Category 1 Approval Submission Template

Category 1 Approval Submission Template

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
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

Open Disclosure

1. Programme Title:

Date

Date:

2. Please indicate if the submission relates to a:

Conference No/ Yes

SeminarNo/ Yes

Study DayYes

Short courseNo/ Yes

E-learningNo/ Yes

Other (specify)

3. Is this programme available to external applicants?

No/ Yes

Name

4. Programme Facilitator:

Title

Title:

e.g. Clinical Nurse Specialist

Professional Qualifications

e.g. SRN. RM. Clinical Nurse Specialist

Academic Qualifications:

Name and Address

Organisation, Name

and address:

e.g. Division of General Nursing

Professional Registration

Details:

PIN xxxx

Personal Identification No.

5. Other Course personnel (as relevant)

Name
  1. Name:

e.g. MSc Healthcare (Risk Management & Quality) etc.

Qualifications:

xxxx

Registration No.

  1. Name:

Qualifications:

Registration No.

  1. 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

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)

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 / Introduction & Overview of PILOT SITE OC proposal & their role in its implementation.
15 mins / Overview of Open Disclosure to include:
  • Definition
  • 10 principles of Open Disclosure
  • Summary components
  • Exercise 1 – Case Reflection

15 mins / Overview of Adverse Events to include:
  • Definition
  • Breakdown of outcomes for patients
  • Statistics
  • Claims data

10 mins / 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
  • Exercise 2: Watch DVD – list the patients expectations
  • Group discussion
  • Feedback and general information/research based evidence
  • CIS exploratory study

Break 15 mins
30 mins / Adverse Events - The Clinician’s perspective and considerations
  • 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

30mins / 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
30 mins / Putting it all into practice:
Exercise 5: Role play using real case scenarios
Divide into groups of 3 – every person will play the role of doctor,
patient and observer.
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 completethepost 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 completethepost training-evaluation form to assess learning and influence future training programmes.

18. Programme Evaluation (if applicable)

Evaluation:Trainees will completethepost 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______

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
Phone Number / +353 phone number
Email Address / Email address
Website /
Date: / Date

22.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
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
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 / CEU / Approved by / Posted on website:

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