skills in the section within the skills passport entitled, “Complete before 10 weeks” (CSF period).
Complete CAF training, link from our moodle page – Date completed……………….
Complete Health records training on trust moodle – Date completed……………….
Complete Child Protection Level 3 on trust moodle – Date completed……………….
Complete BCH clinical competency – Blood glucose
Complete BCH clinical competency – Capillary sampling
Complete BCH clinical competency – Transfusion sampling
Complete BCH - IV Moodle package – Date Completed………. Mentor Comments: Foundation Member Comments: Foundation Member: Mentor: Print name…………………………….. Print name…………………………….. Sign…………………………………..… Sign…………………………………….. Date…………………………………….. Date…………………………………..…
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Interview / Performance Review Month 2. CSF phase (week 8)
Week 8, Progress so far interview: The purpose is to review progress of the skills achieved but more importantly those outstanding. Outstanding skills should be a priority to learn in the final CSF week. If you have concerns that there may be insufficient time to achieve these skills in remaining CSF time, please email the PICU Education Team ([email protected]) Outstanding Skills from section entitled, “complete before 10 weeks” in skills passport:
Outstanding Skills from section entitled, “complete before 10 weeks” in skills passport.
Complete Manual handling booklet by: Date …………………………………….. Date for completion: Mentor Comments: Is the Foundation member meeting everything set in probationary responsibilities? Yes No Please make any comments needed. Foundation Member Comments: Foundation Member: Mentor: Print name…………………………….. Print name…………………………….. Sign…………………………………..… Sign…………………………………….. Date…………………………………….. Date…………………………………..…
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Performance Review meetings.
Perfomance Review Month 3 Date……………………
Preceptors Comments. Is foundation member achieving all probationary responsibilities? Yes No
Preceptees comments
Preceptors Signature……………………. Preceptee Signature………………..….
Perfomance Review Month 4 Date……………………
Preceptors Comments. Is foundation member achieving all probationary responsibilities? Yes No
Preceptees comments
Preceptors Signature……………………. Preceptee Signature………………..….
Perfomance Review Month 5 Date……………………
Preceptors Comments. Is foundation member achieving all probationary responsibilities? Yes No
Preceptees comments
Preceptors Signature……………………. Preceptee Signature………………..….
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Perfomance Review Month 6 Date……………………
Preceptors Comments. Is foundation member achieving all probationary responsibilities? Yes No
Preceptees comments
Preceptors Signature……………………. Preceptee Signature………………..….
Perfomance Review Month 9 Date……………………
Preceptors Comments. Is foundation member achieving all probationary responsibilities? Yes No
Preceptees comments
Preceptors Signature……………………. Preceptee Signature………………..….
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Skills Passport
Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Handover Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Notes made appropriately
Infusions cross checked and calculated
Further information asked for appropriately
IV lines secure
Effectively communicates during handover
Logical progression through handover (using the handover sheet)
Documentation
Nursing assessment form completed appropriately
Child and Family profile/ activity of daily living
Observations charted appropriately
Line and circuit changes form
Urine catheter form
Manual Handling form
Tissue Viability
Pain Standard
TISS from completed
All significant event’s / changes in condition & communication with families documented appropriately
Aware of Nursing Care Quality Indicators (NCQI’s) and able to list them
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Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Essential Patient Care Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Staff hand washing
Mouth care
Cleaning teeth
Eye care
Skin care & assessment
Catheter care
Use of hoist
Use of sliding sheets
Use of pat slide
Patient positioning
Prone positioning
ASEPTIC Non Touch Technique
Using the monitors & mini-me
Admitting and Discharging patient from monitor
Infection Control
Safe disposal of sharps & awareness of what to do following a needle stick injury
Identify the different colour codes used in relation to infection control
Isolation procedures – source/protective
Identify the personal protective equipment used
Respiratory
Able to assess airway
Able to assess breathing
Auscultation of chest
Can identify signs of respiratory distress
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Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Respiratory continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
PEWS
Completed pews online training, including:
Recognition of a sick child
O2 Therapy
Neurological assessment
Demonstrate correct use & ability to interpret PEWS chart
Knowledge of observation and monitoring policy
Resuscitation Trolley
Check resuscitation trolley
Assess and open airway
Size and insert OP/NP airway
Practice use of re-breath circuit
Effective use of ‘Rebreath’ circuit
Effective use of face mask and self inflating bag
Suction
Oropharangeal (OP)
Nasopharangeal (NP)
Nasopharangeal airway (NPA)/short tube (ST)
Endotraceheal tube (ETT)
Tracheostomy
Set up O2
Face mask emergency
Humid facemask / Trachy mask
Nasal specs
Head Box
Optiflow
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Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Respiratory continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Assisting with intubation
Awareness of drugs used
Equipment used
Servo I ventilation checks
Ventilator settings/alarm limits for children’s age
Set appropriate temperature for humidifier
Emptying water from tubing and traps
Knowledge and use of VAP Care bundle
High frequency oscillation
Ventilator settings/alarm limits for children’s age
Set appropriate temperature for humidifier
Emptying water from tubing and traps
Nebulizers
Face mask / Trachy mask
Bagging
Via Servoi
Cleaning and storage of pots
X-ray
Recognise endotracheal tube position on x-ray
Pulse Oximetry
Probe selection and placement
Setting alarm limit
Probe placement for pre and post ductal saturation monitoring
Blood gases
Identify normal values
Interpretation
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Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Cardiovascular Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Able to assess circulation
Correct placement of ECG / respiratory leads
Identify Sinus Rhythm
Feeling Pulses
Capillary Refill time
Identify ectopic beats
NIBP
Perform blood pressure measurement
Select correct cuff size
Select and review time intervals
Setting alarm limits
Invasive Monitoring
Zeroing transducers
Setting up flush system and transducer set
Troubleshooting
Change scales, labels & alarm limits
Temperature Monitoring - Select, apply and safely use appropriate heating/cooling
device
Axilla (Neonatal)
Rectal
Skin / Toe
Sure Temp
Chest Drains
Preparation/Setting up for insertion of a drain /setting up bottle
Assist with insertion of chest drain
Changing bottle
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Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Chest drains continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Use of clamps
Connecting suction
Observation of chest drain-bubbling, swinging, draining
Difference between mediastinal and pleural drains
Removal of chest drain
Defibrillator
Be able to switch on
Awareness of joules required
Ensure safety for staff and patients
Able to connect defib to monitor using interface cables
Able to change cables for internal or paddle cable
Demonstrates how to take off the test well, store it in the draw and connect pads
Pacing Box
Safely change the battery
Check the mode of pacing
Be able to locate spare batteries
Be able to locate the pacing box
Able to check the leads are securely attached to the box
Can identify which leads are which
Blood Sampling (MPP)
From an arterial line
From a venous line
Taking blood cultures
Administer blood products (MPP) under supervision
Setting up (rate, choosing appropriate giving set and filters
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Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Blood continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Warming blood
Checking procedure
Documentation & audit trail (sign form & return tag)
Safe disposal
Correct storage (signing in & out of fridge)
Collection & transport of blood products
Cardiovascular Continued
IV drug administration (MPP) Under supervision
of IV assessed person
Care & removal of peripheral intravenous (IV) lines
Care and removal of central venous catheters
Safe administration of bolus drugs under supervision
Use of Central line care bundle
Fluids & Nutrition
Calculate fluid requirements/output
Check fluid balance is accurate regularly
Placement of enteral feeding tube:
Awareness of when to use an oral tube
Nasogastric (NG)
Administration of enteral feeds via NG, oral, NJ & Gastrostomy
Testing ph paper
Care of gastrostomy site and
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tube
Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Feed continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Use of feed pump
Administration of medicines Trust competency documentation completed
Gastro Intestinal Care
Bowel assessment
Stoma Care
Giving suppositories and enemas
Renal
Change & Connect urine drainage bags
Able to check catheter patency
Collect urine samples for analysis
Perform, record and interpret urinalysis
Safely remove urethral catheter
Peritoneal Dialysis (PD)
Care of PD catheter site under supervision
Prepare and set up dialysis fluid bags
Safely interpret prescription
Safely change dialysate bag
Safely take PD fluid sample
Safe dismantling of system to leave PD drain
Assist with removal of PD catheter
Neurological Care
Use and interpret AVPU
Use and interpret Modified
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Paediatric Coma Scale
Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Neurology continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Assisting in insertion of bolt
Set up Camino monitor, interface with monitor
Assist with bolt removal
Be able to safely participate in log rolling
Demonstrate and interpret limb observations following spinal injury and traumatic injury
Care of EVD
I V Assessment
Safe discontinuation of infusions
Safely changing infusions
Have knowledge of safely changing inotropes and vasoactive agents
Complete Stage 1
Demonstrates knowledge of extravasation policy
Heating and cooling devices – set up and safe use:
Cooling mattress
Bear Hugger blanket
Over head radiant heater (burns)
Neonatal
Care of new mother – referral to midwife
Assist and encourage new mothers to breastfeed/express
Knowledge of breastfeeding equipment and know where its located
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Neonatal positioning
Essential Skills
Complete before 6 weeks (supernumerary period)
Complete before 10 weeks (CSF period)
Complete before 6 months Complete before 9 months
Neonates continued Assessor Sign Date Assessor Sign Date Assessor Sign Date Assessor Sign Date
Care of neonates under phototherapy lights
Temperature control
Set up & safe use of an incubator
Minimal handling
Care of a silo bag
You will attend an IV SD as part of the Foundation Course and once completed you can work towards become Stage 1 IV Assessed. Until that time you will be expected to prepare and administer drugs under direct supervision of an IV assessed nurse. It is your responsibility to inform the 2nd nurse that you are not IV assessed
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Requirements for first year on PICU to pass through your gateway
Achievements by 6 weeks:
A
chievAc Achievements by 9 weeks:
Required Study Date Completed Handed in to PICU Education (Yes)
Blood Glucose competency
Transfusion sampling competency
Newly qualified Nurse (NQN) Maths Test
Moodle mandatory training: Core Mandatory training courses
Health Safety and Clinical risk
Information Governance
Local induction
Manual Handling Awareness Role essential Mandatory training courses
Blood transfusion (needs to be completed prior to blood study day)
Child protection level 3 Role essential training courses
Healthcare records
Safe clinical Handover
Capillary Blood sampling competency
ICE training
Manual Handling Workbook (complete moodle or paper copy prior to manual handling study day and submit to Manual Handling Team 1 week prior to study day)
Required Study Date Completed Handed in to PICU Education (Yes)
Administration of Medicines competency
Arterial and Venous sampling competency
Medical Gas Training Moodle Package
Waste Management Training Moodle Package
Basic Life Support
PEWS online Trust Moodle training (Recognizing sick children, O2 Therapy and Neurological assessment) Password - PEWS
Child Protection Level 3 Moodle package (New Staff) – Complete within 2 weeks
Administering IV Therapy on Moodle before IV study day Password – IV2014
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Achievements by 20 weeks (4.5months):
Achievements by 36 weeks (9 months):
Required Study Date Completed Handed in to PICU Education (Yes)
Stage 1 IV Assessed
Manual Handling Study Day
Conflict Resolution Teaching (timetabled)
Required Study Date Completed Handed in to PICU Education (Yes)
Blood Study Day
Blood Collection competency
Stage 2 IV Assessed
6 month appraisal
Medical Devices + online medical device declaration
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Alternative Learning Experiences
During your supernumery time, you will be allocated to work a shift with a Band 7 Clinical Co-ordinator who will hopefully also be your support group leader. This will provide you with an opportunity to better understand the demands of PICU and the role of the Band 7 whilst also meeting another person responsible for your professional development.
You will also be allocated a shift with the Health Care Assistant’s to enable you to gain knowledge of where things are stored, bed space preparation and understand their role on PICU more fully.
We have provided a band 7 learning sheet below which you should complete when with them in order to guide your learning. Please use this worksheet and question the Band 7’s, as this will help you to appreciate why certain actions and decisions are made.
We will attempt for you to go to theatre for one shift to follow a cardiac surgical patient journey. This cannot be guaranteed, dependant on service demand.
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GUIDED LEARNING FOR WORKING WITH BAND 7
Working with the band 7 co-ordinator during this shift is to help you appreciate their role, and have a better understanding of management of PICU; and its part of being a Regional referral centre. 1. During the handover, try and answer the following: a) Who is present and what are their roles?
b) For what reasons are patients admitted to PICU?
2. During the 8.20am meeting, what is discussed and might this be important to communicate? 3. a) During the Dr’s Huddle in morning and afternoon, who is present? b) What is discussed?
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c) Write down any conditions that you do not understand? d) Why do you think this handover is important?
4. What other tasks does the Band 7 have to perform and why are these
important?
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Short reflection of your shift with the Band 7
Description:
Key Learning points:
Evaluation:
How will what you have learned influence your future practice?
Date Band 7 Signature
………………………. ………………………….
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GUIDED LEARNING FOR WORKING WITH HCA
Working with the Health care Assistant’s (HCA’s) during this shift is to help you
appreciate their role and have a better understanding of the roles and
responsibilities of the HCA’s and how this influences the unit on a shift by shift basis.
1. During handover from outgoing HCA to start of new shift, what is discussed?
2. During 8.20am meeting, what information is important for the HCA’s to be
aware of?
3. HCA’s set up bed spaces for elective admissions to the unit.
What equipment is set up at these bed spaces and why?
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32 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
4. Why is it important for HCA’s and team leaders/resource nurses to have good
communication throughout the shift?
5. What tasks do the HCA’s do throughout the day which improves the day to day
running of PICU?
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6. As a staff nurse, how can you help the HCA’s during busy shifts?
7. How does a HCA role differ from the other band 1-4 roles on PICU?
33 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
Short reflection of your shift with the HCA’s
Description:
Key Learning points:
Evaluation:
How will what you have learned influence your future practice?
Date: HCA Signature:
…………….. ……………..
34 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
Total Patient Assessment
The aim of this assessment is to ensure you have gained the appropriate level of knowledge and skills to enable you to provide safe and effective care for the child and family requiring Level 2 PICU intervention. This assessment should take place on a level 2 ventilated patient, which will be identified by the clinical educators prior to your shift. This assessment has been designed to meet learning outcomes 1, 2 and 4. Whilst working with a member of the education team or clinical skills facilitator to complete this assessment there may be aspects of your clinical skills list and / or competencies that may be met. You will receive verbal feedback directly after your shift.
Guidance on Assessing Total Patient Assessment
In order to complete a Total Patient Assessment (TPA) with Foundation course members, the patient allocated must meet the following criteria:
Level 2 patient
Intubated and Ventilated
Stable, at the beginning of the shift
When undertaking the TPA, the assessor will be an education team member or clinical skills facilitator.
They will work with the foundation programme member in a one to one capacity and is allowed to
assist in bedside activities such as suctioning and care provision when asked for by the foundation
course member or if an emergency situation occurs.
The assessor will observe the patient assessment and care.
If at any time during the TPA the patient deteriorates and therefore moves outside of the patient
criteria for the TPA (as above) then the assessment should stop and recommence later that shift or be
re-scheduled.
35 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
Total Patient Care Assessment (To be undertaken between weeks 9 and 14)
Patient Handover:
Wash Hands using the 6 step technique & apply an apron
Yes No
Notes made appropriately Yes No
Infusions cross checked and calculated Yes No
Further information asked for appropriately Yes No N/A
IV lines secure Yes No
Participates in the IPASS Yes No
Immediate Checks:
Summary of overall appearance / identifies any immediate concerns.
Yes No
Assess the security of the airway Yes No
Is able to correctly identify the type of airway in situ & check the size & length of the tube are documented correctly
Yes No
Emergency Equipment: - Anaesthetic bag & Oxygen - Bag valve mask (self-inflating) - Masks - Airways (Measure with the flange at the centre of the incisors, then curve around the face to reach the angle of the mandible – APLS guidelines) - Working suction at an appropriate pressure - Yanker sucker & Correctly sized catheters
Yes No
Alarm Limits appropriately set - Patient Parameters
Yes No
Check that a name band is in situ & apply if not already in place
Yes No
Check patient drug calculator Yes No
Check red bag Yes No
Respiratory: Observed bilateral chest movement Yes No
Observed chest for signs of respiratory distress Yes No
Observation of colour Yes No
Assessment of SpO2 Yes No
Chest auscultated Yes No
Ventilation Mode - ability to explain
Yes No
Set Rate Yes No N/A
Spontaneous rate / respiratory rate Yes No N/A
Tidal volumes identify and correct for child’s wt (ability to identify any leak)
Yes No
Airway pressures Yes No
Ventilator alarms checked Yes No
Fio2 Yes No
Check cuff pressure. Deflate and re-inflate Yes No N/A
Appropriate assessment of last blood gas analysis (referring to normal range reference guide) & identification of when to repeat
Yes No
36 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
Cardiovascular: Heart rate (cross check pulse with monitor for 1 min) Rhythm
Yes No Yes No
Blood Pressure Invasive- Appropriate trace Re-levelled & re-zero’d (gloves worn, new bung) Non-invasive- Appropriate intervals (minimum of 1hrly)
Yes No N/A Yes No N/A
CVP Appropriate trace Re-levelled & re-zero’d (gloves worn, new bung)
Yes No N/A
Capillary refill time assessed (centrally, press for 5 secs)
Yes No
Temperature Appropriate management of temperature if outside normal parameters
Yes No Yes No N/A
Appropriate assessment of chest drain losses (type & quantity of losses)
Yes No N/A
Neurological / Pain Assessment:
Pupil’s assessed Yes No
Spontaneous movements / Response to intervention assessed
Yes No
Identification of pain / sedation score Yes No
Appropriate management /evaluation of pain Yes No N/A
Appropriate management /evaluation of sedation Yes No
AVPU / Glasgow coma score (GCS) score as appropriate
Yes No
Fluid balance: Correct calculation of fluid allowance Yes No
Correct calculation of fluid being administered Adjustments made accordingly
Yes No Yes No N/A
Identification of oedema / can describe the signs Yes No
Assessment of urine output (mls/kg/hr) Appropriate management of reduced urine output (< 1ml/kg/hr in a baby / small child)
Yes No Yes No N/A
Maintain an accurate fluid balance Identification of signs of dehydration / oedema and / or an inappropriate balance (+’ve or –‘ve)
Yes No Yes No N/A
Nutrition:
Document the length / mark the length of the gastric tube (NG or OG)
Yes No N/A
Aspirates the gastric tube appropriately: (Before administering medication or feed & at least 4hly during continuous feeds or when nil by mouth) Assessment of pH (can describe normal range – pH1-5) If pH >5 takes appropriate action (look at the length of the tube, is it taped appropriately? Has it migrated out? Has there been a recent chest x-ray which may confirm the position?, Discuss with the team leader, Does the child require an x-ray )
Yes No Yes No
Correct calculation of feeds Yes No N/A
37 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
General Patient care:
Eye care undertaken appropriately Yes No
Mouth care undertaken appropriately (teeth brushed in older children where appropriate)
Yes No
Moving & Handling risk assessment checked / completed
Yes No
Completion of tissue viability risk assessment Yes No
Identification of any pressure area’s Yes No N/A
Appropriate management of: - Known pressure area’s - Potential pressure points
Yes No N/A Yes No N/A
Patient re-positioned at appropriate intervals Yes No
Appropriate assessment of wounds / CVL sites: - Is the correct dressing in situ - When does the dressing need to be
changed? - Dressings changed appropriately - Identify any signs of infection - Swab sent if indicated
(Guidelines available for sternotomy wounds & CVL sites, there may also be information in the notes form the tissue viability team)
Yes No N/A
ET Suctioning: Need for suctioning identified appropriately Yes No
Suctioning given as indicated by patient condition - in a timely manner - as required - routinely with care / re-positioning if the patient is paralysed / heavily sedated
Yes No
Pre-oxygenation given where appropriate Yes No N/A
Appropriate sized catheter used Yes No
Correct suctioning technique used Yes No
Accurate description of secretions documented Standard descriptions 1-Minimal, 2-Moderate, 3-copious M-Mucoid, M P-Muco-purulent, B-Bloody
Yes No
Appropriate use of personal protective equipment Yes No
Administration of Medicines:
Patient chart reviewed for allergies Yes No
Right patient (check name band) Right drug Right time Right Dose Right Route
Yes No
Observes for signs of extravasation during administration of IV medication (If there are no signs of extravasation can describe the signs that would indicate an extravasation injury)
Yes No
Ongoing communication:
Any concerns reported appropriately to the team leader / nurse in charge and / or medical team.
Yes No
Appropriate communication with the child & family ie. Keep them updated with care / progress
Yes No
Bedside Handover:
Effectively communicates during handover Yes No
Logical progression through handover (using the handover sheet)
Yes No
38 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
Evidence for completion:
o Direct observation o Discussion of appropriateness of assessment / intervention o Accurate completion of the assessment form o Accurate completion of the observation chart
Documentation:
Nursing assessment form completed appropriately Observations charted appropriately Line and circuit changes form
Yes No Yes No Yes No
Urine catheter form TISS from completed Nappy rash care plan
Yes No N/A Yes No Yes No
All significant event’s / changes in condition & communication with families documented appropriately
Yes No
Assessors Comments: Pass Refer
Action Plan (if applicable)
Nurse Comments:
39 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
Shift Reflections
To be completed by your mentors, the CSF’s or the Education
Team at the end of any support shift and during your first nine
weeks. Additional pages are available to print off on Moodle.
Please keep this document with you at all times, so you can get
it completed when you are at work as you go.
This is your responsibility and failure to bring this document will
result in no written feedback.
40 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
FOUNDATION COURSE SHIFT EVALAUATION SHEETS
Please identify and weaknesses/ learning needs
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment:
Clinical Skills :
Response to patient needs:
Organisation and prioritisation:
Observation and paperwork:
Communication:
Other:
LEARNING NEEDS
41 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
42 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Mentor/CSF/ Education Team
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
43 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
44 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
45 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
46 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature: Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
47 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT
Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
48 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment
Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
49 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
50 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
51 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
52 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
53 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
54 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
55 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
56 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
57 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
58 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
59 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
60 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
61 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
62 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
63 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
64 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
65 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
66 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
67 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
68 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
69 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
70 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
71 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
72 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
73 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
74 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
75 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT
Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
76 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
DATE TYPE OF PATIENT Supervisor Name: Signature:
Self Assessment Mentor/CSF/Education Team Assessment Nursing Assessment: Clinical Skills : Response to patient needs: Organisation and prioritisation: Observation and paperwork: Communication: Other: LEARNING NEEDS
77 PICU Education Team 23/12/15 V 1.1.5 (updated 15/7/16) Review Nov 2016
Notes.