GRASPIT Course Organisers Manual
Contents:
1) Aims and Objectives
2) Background to course
3) Purpose of this Training Manual
4) Intended audience
5) Format and Content
6) Arranging a GRASPIT course
7) Training GRASPIT Trainers
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Principles of Learning
Giving a Lecture
Teaching a Scenario
Facilitating a Discussion
Teaching a Skill
Appendix 1: Example timetables
Appendix 2: List of the suggested equipment for running a GRASPIT course
Appendix 3: Flow diagram for organising a GRASPIT course
Appendix 4: Advertising material (posters, information flyers) that can be adapted for local use
Appendix 5: Course registers
Appendix 6: Course evaluation form
Appendix 7: GRASPIT certificate template
Appendix 8: Example of GRASPIT Course Summary Report
Appendix 9: Principles of Learning Further Reading
Appendix 10: Scenarios: Examples and Learning Objectives
1: Aims and Objectives of the GRASPIT Course
The purpose of the GRASPIT course is to promote a systematic and structured approach to the
assessment of acutely unwell patients and their initial treatment. The course encourages the
application of basic principles and knowledge coupled with simple interventions utilising widely
available equipment and is suitable for both medical and nursing staff: junior or senior. Its focus is on
the initial stabilisation and treatment of patients rather than the management of specific diseases or
conditions. The principals conveyed are applicable to a wide spectrum of patients whether they are
presenting with medical or surgical conditions or are young or old. Although it covers the use of
simple interventions such as oxygen, IV fluids and simple airway adjuncts it is not dependent on the
availability of these resources.
2: Background
The failure to recognise the deteriorating acutely ill patient is well recognised as a significant risk
factor for a poor outcome. When reviewing these cases two consistent themes emerge; either the
failure to take and record appropriate observations and / or a failure to recognise abnormal vital signs
as a trigger for timely action. The interventions required are often relatively simple in nature (basic
airway management, oxygen therapy, intravenous fluids coupled with escalation for senior clinical
review), but have a profound impact on the patients chances for survival.
In the UK, in order to address the problems identified above, national courses such as ALERT (Acute
Life Threatening Events Recognition and Treatment) and local courses (eg SOS, Stabilisation of the
Sick, Torbay Hospital) have been developed. These are aimed to be delivered to a multidisciplinary
audience of doctors and nurses, both junior and senior, with the aim of reinforcing prior knowledge
and promoting a systematic approach to the assessment and treatment of acutely unwell patients. An
important component of these courses is promoting effective communication tool and we promote the
use of the SBAR+ (Situation Background Assessment Recommendation plus) tool to enhance
transfer of information.
Experience gained during Kenya Orthopaedic Project missions to Coast Province General Hospital,
Mombasa and Nanyuki District Hospital suggested that very similar challenges existed in Kenya.
Therefore a context appropriate course, named GRASPIT (Global Recognition and Assessment of the
Sick Patient and Initial Treatment) was developed. Pilot courses were refined in the light of feedback
received from Kenyan staff.
Although delivered as a course GRASPIT actually represents a system wide approach to patient care.
If its principals are to be adopted and consistently applied in Kenyan hospitals then the requirements
extend beyond simply providing staff with a one day training course. Other factors that need to be
addressed include the availability of simple equipment, improved monitoring and recording of vital
signs and effective communication between members of the health care team. All these objectives
are achievable within the resources currently available. However the critical factor for the success of
this approach is that staff recognise the significant benefits it can provide, not only for patient care, but
also their professional lives. Only then will it become embedded and have a sustained impact.
3: Purpose of this Training Manual
In order for the GRASPIT course to be sustainable and widely disseminated it is important that
Kenyan medical and nursing staff become confident in taking on the delivery of this teaching. This
manual not only provides suggestions on the practical aspects of organising a course, but also gives
guidance on how to be a successful educator. The manual will be of particular value to those who
have little or no experience in teaching, but will hopefully useful to experienced teachers as well.
4: Intended Audience
The principles and systematic approach promoted through the GRASPIT course are relevant to both
medical and nursing staff. Both junior and senior qualified staff as well as those still in training should
be encouraged to come. Experience shows that this approach works well as the more experienced
staff can guide the less experienced, as they would in real life clinical situations. The wide
dissemination of the GRASPIT approach also aids team working and communication when managing
acutely unwell patients.
Although experienced faculty may visit an institution to deliver a GRASPIT course it is important that
they identify, from amongst those attending, suitable local candidates who can be trained to continue
its delivery.
5. Format and Course Content
The course comprises a mix of delivered lectures, faculty demonstrations and clinical scenario based
teaching. However there is great flexibility in how the course could be organised and the exact
content depending on local requirements.
Lectures:
Introduction to the Course: Why GRASPIT Needed
ABCDE: Assessment of Critically Ill Patient and Initial Treatment
The Hypotensive Patient (including management of oliguria)
The Breathless Patient (including role of pulse oximetry)
Decreased Level of Consciousness
Pain Management
Communication Using the SBAR (Situation Background Assessment Recommendation) Tool
Demonstrations:
Assessment of Acutely Ill Patient
Communication
Lifebox pulse oximeter (if available)
Clinical Scenarios
In the scenarios delegates undertake the assessment of simulated patients supervised and guided by
trainers. Each scenario focuses on a particular aspect of patient management eg fluid resuscitation,
oxygen therapy utilising basic equipment (oxygen masks, IV cannula and fluids, Guedel airways)
which should be available in the clinical environment.
Appendix 1 Example timetables
We have found that having a mix of lectures and scenario teaching in the morning and afternoon is a
successful way of keeping delegates engaged and interested. Having breaks timetabled between the
sessions is very useful as they can not only be used for refreshment, but also be used for answering
questions or exploring topics raised by the delegates without the day overrunning.
The course length of a day is a compromise between having time to deliver a comprehensive and
effective course balanced against taking staff away from their workplace. However it would be quite
feasible to run the course divided up over shorter duration sessions, such as half days. A possible half
day course could comprise of a lectures covering the assessment of the acutely ill patient followed by
clinical scenario teaching. The remaining material could either be provided to candidates in other
formats or presented at another date, again combined with further scenarios.
6. Arranging a GRASPIT Course
Institutions may wish to run a GRASPIT course because members of staff have attended courses at
other locations or through contact with central organisations (National Resuscitation Council) or the
founding charity EGHO (Exploring Global Health Opportunities). The course is suitable for a wide
range of institutions, from District Hospitals to large national referral teaching centres. A critical factor
for the success of the course is identifying a local coordinator within the healthcare institution who will
be able to help with its organisation. This might be the CPD co-ordinator, administrator, nurse or
clinician. They will be invaluable in assisting in the pre-course organisation (such as recruiting
delegates, identifying venues) and ensuring that the course and the concepts embedded within it
become established in their hospital.
It is critical for the course credibility that it is relevant and appropriate to the clinical environment in
which the delegates attending work. It is particularly important to know the equipment that is available
in the clinical workplace for staff to use or the practicalities of getting that equipment to the patient e.g.
having to fetch oxygen cylinders from a store as it makes the training more relevant if these contexts
are factored into the teaching. If the course organiser and faculty aren’t familiar with the institution
hosting the course it is important this information is sought from the local coordinator. Absence of
equipment does not mean that it is not appropriate to teach on its use as an important outcome of the
course can be identifying the resources that are required.
In situations where the course is been delivered by a visiting faculty it is very useful to identify and
recruit local faculty to work alongside them. These individuals will hopefully then continue to develop
and deliver the course in that locality. It might be possible to identify potential candidates beforehand
in which case they can be included in the pre-course planning. These could be staff with some
experience in teaching and training or who have attended GRASPIT at other venues. Alternatively
potential future trainers maybe identified from amongst the delegates attending the course. Ideally
new faculty would be provided with the opportunity of shadowing experienced faculty before delivering
courses independently. The need for this will be influenced by the experience of the new trainers and
the logistical difficulties of them travelling to other institutions where courses are being delivered.
The number of delegates that can be catered for on a course is primarily dictated by the number of
faculty available to run scenarios. Six delegates is a manageable number for each scenario station as
any more than this limits the ability to gain hands on experience. A faculty of four trainers can
therefore comfortably accommodate a total of twenty four delegates, as this enables groups of six
delegates to rotate through four scenario stations. These numbers are of course flexible and just
given as examples. With careful timetabling not all faculty need to be present for the whole course ie
one or two faculty members can deliver the lectures with additional support available for the scenario
sessions. In some circumstances this might favour grouping all the lectures into the first part of the
day and running the scenarios in the afternoon; however feedback from courses does suggest that
delegates appreciate mixed sessions.
Appendix 2: List of the suggested equipment for running a GRASPIT course
Appendix 3: Flow diagram for organising a GRASPIT course
Appendix 4: Examples of advertising material (posters, information flyers) that can be
adapted for local use
The venue ideally needs to have a reasonable sized room that can accommodate approximately
twenty four delegates and permit the projection of slides. At each scenario station one of the
delegates will be acting as a patient and needs to lie down on either a bench, table or if available
trolley or bed. In larger venues the scenario stations may be able to be accommodated within the
same room as where the lectures are delivered. Alternatively stations may need to be set up in
adjacent rooms or other convenient locations, even outside. Ideally the stations should be relatively
close together to minimise the loss of time as groups rotate around. The timing of the scenario
sessions can be allocated to one of the faculty (or a helper if available) and it is helpful if a warning
can be given five minutes before the end of the session to give the opportunity for the trainers to
summarise the key learning points before the groups rotate.
Depending on local arrangements the delegates details may have been recorded by the local
coordinator when they booked on the course, alternatively the register will need to be completed as
the delegates arrive. To aid the completion of the course certificates it is helpful if delegates can print
their names. The certificate template (Appendix VV) can either be completed electronically and
printed if facilities permit or handwritten. The delegates e-mail and/or mobile telephone numbers are
useful to collect as this will provide ways of providing follow up information after the course has
finished. It is very helpful if the delegates can be provided with a name badge (handwritten sticky label
or tape) for the day as this facilitates the faculty getting people to engage and participate, especially in
the scenarios.
Appendix 5: Example of a course register
Suggestions for giving the lectures and running the clinical scenarios are given in the relevant section
of this handbook, but a key aim is to keep the audience engaged and actively participating. This can
be achieved in a variety of ways, but asking questions of the audience, running mini-quizzes
(rewarded with appropriate prizes such as sweets) and encouraging discussion and debate are all
useful strategies.
Whether refreshments and lunch are provided for delegates will depend on local circumstances.
EGHO does not support per diem payments for attendance, but the course organisers may wish to
consider reimbursing expenses for those that have had to travel significant distances.
It is very important to get feedback from the delegates at the end of the course. Obviously the course
evaluation form will need adapting depending on the programme of the course that has been
delivered. To stop people leaving before they have returned the evaluation forms, an option is to only
give out the course certificates in return for a completed form.
Appendix 6: Example of a course evaluation form
Appendix 7: Course certificate template
At the end of the course it is very useful if the faculty can have a brief meeting to review the day.
Often this provides very useful suggestions for how the course could be improved either in terms of
content or organisation. It is also a good opportunity for the faculty to identify potential future trainers
from amongst those who have attended. Ideally their willingness to participate as faculty in future
courses will have been established during the day.
A report on the course should be collated, either by a member of the faculty or local coordinator. As
well as information on the numbers and type of staff who attended, it should include a summary of
their feedback. This report should be provided to the senior staff at the healthcare institution and
include any recommendations the faculty have for the delivery of further courses. A copy of the report
should be sent to the EGHO GRASPIT coordinator Dr Matt Halkes [email protected]
Examples of GRASPIT reports are available for review on the EGHO website
Appendix 8: Suggested content for GRASPIT Course Report
Appendix 1: Example Timetables for GRASPIT Course
Time
(mins)
20
60
09:00 - 09:20
09:20 – 10:20
20
20
10:20 - 10:40
10:40 – 11:00
40
11:00 – 11:40
5
30
30
11:40 – 11:45
4 groups of 5-6
delegates
11:45 – 12:45
12:45 – 13:30
13:30 – 13:50
13:50 - 14:10
14:10 – 14:30
14:30 – 14:40
4 groups of 5-6
delegates
14:40 – 15:40
15:40 – 15:50
15:50 – 16:10
16:10 – 16:20
16:20 – 16:30
45
20
20
20
10
30
30
10
20
10
10
Topic
Welcome / Why GRASPIT Needed
ABCDE: Assessing the Critically Ill Patient and Initial Treatment
Patient Assessment Demo
Break and Refreshments
The Breathless Patient
ABCDE: Assessing the Critically Ill Paediatric Patient
Paediatric Assessment Demo
Break to organise groups
Scenario A:
Scenario B:
Scenario C:
Scenario A:
Scenario B:
Scenario C:
Scenario D:
Scenario D:
Lunch
The Hypotensive Patient (inc oliguria)
Decreased Level of Consciousness
Pain Management
Break to organise groups
Scenario A:
Scenario B:
Scenario C:
Scenario A:
Scenario B:
Scenario C:
Scenario D:
Scenario D:
Break
SBAR+ Communication
Summary
Evaluation
Certificates
Appendix 2: Suggested List of Equipment for GRASPIT Course
Projector (spare bulbs)
Laptop / computer
Printer / paper / ink
Extension cables / screwdriver
Screen / sheet / wall
Sticky labels (for name badges)
Marker pens
Pens
Sticky tape
Blu tac (or equivalent method putting up posters / Scenario station labels etc)
Course slides (backed up on data sticks)
Course handbook / posters
SBAR stickers
Register sheets
Evaluation sheets
Course certificates
Badges
Laminated scenario cards
Laminated example observation charts
Equipment boxes
- laminated checklist of contents
- IV cannulas (variety sizes and ideally of type used by that institution)
- IV fluid bag (can be empty) and giving set
- oxygen tubing
- nasal cannula / Hudson mask / venturi masks / non-rebreath mask
- oropharyngeal airways (various sizes)
- nasopharengeal airways (various sizes)
- blood sample bottles
Pulse oximeter
Airway manikin
Bag –mask valve
Appendix 3: Flow diagram for Organising a GRASPIT Course
Identify Healthcare Institution
to host GRASPIT Course
Identify Local Course Co-ordinator
Recruit Faculty: Local and Visiting
Book Venue / Catering
Advertise Course / Recruit Delegates
Day of the Course:
Set up venue
Register Delegates
Deliver course
Give out certificates
Collect Evaluation Forms
Faculty Debrief
Identify potential faculty
GRASPIT Report and Feedback to
Healthcare Institution
Appendix 4: Advertising Material
GRASPIT
Global Recognition and Assessment
of the Sick Patient and Initial Treatment
The failure to recognise the deteriorating acutely ill patient is well recognised as a significant
risk factor for a poor outcome. When reviewing these cases two consistent themes emerge;
either the failure to take and record appropriate observations and / or a failure to recognise
abnormal vital signs as a trigger for timely action. The interventions required are often relatively
simple in nature (basic airway management, oxygen therapy, intravenous fluids coupled with
escalation for senior clinical review), but have a profound impact on the patients chances for
survival.
In the UK, in order to address the problems identified above, national courses such as ALERT
(Acute Lifethreatening Events Recognition and Treatment) and local courses (eg SOS,
Stabilisation of the Sick, Torbay Hospital) have been developed. These are aimed to be delivered
to a multidisciplinary audience of doctors and nurses, both junior and senior, with the aim of
reinforcing prior knowledge and promoting systematic approach to the assessment and
treatment of acutely unwell patients. An important component of the course in Torbay is the use
of a communication tool (SBAR) to enhance transfer of information. As in many hospitals, these
courses in Torbay are coordinated and delivered by the intensive care outreach service.
Experience gained during Kenya Orthopaedic Project missions to Coast Province General
Hospital, Mombasa and Nanyuki District Hospital suggested that very similar challenges existed
in these hospitals. Our aim was therefore to develop a context appropriate version of our local
SOS course which was named GRASPIT (Global Recognition of Acutely Sick Patient and Initial
Treatment).
The format of the course consists of a combination of lectures, which cover a systemic
approach to assessing the acutely ill patient and more detailed reviews of commonly
encountered clinical problems (for example hypotension, reduced level of consciousness). The
lectures are reinforced by practical demonstrations and delegates undertaking assessments of
simulated patients under the guidance and supervision of the trainers.
For further information please contact
[Insert contact name and details]
Appendix 4: Advertising Material
GRASPIT
Global Recognition and Assessment
of the Sick Patient and Initial Treatment
This one day course is suitable for nurses, clinical officers, medical
officers and doctors, both newly qualified and experienced
Content:
 Importance of vital signs monitoring
 Recognition of abnormal physiology
 Systematic clinical assessment
 Initial stabilisation of sick patients
 Communication skills
Delivered through a combination of
Lectures
Demonstrations
Clinical Scenarios
Please see attached programme for details
For further information please contact
[Insert contact name and details]
GRASPIT
Global Recognition and Assessment of the Sick Patient and Initial Treatment
Register for Date: ……………………..
Name (please print)
Appendix 5: Course Register
Role
Hospital /Institution
Mobile number
E-mail address
GRASPIT
Evaluation Form
Global Recognition and Assessment
Of the Sick Patient and Initial Treatment
Are you a: Nurse, Clinical Officer, Doctor, Other……………
Please circle 1 to 5 for feedback on the talks and scenarios
(1 is poor, 5 is excellent)
Assessing the Critically Ill Patient
The Hypotensive Patient
The Breathless Patient
Managing Oliguria
Decreased Level of Consciousness
Pain Management
Communication: Use of SBAR
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
5
5
5
5
5
5
5
Please score the four scenarios you attended:
Clinical Scenarios A
Clinical Scenarios B
Clinical Scenarios C
Clinical Scenarios D
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
Any other comments, please tell us one thing you have learnt today and one
suggestion to improve the course? Please write below or on the back of this
form.
Appendix 6: Evaluation Form
Appendix 7: Course Certificate
Append
Certificate of Attendance
This is to certify that
attended
GRASPIT
Global Recognition and Assessment
of the Sick Patient and Initial Treatment
Nanyuki Hospital 28th June 2012
Course Faculty
Hazel Robinson Sister
James Webster Charge Nurse
Dr Matt Halkes Consultant Dr Mike Swart Consultant
Intensive Care Unit
South Devon Healthcare Foundation Trust, England, UK
Appendix 8:
Suggested Content for a GRASPIT Course Report
1
Name and contact details of course organiser
2
Names of the faculty involved in delivering the course
3
Location of the course ie name of hospital / clinic
4
Delegate list
5
Course programme
6
Brief description of how the course went
6
Summary of feedback from delegates
7
Feedback from the faculty - what went well? - what could be improved?
8
Contact details of delegates identified as future GRASPIT Trainers
9
Future plans
10
Thanks and acknowledgements
A copy of the report should go to
1) Members of the course faculty
2) The senior management at the healthcare institution where the GRASPIT course
was delivered
3) The EGHO GRASPIT Coordinator Dr Matt Halkes [email protected]