CATEGORY 1 APPROVAL SUBMISSION TEMPLATE
Please ensure that the submission has been signed by the relevant personnel responsible for
the submission. You are advised that your contact details may be posted on our website.
The submission may be mailed to Bord Altranais agus Cnáimhseachais na hÉireann or emailed
to [email protected]
Please submit application for Category 1 approval a minimum of four weeks prior to the
event. Category 1 approval is valid for two years from date of approval.
Approved programmes should state “Category 1 approved by Bord Altranais agus
Cnáimhseachais na hÉireann.
PLEASE COMPLETE THE RELEVANT SECTIONS BELOW
1. Programme Title:
Open Disclosure
Date:
Date
2. Please indicate if the submission relates to a:
Conference
No / Yes
Seminar
No / Yes
Study Day
Yes
Short course
No / Yes
E-learning
No/ Yes
Other (specify)
3. Is this programme available to external applicants?
No/ Yes
4. Programme Facilitator:
Name
Title:
Title
Professional Qualifications
e.g. Clinical Nurse Specialist
Academic Qualifications:
e.g. SRN. RM. Clinical Nurse Specialist
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Organisation, Name
and address:
Name and Address
Professional Registration
Details:
e.g. Division of General Nursing
Personal Identification No.
PIN xxxx
5. Other Course personnel (as relevant)
a. Name:
Name
Qualifications:
e.g. MSc Healthcare (Risk Management & Quality)
etc.
Registration No.
xxxx
b. Name:
Qualifications:
Registration No.
c. Name:
Qualifications:
Registration No.
6. Short summary of the programme (to be displayed on the CPD Directory)
To train healthcare personnel to be competent in the delivery of open disclosure training to
all health and social care staff
7. Philosophy underpinning the course
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To train healthcare personnel on delivering on the principles of open disclosure within
their respective divisions
8. Programme Rationale and Justification (please see contextual factors in policy)
9. Aims and Objectives
1. To brief staff about the pilot and its significance nationally.
2. To have an understanding of Open Disclosure and its implications for the
Enterprise.
3. To build understanding as to how OD links into the existing HSE Quality, Safety
and Risk framework.
4. To know how to implement the Principles of open disclosure.
5. To provide information and training via case scenarios and role play on delivering
on the principles of open disclosure.
6. To practice key skills needed to implement the guidance effectively.
7. To provide awareness to staff on the resources currently available to them.
10. Content, (to include Theoretical and Clinical input if appropriate)
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11. Course membership (target audience)
All healthcare personnel
12. Duration (length in hours/days)
4 hours in total
13. Venue
Name and Address of where training is been given
14. Educational Facilities and Resources
Open Disclosure Workbook which includes scenarios, checklists etc.
15. Programme Structure/Outline to include a detailed breakdown of the programme
timetable (insert here or attach as an appendix)
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10 mins
15 mins
15 mins
Introduction & Overview of PILOT SITE OC proposal & their role in its implementation.
Overview of Open Disclosure to include:
 Definition
 10 principles of Open Disclosure
 Summary components
 Exercise 1 – Case Reflection
Overview of Adverse Events to include:




10 mins
Definition
Breakdown of outcomes for patients
Statistics
Claims data
Overview of current status in the Republic of Ireland to include:



Update on Legislation
Information on national and international agencies endorsing and supporting
OD principles
Report: Building a culture of patient safety 2009
Feedback and information
30 mins
Adverse Events – what patients expect from us


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Exercise 2: Watch DVD – list the patients expectations
o Group discussion
Feedback and general information/research based evidence
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
CIS exploratory study
Break 15 mins
30 mins
Adverse Events - The Clinician’s perspective and considerations





30mins
Exercise 3: Watch the DVD – Consider the feelings and emotions of the doctor
whose patient is being referred to by their medical colleague.
Feedback and discussion
Impacts of adverse events on staff
Discussion on staff supports available and evidenced based research re same
Research based information regarding the benefits of open disclosure for staff
The Open Disclosure Process
The 5 W’s: Why/Who/When/Where/What
Language
Documentation
The OD process using the MPS A.S.S.I.S.T Model
Exercise 4: Watch the DVD: Consider how the Doctor demonstrated his use of the
A.S.S.I.S.T Model.
Discussion and Feedback
Feedback and information
Putting it all into practice:
30 mins
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Exercise 5: Role play using real case scenarios
Divide into groups of 3 – every person will play the role of doctor,
patient and observer.
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Feedback and discussion
10 mins
Summary and close
Exercise 6: Using case scenario in exercise 1 reflect on learning and changes to practice
16. Methods of facilitating learning
Evaluation: Trainees will complete the post training-evaluation form to assess
learning and influence future training programmes.
Please attach evaluation form in your application
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17. Assessment of Learning (if applicable)
Evaluation: Trainees will complete the post training-evaluation form to assess
learning and influence future training programmes.
18. Programme Evaluation (if applicable)
Evaluation: Trainees will complete the post training-evaluation form to assess
learning and influence future training programmes.
19. Sponsorship (if applicable)
20. Declaration Re: International Code of Marketing of Breast milk Substitutes WHO 1981
(if applicable)
I confirm that all elements of this programme adhere to the Code of Marketing of
Breast-milk Substitutes (WHO 1981)
Authorised _______Signature______________________Date________Date______
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21.
Please note Bord Altranais agus Cnáimhseachais na hÉireann do not endorse any product or
service and reserve the right to interpret whether the event is appropriate for obtaining CEU
accreditation for professional development.
In seeking Category 1 approval, you are authorising Bord Altranais agus Cnáimhseachais na
hÉireann to post your details in the CPD Directory.
By submitting this form you are declaring that the information submitted is correct to the
best of your knowledge.
Name:
Your Name
Title:
Your Title
Organisation:
Your Organisation
+353 phone number
Phone
Number
Email Address Email address
22.
Website
http://website
Date:
Date
Additional Requirements for Approval of ELearning Programmes only
Provide a short description of the ELearning programme provider
The Time required for learners to complete the programme and achieve outcomes is:
Please state how engagement with material and achievement of the outcomes is monitored
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Date programme was developed _______________________
Date programme will be reviewed _____________________
Names and qualifications of team that developed the programme (including Registration
PINs if appropriate)
I confirm that the ELearning programme is free from commercial bias:
Signature ____________________________ Date________________
Please declare details of the source and amount of any funding/sponsorship to support the
development of the programme
Outline the means by which student feedback on the ELearning programme will be
ascertained
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I confirm that CEUs will only be achieved on completion of the programme
Signature:_______________________
Date:_____________________
I declare that personal information will be maintained in keeping with the Data Protection
Act.
Signature:___________________________
Date: _____________________
________________________________________________________________________________
For office use only:
Course Grouping
April 2013
CEU
Approved by
Posted on website:
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