- Email: [email protected]
Development of an advanced bariatric practitioner training program
Abstracts / Surgery for Obesity and Related Diseases 6 (2010) 224 –234
sensus building, a list of processes was compiled to create a SOP. The present application of each of these processes during routine clinical practice was evaluated in 2 separate, large-volume bariatric units. Results: The consultative SOP included “never events” (wrong procedure or wrong patient), equipment-related problems, interventions for surgical site infections or venous thromboembolism, and key postoperative issues (e.g., out-of-hospital use of lowmolecular-weight heparin). For the consensus-building exercise, the listed processes were separated into 3 categories: (1) processes that were supported by strong evidence to improve patient safety, such as thromboembolism prophylaxis; (2) processes related to surgical technique, such as intraoperative testing for anastomotic leakage, that are widely used but unsupported by rigorous data; and (3) processes for which there does not appear to be common practice or rigorous data, such as the use of diabetes medication after discharge from the hospital. On comparative evaluation, a wide variability (10 –90%) was found between the 2 centers in the current application of the components of the SOP. Conclusions: A multidisciplinary, collaborative approach was effective to generate a prototype multiprocess SOP for gastric bypass. Marked variation was found in the current application of the SOP. Additional consultation, consensus building, and outcome evaluation are needed to generate a validated SOP that can optimize surgical safety. EDUCATING THE MULTIDISCIPLINARY BARIATRIC SURGERY OPERATING TEAM: USE OF MULTIMEDIA AND ELECTRONIC LEARNING TECHNOLOGY Andrea Fox-Hiley, Joanne Johnson, Abeezar Sarela, St. James’s University Hospital, Leeds, United Kingdom Background: Rapid expansion of bariatric surgery has created a critical need for education of an entire cohort of healthcare professionals trained in a “prebariatric” era and for structured dissemination of knowledge to trainees in allied disciplines. Creative electronic and multimedia technology can enhance deep learning by promoting the sequential development of underpinning knowledge, skills, and attitude for multidisciplinary best practice in bariatric surgery. The aim of this study was to develop interactive and easily accessible educational tools for the bariatric operating room team to improve patient safety. Methods: A multidisciplinary working group with expertise in education, operating room nursing, bariatric surgery, and dietetics was formed. Extensive information synthesis was conducted. Close links were formed with the information technology department of the affiliated university and website design professionals. A simulated operating room and film technician in the education department were used. Results: A multifaceted educational website, an E-learning program, and simulated operating room scenarios were created. The website was mainly directed at nursing and allied health professionals. As unique features, the website provides detailed, bariatric-specific nursing care plans and a comprehensive database of bariatric equipment in the United Kingdom, from patient transport and transfer devices to laparoscopic stacks, with industry-sponsored links to individual websites. A prototype E-learning module for bariatric surgery has been created using the Articulate software. The module includes quizzes, links, layering, and videos and can be modified for the needs of different healthcare professionals.
233
Videos of simulated operating room scenarios including operating department practitioners, nurses, anesthetists, and surgeons are used to create intense awareness of “near-misses” and highlight the importance of a bariatric surgery-specific briefing session and surgical safety checklist. Conclusions: Multidisciplinary collaboration generates creative learning tools. The dissemination and evaluation of these tools is in progress to produce validated resources that can be used by professional societies and institutions. DEVELOPMENT OF AN ADVANCED BARIATRIC PRACTITIONER TRAINING PROGRAM Jayne Brocklehurst, Jonathan Barry, Conor Magee, Shafiq Javed, Robert Macadam, David Kerrigan, Gravitas, Wirral, United Kingdom Background: The bariatric surgeon, dietitian, and nurse are all key members of the team. However, the amount of overlap in the roles undertaken by these specialists in the outpatient management of bariatric patients is large. We believe that a new role of an advanced bariatric practitioner (ABP) could be developed for nonsurgical staff that could be undertaken by either a dietitian or a nurse after appropriate training. Methods: A training package with aims and learning outcomes was developed. This covered the essential components of the ABP role. Both dietitians and nurses underwent a period of training by experienced professionals until competence had been attained in all areas. Results: On completion of the ABP training program, both dietitians and nurses had acquired the skills necessary to perform follow-up assessments independently. This included undertaking gastric band adjustments, providing appropriate dietary advice, blood monitoring, and the recommendation of supplements for nutrient deficiencies in line with standard protocols, which are performed in conjunction with an experienced bariatric surgeon. All practitioners could seek support from the relevant healthcare professional, if required. Conclusions: The ABP training program has enabled us to provide a more effective service for patients and has increased the job satisfaction of the dietitians and nurses working within our units. STANDARDIZED PERIOPERATIVE PROTOCOL WITH ENHANCED RECOVERY AFTER MAJOR LAPAROSCOPIC BARIATRIC SURGERY REDUCES LENGTH OF STAY, IMPROVES QUALITY OF CARE, AND OPTIMIZES RESOURCES IN HIGH-VOLUME BARIATRIC UNIT Marco Adamoa, Francesca Lirosia, Cynthia M. Borga, James C. Hewesa, Hasan Maana, Rachel L. Batterhamb, aUniversity College Hospital, London, United Kingdom, bUniversity College London, London, United Kingdom Background: The advantage of standardized perioperative management protocols with enhanced recovery (ER) has been demonstrated for large-volume colorectal units. We have recently implemented a new perioperative and ER program for patients undergoing major laparoscopic bariatric surgery: gastric bypass, sleeve gastrectomy, and revision surgery. This new protocol defines the expected analgesia requirement, especially opioids, abolishes routine use of abdominal drains and postoperative contrast
sensus building, a list of processes was compiled to create a SOP. The present application of each of these processes during routine clinical practice was evaluated in 2 separate, large-volume bariatric units. Results: The consultative SOP included “never events” (wrong procedure or wrong patient), equipment-related problems, interventions for surgical site infections or venous thromboembolism, and key postoperative issues (e.g., out-of-hospital use of lowmolecular-weight heparin). For the consensus-building exercise, the listed processes were separated into 3 categories: (1) processes that were supported by strong evidence to improve patient safety, such as thromboembolism prophylaxis; (2) processes related to surgical technique, such as intraoperative testing for anastomotic leakage, that are widely used but unsupported by rigorous data; and (3) processes for which there does not appear to be common practice or rigorous data, such as the use of diabetes medication after discharge from the hospital. On comparative evaluation, a wide variability (10 –90%) was found between the 2 centers in the current application of the components of the SOP. Conclusions: A multidisciplinary, collaborative approach was effective to generate a prototype multiprocess SOP for gastric bypass. Marked variation was found in the current application of the SOP. Additional consultation, consensus building, and outcome evaluation are needed to generate a validated SOP that can optimize surgical safety. EDUCATING THE MULTIDISCIPLINARY BARIATRIC SURGERY OPERATING TEAM: USE OF MULTIMEDIA AND ELECTRONIC LEARNING TECHNOLOGY Andrea Fox-Hiley, Joanne Johnson, Abeezar Sarela, St. James’s University Hospital, Leeds, United Kingdom Background: Rapid expansion of bariatric surgery has created a critical need for education of an entire cohort of healthcare professionals trained in a “prebariatric” era and for structured dissemination of knowledge to trainees in allied disciplines. Creative electronic and multimedia technology can enhance deep learning by promoting the sequential development of underpinning knowledge, skills, and attitude for multidisciplinary best practice in bariatric surgery. The aim of this study was to develop interactive and easily accessible educational tools for the bariatric operating room team to improve patient safety. Methods: A multidisciplinary working group with expertise in education, operating room nursing, bariatric surgery, and dietetics was formed. Extensive information synthesis was conducted. Close links were formed with the information technology department of the affiliated university and website design professionals. A simulated operating room and film technician in the education department were used. Results: A multifaceted educational website, an E-learning program, and simulated operating room scenarios were created. The website was mainly directed at nursing and allied health professionals. As unique features, the website provides detailed, bariatric-specific nursing care plans and a comprehensive database of bariatric equipment in the United Kingdom, from patient transport and transfer devices to laparoscopic stacks, with industry-sponsored links to individual websites. A prototype E-learning module for bariatric surgery has been created using the Articulate software. The module includes quizzes, links, layering, and videos and can be modified for the needs of different healthcare professionals.
233
Videos of simulated operating room scenarios including operating department practitioners, nurses, anesthetists, and surgeons are used to create intense awareness of “near-misses” and highlight the importance of a bariatric surgery-specific briefing session and surgical safety checklist. Conclusions: Multidisciplinary collaboration generates creative learning tools. The dissemination and evaluation of these tools is in progress to produce validated resources that can be used by professional societies and institutions. DEVELOPMENT OF AN ADVANCED BARIATRIC PRACTITIONER TRAINING PROGRAM Jayne Brocklehurst, Jonathan Barry, Conor Magee, Shafiq Javed, Robert Macadam, David Kerrigan, Gravitas, Wirral, United Kingdom Background: The bariatric surgeon, dietitian, and nurse are all key members of the team. However, the amount of overlap in the roles undertaken by these specialists in the outpatient management of bariatric patients is large. We believe that a new role of an advanced bariatric practitioner (ABP) could be developed for nonsurgical staff that could be undertaken by either a dietitian or a nurse after appropriate training. Methods: A training package with aims and learning outcomes was developed. This covered the essential components of the ABP role. Both dietitians and nurses underwent a period of training by experienced professionals until competence had been attained in all areas. Results: On completion of the ABP training program, both dietitians and nurses had acquired the skills necessary to perform follow-up assessments independently. This included undertaking gastric band adjustments, providing appropriate dietary advice, blood monitoring, and the recommendation of supplements for nutrient deficiencies in line with standard protocols, which are performed in conjunction with an experienced bariatric surgeon. All practitioners could seek support from the relevant healthcare professional, if required. Conclusions: The ABP training program has enabled us to provide a more effective service for patients and has increased the job satisfaction of the dietitians and nurses working within our units. STANDARDIZED PERIOPERATIVE PROTOCOL WITH ENHANCED RECOVERY AFTER MAJOR LAPAROSCOPIC BARIATRIC SURGERY REDUCES LENGTH OF STAY, IMPROVES QUALITY OF CARE, AND OPTIMIZES RESOURCES IN HIGH-VOLUME BARIATRIC UNIT Marco Adamoa, Francesca Lirosia, Cynthia M. Borga, James C. Hewesa, Hasan Maana, Rachel L. Batterhamb, aUniversity College Hospital, London, United Kingdom, bUniversity College London, London, United Kingdom Background: The advantage of standardized perioperative management protocols with enhanced recovery (ER) has been demonstrated for large-volume colorectal units. We have recently implemented a new perioperative and ER program for patients undergoing major laparoscopic bariatric surgery: gastric bypass, sleeve gastrectomy, and revision surgery. This new protocol defines the expected analgesia requirement, especially opioids, abolishes routine use of abdominal drains and postoperative contrast