On the eve of a New Year it is wise to look back so we can value and appreciate progress made, but importantly determine ways we want to move forward positively to improve vascular access for our patients. Healthcare remains challenging in many ways including finite resources, but it continues to be dynamic and fast paced with driven clinicians who strive for the best. Here Sarah emphasises that focus remains key and not losing sight of these commonly practiced skills in the complex organisations of healthcare. VeinTrain co-chaired this fantastic Train the Trainer day for NIVAS - National Infusion Vascular Access Society at the Royal College of Surgeons, London on 12th October 2015. This presentation shows an overview of key things that work in Vascular Access for Private and Public Sector. The day encouraged lots of lively discussion and engagement on things clinicians find challenging in vascular access training. Vein Train shares some of the decades of experience in this sector including large training projects in the private sector and NHS, including NHS Direct, Chelsea and Westminster NHS Foundation Trusts, Guys' and St Thomas's NHS Foundation Trust and King's College University (Medical School).

1. VeinTrain/NIVAS Study
Day
What Works and What does
not in healthcare training
Sarah Phillips: Author, MA, BA, Dip N
MD and Organisation Consultant – Systems Psychoanalytic
© Vein Train Ltd 2015 1

2. Who We Are and What We Do?
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In a world where reality is not as simply
Packaged ……..
…As it would first appear

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5. VeinTrain keeps learners
focussed on Vascular Access
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6. Joining the dots
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Published in 2011 UK and
Indonesia 2014
Book signing due in Bali by 2016

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2001 Sarah introduced Compulsory Annual smiling
Training for 240 Imperial College Medical Students

9. 9
Training for competency before and
after at Chelsea and Westminster
41%
43%
16%
Competent Not Comp Left
98%
2% 0%
Competent Not Comp Left
BEFORE
AFTER
Training of all 500 nurses in 2000

10. 10
Supervision was key
Supervised Practice
3%
24%
73%
Essesntial
Helpful
Not Needed
“ made me feel
confident”
“Would not have done
skills without supervisor”
 “Difficult sometimes,
needed more time”
“Motivated you to do the
skill”
Collins et al (2006)

11. 11
Benefits of Training for patients
36%
4%
57%
1%
Venepuncture Reasons
n= 242
Routine
Patient
Pre-Tx
Pre Dx
Fasting
Bloods
23%
19%
57%
1%
Cannulation Reasons
n = 163
Routine
Re-Siting
Awaiting
Treatment
Collins et al (2006)

12. She was my
allocated patient
Post-operative bloods to
allow the patient
to be discharged on time.’
Patient went home
earlier as doctors
busy and had missed
the phlebotomy round.
Team in theatre. Cross
match not taken before
theatre. Able to oblige.
Team in theatre. Cross
match not taken before
theatre. Able to oblige.’
Patient relieved and
appreciated the
technique adopted for
her, that is, butterfly
Needle phobic – knows
me. Sat with patient
and explained
necessity for blood test.
Rapid results of
cardiac markers
ensures correct
treatment.
Collins et al (2006)

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Anyone who came in the
skills lab had to learn
these skills!
I managed gloves, a
sharps bin in view and got
a smile and compliment. I
gave him ‘confidence’
apparently. His photo
helped me with my sharps
management work.
No Escape!
Sir Nigel Crisp, CEO of the NHS 2004

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15. Common Skill
Over 60% of admitted patients will need
intravenous therapy
15 million patients are admitted in UK
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“The wide variety of clinicians offering these skills to their
patients is welcome and makes the most of the talent in the
NHS, while offering patients choice and an efficient service.
However, such diversity risks different types of practices
evolving.”
Lord Darzi PC, KBE, FMedSci, HonFREng
(In Phillips et al Venepuncture and Cannulation. 2011)
Standardising in Complex Healthcare

17. Lots of small measures
make a big difference
particularly with these
common skills
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Standardised
assessment
70,000
NHS/Private
3rd Edition
Est.14.5 Million
patient outcomes
per year!
(based on 4 cannula a week on 70 000
staff

19. A Structured
Learning Programme
ABSTRACT – Updated 2012
This project has been developed by a group of Intravenous Therapy Nurses and
Trainers. The group (Vascular Access Network) continued to work sharing
educational and audit material and experience to produce this standardised learning
and assessment tool for Venepuncture and Cannulation. This innovative booklet is a
high quality yet economical tool that enables learning while working and facilitates
competency achievement. It is now in its 3rd Edition with 50000 copies in
circulation/ The whole of South Central SHA has adopted it as have many NHS Trust,
two medical schools as well as private sector uptake. The current aim is to ensure
sustainability and continue encouraging uptake across the UK. It is a project for
patients, not for profit.
The book leads the learner and assessor through a structured yet simple process that
considers the core elements of professional understanding, theoretical knowledge
and practical skills and assessment. The book is aimed at a multidisciplinary
workforce, as part of inter professional learning and development. It can also be
adapted to encompass competency achievement within specialised care areas such as
paediatrics and neonates. Once completed it provides evidence of a solid
foundation of knowledge and a record of personal achievement.
Objectives
• Equip practitioner with relevant expertise to deliver high quality of care.
• Standardised and simplified training programme to enable competency
achievement.
• A flexible approach to education and training to promote high quality
learning that is also value for money.
• Improve skills transference between organisations/departments and limit
the need for unnecessary re-training.
• Reduce printing costs and re-inventing the wheel by
fellow trainers.
• Encourage fair, valid and reliable assessments.
• Adapt this successful framework for future
intravenous skills standardisation.
Vision
Standardise training and assessment for venepuncture and cannulation across the UK in
order to improve the experience for the patient receiving these procedures and the
learner acquiring them.
Philosophy
Fostering strong working relationships and shared learning between organisations
through collaborative work to create the best way forward for the patient, practitioner
and organisation.
Authors: Mary Collins, Sarah Phillips, Lisa Dougherty, &
Annie de Verteuil.
COPIES FROM www.Veintrain.co.uk

20. REFERENCES:
Bloomfield, J. Pegram, A and Jones, C. (2010) How to pass your OSCE:
A guide to success in Nursing and Midwifery. Harlow, Pearson
Education Ltd.
GMC (2015)Promoting excellence: standards for medical education and
training http://www.gmc-uk.org/education {accessed 3rd September
2015}
Health and care professions Council (2014) Standards of education and
training guidance. http://www.hcpc-
uk.org/assets/documents/10001A9DStandardsofeducationandtraininggu
idanceforeducationproviders.pdf {accessed 3rd September 2015}
Hughes, S.J. & Quinn, F.M. (2013) Quinn’s principles and practice of
nurse education. 6th ed. U.K. Cengage learning.
NMC(2015) The Code: Professional standards of practice and behaviour
for nurses and midwives
http://www.nmc.org.uk/globalassets/sitedocuments/nmc-
publications/revised-new-nmc-code.pdf {accessed 3rd September 2015}
Skills for Care and Skills for Health (2013) Code of Conduct for
Healthcare Support Workers and Adult Social Care Workers in England
(2013) http://www.skillsforhealth.org.uk/images/services/code-of-
conduct/Code%20of%20Conduct%20Healthcare%20Support.pdf
{accessed 3rd September 2015}
INTRODUCTION:
Learning the skill of venepuncture and/or cannulation requires
effective supervision and assessment.
The direct link to safeguarding the health and well being of the public warrants that
high priority is given to supervision and assessment of these skills. Effective and
well-supported supervision is key to ensuring that the Health Care professional
learning the skill/s of venepuncture and/or cannulation are fit for purpose upon
completion of the Structured Learning programme.
WHO IS THE ASSESSOR?
An expert with the required qualification who makes the final judgement
to determine the learner has achieved the knowledge, skills and
competence required to safely perform the skill/s being assessed. They
will have undertaken a relevant teaching qualification to develop the skills
in assessing the learners proficiency and remain accountable for their
decision
MEETING PROFESSIONAL REQUIREMENTS:
Allied Health Professional Council (2014) “Learning, teaching and
supervision must encourage safe and effective practice, independent
learning and professional conduct”.
General Medical Council (2015) “Supervisors must determine a learner’s
level of competence, confidence and experience”.
Nursing and Midwifery Council (2015) “support any staff you may be
responsible for to follow the Code at all times. They must have the
knowledge, skills and competence for safe practice”.
Skills for Care and Skills for Health (2013) “Strive to improve the quality of
healthcare, care and support through continuing professional development “.
The supervisor and assessor must maintain the professionalism and
reputation of their profession when assessing the learner. They must
have:
•Clinical currency and capability in the skill for which the learner is being
assessed
•A working knowledge of the Venepuncture and Cannulation Structured
learning programme
•An understanding of the regulator requirements for the individual learner
and the contribution they make to meet these requirements.
Supervisors must also have:
•Time to supervise, reflect and give feedback to the learner.
•Assessed the student on more than one occasion to see if competence
has been achieved and sustained; to ensure reliability.
Assessors must also have:
•Met their professional/organisational requirements to be an assessor.
•An in-depth understanding of their accountability to their profession and
organisation for the decision they make to pass or fail a learner when
assessing proficiency requirements at the final assessment.
WHO IS THE SUPERVISOR?
A supervisor is defined as someone who enables the professional and
personal growth of the learner. The have the clinical expertise in
venepuncture/cannulation to oversee the performance of the skill by the
learner. They must be currently practicing the skill on a weekly basis.
Core objectives achievable using the V&C programme to supervise and
assess learners are:
•Improve patient care
•Reduce risks to patients and staff
•Improve the patient journey and reduce waiting times
•Encourage access to training by making it flexible, appropriate and safe
The supervised practice assessments offer a holistic and integrated
approach to facilitate the learner to achieve core knowledge for the skills
they are working towards accomplishing. It enables the learner with an
opportunity to learn while working with direct access to patients and
supervisor/assessor.
A standardised approach to assessment reduces variations in
practice among supervisors and assessors. This standardisation aims to
provide transferable evidence for practitioners competence to perform
independently should they move to another healthcare organisation.
Using a Structured Learning programme to supervise and
assess skills of Venepuncture and Cannulation
E
n
a
b
l
i
n
g
s
u
p
e
r
v
i
s
o
r
Competency
pathway
Expert assessor
Safe Practitioner
Mary Collins, Senior Lecturer - Mentorship
and Practice Education, Kingston and St
George’s Joint Faculty
OSCE as an assessment tool for supervisors and assessors:
Bloomfield et al (2010) point out that an assessment using OSCE assesses
performance relating to the following:
Knowledge: a student’s knowledge and understanding of a particular skill
Motor: the motor or technical aspects of a skill
Attitude: the affective aspect or attitude associated with the performance of a
skill
Structure: how a student approaches a skill in terms of a systematic, logical
and organisational approach.
OSCE is a recognised assessment tool across all fields of healthcare. It offers
an important advantage to the supervisor and assessor to engage with the
student during the acquisition and assessment of skill/s and is a valid
examination for the formative and summative assessment (Hughes and
Quinn, 2013).
How To Use
the Structured
Learning
Programme
Collins 2015

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Clinicians first
responsibility
and personal
expectation
‘First do no
harm’

22. 22
The public are worried

23. Dramatic but still current
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24. 24

25. Dynamic arena - Technologies
that look odd but work well!
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VeinTrain 2014 highlight – Back to London!
Invited to Guys’ and St Thomas’ NHS Foundation
Trust (GSTT) for a large project that would benefit
from external resourcing

27. GSTT – Where the Intravenous
Therapy was already outstanding
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VeinTrain was immediately aware we
would be working in historically steeped
organisation with dynamic origins.

29. Where
History is
rightly
respected
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Where nursing
leadership is
strong, and
acknowledged
by the Nation
Chief Nurse,
Guys’ and St Thomas’s
NHS Foundation Trust
Dame Eilieen Sills,DBE

31. Where we were reminded how
much practice changes
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32. Visiting the Wards at St Thomas’s revealed lots of
implementation of best practice and high calibre professionals
Clearly still dynamic and leading edge
32
VeinTrain clinical walk around at
St Thomas’s Hospital, London

33. Which hosts students from the
UK/World Top University
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34. Guy’s and St Thomas’s, 2015
160 Nursing Students VeinTrained
1st for the UK
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35. Guy’s And St Thomas’s
160 Nursing Students
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36. Large Event lecture with high
trainer ratio workshops
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High trainer:learner ratios
And minimum of two limbs per trainer

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Time, space and equipment
management in any venue

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Nursing
Student
Feedback

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Comments
from Nursing
Students

41. Before we VeinTrain
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After
VeinTrain

43. King’s College 150 Medical
Students
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VeinTrain National
courses attract
delegates
from all clinical
backgrounds. This
can be difficult to
pitch, but
fascinating.

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A leap of faith into our new
Stunning Nottingham HQ

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Stunning Suite of Offices and
Training space in Nottingham HQ

50. Working on our business
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EU and Local Nottingham Angels Den achieves
our very own Dragon Consultant

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VeinTrain Ltd brand UK is recognised
and awarded support from DTI 2015

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• Webinars - Live
Training
• Instant referencing
• Communications
• Apps!
• Images
• Patient Information
Tapping into our
‘connected’ world
Locally, nationally,
globally

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LIVE Webinars
VeinTrainers come
to learners

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57. Certifcates only Certify
Attendance
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58. Reason for continuing to
challenge practice decades on
Professional Issues Continue
• Research – we still have issues
• It is simple to improve, albeit a challenge
Personal:
• “no we have not been trained but we will
have a go” GP receptionist at Sarah’s children annual blood
tests
• “you will not believe this…..” Photo messages from
friends
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Work is fascinating and essential
Studied an MA in Organisations
We spend a lot of time at work!
Out of 77 years of Life
Red is sleep! Pink, just behind, is work

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• Expertise and drive to improve
these skills
• Unmet need identified while in NHS
• Sole provider for the family
• Business qualification but remain
vocational
• Role model for clever young ladies.
Two diplomas, Two degrees and a
profession = ‘working’ mum!
MD Reason for working
on VeinTrain
Royal College of Surgeons, London,
where once women were not
permitted to be surgeons.

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:
Flexible Working hours
with occasional trips in to
‘help’ and boost morale.
“I can work 24 hours a
day, as long as I am not
late in the morning!”
The children like it and
small amounts of inclusion
is supported in
pyschoanalytic thinking for
secure attachment.
Benefits of building a
business for a family

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• Training in hospital could lead
to cancelled courses due to
rooms and staffing.
• As a company we are set up
not to need one individual.
• VeinTrain has never
cancelled a course on
trainer/service issues.
• Vein breaks are mandatory
for all the team, including the MD
Reliable Service

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