Development and evaluation of an electronic medical device training passport to identify nurses’ training needs
Intended for healthcare professionals
Evidence and practice    

Development and evaluation of an electronic medical device training passport to identify nurses’ training needs

Kellie-Jayne Mohess Critical care health informatics nurse lead, Guy’s and St Thomas’ NHS Foundation Trust, London, England
Jonathan Turner Lecturer, Centre for Health Informatics, City, University of London, London, England

Why you should read this article:
  • To recognise some of the factors that can make it challenging for nurses to access training and maintain competence in using medical devices

  • To learn about development of an electronic medical device training passport that aims to better identify nurses’ training needs

  • To understand the benefits of an electronic medical device training passport for nurses, nurse managers and clinical leaders

Background All nurses, particularly those working in critical care settings, are required to use medical devices when providing patient care. However, inconsistent practice and variations in documentation can make it challenging for nurses and nurse managers to identify what medical device training is required and when.

Aim To develop and evaluate the use of an electronic medical device training passport to identify the training needs of nurses in intensive care units (ICUs).

Method A pilot study was conducted in a multi-unit critical care department in London, England, to determine if the passport could make it easier to identify ICU nurses’ medical device training needs compared with existing practice. Nine participants were first asked to identify their needs using existing spreadsheets or paper records, then asked to identify them using the passport. The participants were also interviewed to identify their training requirements before and after using the passport. The data were analysed quantitatively and qualitatively.

Findings The electronic passport significantly improved identification of medical device training needs compared with paperwork or spreadsheets for all device groups, except for medical devices used on high dependency units (P≤0.005). However, there may be issues related to nurses’ behaviours and expectations, particularly that staff do not always recognise their need for training.

Conclusion The findings of this pilot study suggest that the use of an electronic medical device training passport has many benefits and could make it easier to identify ICU nurses’ training needs in clinical practice.

Nursing Management. doi: 10.7748/nm.2021.e2024

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

Kellie-Jayne.Mohess@gstt.nhs.uk

Conflict of interest

None declared

Mohess KJ, Turner J (2021) Development and evaluation of an electronic medical device training passport to identify nurses’ training needs. Nursing Management. doi: 10.7748/nm.2021.e2024

The authors wish to thank Neil Gallacher, head of informatics and audit (critical care), Karen Franklin, critical care health informatics nurse lead, and nurses in Guy’s and St Thomas’ NHS Foundation Trust critical care department

Published online: 20 December 2021

Background

The World Health Organization (2021) defines a medical device as ‘any instrument, apparatus, implement, machine, appliance, implant, reagent for in vitro use, software, material or other similar or related article, intended by the manufacturer to be used, alone or in combination, for a medical purpose.’ It is essential that staff working in clinical areas have appropriate training and competency assessments in the safe use of medical devices, including the ability to interpret results, manage complications and maintain up-to-date training records (Medicines and Healthcare products Regulatory Agency (MHRA) 2014, Ericole and Dean 2019, Thomas and Roberts 2019, Intensive Care Society 2021).

Intensive Care Society (2021) guidelines and standards for critical care in the UK reflect the Care Quality Commission (CQC) (2017) requirement for healthcare services to maintain records of training and competence in the use of medical devices. However, this essential requirement is often overlooked and there is a lack of research on how medical device training, competence and documentation can be achieved (Thomas and Roberts 2019).

Box 1 lists some of the factors that can make it challenging for healthcare professionals to access and maintain medical device training and competence.

Box 1.

Factors that can make it challenging for healthcare professionals to access and maintain medical device training and competence

  • Staff turnover

  • Diverse medical device types

  • Migration of staff between specific clinical areas

  • Infrequent use of items of equipment

  • Lack of training resources

  • Lack of a system to track, document and manage the training status of staff

  • Challenges in communicating details of device risks

  • Increasing complexity of device function and operation

  • No consensus about which medical devices healthcare professionals should be trained in using and when they should be trained

  • Increasing time pressures

  • Lack of managerial support

  • Demands of the clinical environment

  • Healthcare professionals not recognising the need for training

(Brand 2012, Ewertsson et al 2015, Clarkson 2017)

Guy’s and St Thomas’ NHS Foundation Trust in London, England, has a large critical care department comprising ten intensive care units (ICUs) and high dependency units with approximately 600 nursing staff, so maintaining up-to-date medical device training records can be challenging. The Intensive Care Society’s Standard for Equipment in Critical Care (Thomas and Roberts 2019) provides some guidance on how to improve medical device training and competence among clinical staff, which is summarised in Box 2. Based on this information, accurate documentation appears to be central to addressing many of the factors detailed in Box 1, particularly in relation to staff turnover and movement between departments.

Box 2.

Summary of Intensive Care Society’s guidance on improving medical device training and competence

  • Have a register of what equipment staff are expected to use

  • Identify what different staff groups are expected to know about each medical device

  • Have a register of what training and competency assessment each staff member has received and at what level

  • Have clear expectations for different medical devices of what temporary staff members can or cannot do

  • Plan and assess the training needs of all new starters

  • Provide ‘just in time’ training resources for staff to access at the point of care

(Thomas and Roberts 2019)

Using an electronic training passport was identified by the researcher (author KJM) as a potential way to improve and document medical device training and competence records for critical care nursing staff at Guy’s and St Thomas’ NHS Foundation Trust. Before the pilot study, practice at the trust for maintaining records was not standardised and records were held in multiple repositories that were not easily accessible for staff or managers. Although there is limited literature on the topic, the challenges associated with maintaining medical device training records are potentially widespread across many NHS trusts. For example, the Black Country Partnership NHS Foundation Trust (2019), now called the Black Country Healthcare NHS Foundation Trust following a merger in April 2020, had a bespoke central medical equipment repository maintained by designated staff within the medical physics and clinical engineering department and was reliant on local managers collecting training information for their staff.

Competency and training passports

Several authors have investigated the use of competency and training passports in areas other than medical devices (Hickerson et al 2016, McKew 2017, Read 2017, Maxwell-Murphy 2018). The potential benefits of such passports reported in their work are summarised in Box 3.

Box 3.

Potential benefits of competency and training passports

  • Enable learners to seek out their own opportunities

  • Improve retention by encouraging staff to pursue professional development opportunities

  • Assist with Nursing and Midwifery Council (NMC) revalidation

  • Standardise nursing practice

  • Identify training gaps

  • Reduce training duplication costs

  • Reduce waste of limited training places

  • Support and improve recruitment

(Hickerson et al 2016, McKew 2017, Read 2017, Maxwell-Murphy 2018)

Maxwell-Murphy (2018) discussed the potential implementation of neonatal nurse passports to improve staff training, competency, recruitment and retention and suggested that using them to record work history, training, education and competency history could enable nurses to move easily within a critical care network – which provides collaborative care delivery within a specific geographic area - without having to retrain.

As part of a pilot study that aimed to increase novice nurses’ (n=40) knowledge, competence and preceptor experience in a paediatric ICU, Hickerson et al (2016) developed a competency passport to record their progress. The authors reported that one of the benefits was that the passport revealed competency and skills gaps which alerted novice nurses and their preceptors to seek opportunities for learning and teaching these skills. Read (2017), meanwhile, who undertook a prospective evaluation of the effects of introducing a ‘clinical skills passport’ on US medical students (n=337), found that the document increased participants’ reporting of their performance of basic clinical skills.

The UK Oncology Nursing Society (2018) launched the Systemic Anti-Cancer Therapy Competency Passport in 2018 to reduce variation in skills and competency assessments in London NHS trusts. This passport is an educational tool consisting of theoretical and competency elements to train and assess chemotherapy skills for cancer nurses and provides a standardised and portable approach to training and competency, enabling nurses to move between London NHS trusts without having to retrain. The passport could be adopted across the UK (McKew 2017), although this would require a nationally agreed set of standards to ensure nurses working in different geographical locations have the same skill sets to provide consistent care.

NHS Wales (2003) has a training passport for manual handling that is used across its health boards, enabling nurses who have undertaken this training to work anywhere in Wales without having to retrain. However, although the scheme has been running since 2003 there does not appear to be published research on its benefits or effectiveness.

The MHRA initiated a project in 2010 to develop a Medical Device Driving Licence (2019) that was intended to lead national standards. However, although this appeared to be a promising initiative, when the authors reviewed the medical devices listed in the licence they found the number was small compared with the number used in the UK for which staff require training. The project ended at the end of 2019.

While research on training and competency passports is limited, the potential benefits shown in Box 3 suggest they could assist in meeting the requirements for medical device training and competency documentation. Such a passport could make it easier for nurses, their managers and nurse leaders to manage medical device training needs and to maintain the records required by the CQC.

This article describes a pilot study of the development and evaluation of an electronic method of identifying and documenting ICU nurses’ medical device training requirements.

Implications for practice

  • The use of an electronic medical device training passport has many potential benefits for nurses, nurse managers and clinical leaders and is well suited to meet requirements for medical device training documentation

  • An electronic medical device training passport could provide a central repository for training documentation that is easily accessible for nurses and managers and could be portable between departments and employers

  • The electronic medical device training passport could reduce the time and resources required to retrain nurses to enable them to practise safely in different environments

  • In the context of the coronavirus disease 2019 (COVID-19) pandemic, during which staff have been redeployed to different clinical environments, using an electronic medical device training passport could identify what medical device training is required for individual nurses

Aim

To develop and evaluate the use of an electronic medical device training passport to identify the training needs of ICU nurses. The electronic medical device training passport is a desktop application which nurses can access to update their records. These records are then validated by their managers. Nurses can print out or ‘save’ their own passport on the system and managers can access the passports of staff that they manage.

Method

This pilot study was conducted between June 2019 and January 2020 in Guy’s and St Thomas’ NHS Foundation Trust’s critical care department, which comprises ten units across three hospital sites. Only nurses working in the ICUs were recruited as they are often deployed to other critical care areas so have the most exposure to different medical devices. A total of 11 nurses volunteered to participate but only nine were included due to time limits and availability. Six of the participants were band 6 nurses and three were band 7.

Development of the electronic medical device training passport

Box 4 lists the functional requirements of an electronic medical device training passport which were identified based on the literature. These functions would ensure that medical device documentation was accurate and would help staff to identify their training requirements easily.

Box 4.

Functional requirements of an electronic medical device training passport

  • Lists medical devices by category

  • Lists all the medical devices that are used in the critical care department

  • Highlights if the competency date has passed but training is still required

  • Highlights if no values are present on the date of training or competency date

  • Shows only the latest data entry, even if there are multiple entries for training dates or competency

  • Produces individual training records for nurses

  • Provides a warning if it is more than three years since a training date

  • Restricts selection of devices to appropriate nurse grades only

  • Highlights if it is more than one year since a competency date

  • Confirms the identity of the nurse

  • Identifies what the requirement is – training or competency assessment

  • Identifies which units the medical devices are used in

To achieve these functions, the electronic medical device training passport required the following technical functionality:

  • An application in which medical device training data can be entered into the Structured Query Language (SQL) database.

  • An SQL database that can store nurses’ medical device training data.

  • An output in the form of a medical device training passport.

To fulfil these technical requirements, three tools were used to develop the medical device training passport application:

  • SQL Server 2008 - this was used to develop a SQL database that could store and update medical device training dates.

  • ASP.NET MVC using Visual Studio 2019 - this was used to develop the create, read, update and delete functions of the application so that data could be entered into the SQL database.

  • Microsoft Report Builder 2019 - this was used to develop the medical device training passport output.

Figure 1 shows an example screen of part of the medical device training passport output that was built for the project which met the functional requirements outlined in Box 4. The training and competency assessments required are highlighted in red, while the ‘in date’ and ‘correct’ training is shown in green. Some medical devices are greyed out because they are not required by that nurse based on their band or level of experience, but they may still require, or have had, training and/or competency assessments if they have had to use a particular device in their clinical practice.

Figure 1.

Example screen of part of the medical device training passport output

nm.2021.e2024_0001.jpg

Data collection and analysis

There were two parts to the data collection and analysis in this pilot study. Participants were first asked to identify their medical device competence and training needs using existing spreadsheets or paper records, then asked to identify these using the medical device training passport. The information used to generate the medical device training passport database came from the existing paper training and competency documents that the participants had completed. The participants were interviewed and asked standard, pre-determined questions to identify their training requirements before and after using the medical device training passport. The interviews were transcribed verbatim and analysed.

Quantitative data were used to identify how accurately nurses could determine their training needs on different medical devices before and after using the passport. Correct answers were determined by counting the number of medical devices that had outstanding training requirements. The passport was used to determine the correct answers since it contained the up-to-date training and competence information collected from participants’ paperwork and spreadsheets.

The interview data were analysed qualitatively using thematic analysis (Braun and Clarke 2006). All data obtained were anonymised to maintain confidentiality.

Ethical approval

Ethical approval was obtained from the Health Research Authority and from Guy’s and St Thomas’ NHS Foundation Trust.

Findings

Quantitative findings

The nine participants were asked to list which devices they required training for, first using existing paper records or spreadsheets, then using the medical device training passport. Table 1 shows participants’ correct identification of their training needs before using and when using the medical device training passport. In each cell, the first number relates to devices identified correctly as requiring training, while the second number is the participant’s total number of training and competency requirements for that category. For the purpose of the pilot study, participants were asked to identify only those devices for which they required training or retraining, meaning that there was a different total number of devices for each participant.

Table 1.

Participants’ correct identification of their training needs before using and when using the medical device training passport

nm.2021.e2024_0001_tb1.jpg

To determine whether there was significant improvement between existing methods and the passport in identifying training needs, a paired t-test was conducted on each of the categories of medical devices asked about in the interviews. A significance level of P <0.05 was used.

The null hypothesis was ‘there is no difference in the identification of training needs using existing methods and using the medical device training passport’. For all device groups, except for medical devices used on high dependency units, the P value was ≤0.005, indicating that the passport improved identification of medical device training needs significantly compared with paperwork or spreadsheets. Specifically, there was significant improvement in identification of cardiac, respiratory, emergency and ‘any other’ medical device training needs, but not the medical devices used on high dependency units (P=0.129).

Qualitative findings

The themes generated from analysis of the interview data are shown in Box 5.

Box 5.

Themes generated from analysis of the interview data

Themes from interviews conducted before using the electronic medical device training passport

  • Methods to identify training needs

  • Uncertainty (in general, about training needs, about medical device use)

  • Misinformation

  • Medical device used without training

  • Confidence

  • Difficulties in identifying training needs

  • Ease in identifying training needs

  • Recognition of training needs

Themes from interviews conducted after using the electronic medical device training passport

  • List medical device with ease

  • List medical device with difficulty

  • Uncertainty (in general, about training needs, about medical device use)

  • Suggestions for improvement

  • Misinformation (about paper documentation, about training needs)

  • Recognition of training needs

  • Use of electronic medical device training passport (positive responses, negative responses)

Findings from the first interviews, which were conducted before using the medical device training passport, showed that the methods participants used to identify their training needs were memory, experience, competency and training paperwork and/or training session certificates. Although spreadsheets containing their training information were available, participants did not use them. The methods they used often caused uncertainty or provided misinformation about specific areas. For example, participants made statements such as:

‘I don’t know how often we need to be trained.’ (Nurse 1).

‘I think I’m mostly up to date [when they were not].’ (Nurse 6).

‘I was not quite sure about all of the pumps training.’ (Nurse 2).

‘This form doesn’t say exactly what you need to have training on once you have had it.’ (Nurse 4).

Participants also made various comments that suggested they used medical devices such as new ventilators and defibrillators without training. These comments included:

‘I don’t think I need training on the defibrillator because I know how to use this anyway.’ (Nurse 8).

‘The new ventilator that is the upgrade from the old ventilator [that] I never had official training on.’ (Nurse 5).

The only section where participants could answer questions about their training needs with ease was medical devices used on other units.

During the second interviews, which were conducted after using the passport, participants were asked what their thoughts were on using the medical device training passport to identify their training needs. They reported that the passport was similar to the existing systems used at the trust in terms of its layout in alphabetical order, by body system and colour coding.

One participant said the passport was unclear about which competency assessment and what training was required, which indicated that the information displayed to the user could be improved to make it easier to find.

In terms of recognising their training needs, participants could list the medical devices for which they required training, but they often included devices for which competency assessment was required. The following comment illustrates this conflation:

‘Yep, the [pulmonary artery] catheter output monitoring, fem stops [FemoStop], pacing boxes, oh and these as they are red, but they are in date though, oh right it’s training I need rather than competency assessment. Well, I must have been trained to be assessed as competent. Oh, but you can self-assess competency too, can’t you? That’s what I must have done. PiCCO, dual-chamber pacing and LiDCO. That’s a lot.’ (Nurse 1).

Discussion

There are numerous devices for which nurses require training and competence to enable them to use them safely and this requires careful management of records. The medical device training passport provides a central, accessible, easily updated and nurse-centred repository of this information.

The quantitative findings of this pilot study suggest that the electronic medical device training passport could improve identification of nurses’ medical device training needs if it was implemented in practice. The qualitative findings show that the passport enables easy identification of training needs, since it is in a similar format to existing mandatory training records - that is colour coded, in alphabetical order and ordered by body system and ‘other’ devices. However, some participants were uncertain about their training requirements for some medical devices due to the frequency of training and competency assessment.

For the purpose of the pilot, a typical training interval of three years was added as a condition on the electronic medical device training passport, in line with the revalidation requirements of the Nursing and Midwifery Council (2019). For example, some participants said they had completed training on certain medical devices despite a red warning label on the passport alerting them that they required training or retraining. In addition, despite their familiarity with the existing record-keeping systems, it appeared that some participants were unable to identify their training needs fully.

Box 6

lists the benefits of using an electronic medical device training passport for nurses and managers. Further research is required to determine the extent of these benefits.

  • Meets the documentation requirements of the Care Quality Commission (2017)

  • Identifies what training needs to be made available to staff

  • Increases managerial support for staff by helping managers to identify training requirements efficiently and initiate relevant training

  • Guides discussions about the frequency of training required

  • Assesses whether existing training meets the needs of staff using different medical devices

  • Reviews training records for new and redeployed nursing staff easily

  • Guides discussions regarding what training is required in the upcoming year during appraisals and Nursing and Midwifery Council (2019) revalidation

  • Guides discussions when staff wrongly believe they do not need training

  • New medical devices can be added easily to the passport

  • Easily validates nurse entries of medical device training and competence

  • Standardises nursing practice in clinical areas

  • Reduces costs because there is no need for duplication of training for new and redeployed staff

  • Enables open discussions with staff if there is uncertainty about their training requirements

Limitations

The sample size for this pilot study was small since only nine out of more than 350 ICU nurses in the trust’s critical care department participated due to time pressures and availability issues. Although the information gathered through the interviews was valuable for providing preliminary findings on whether using an electronic medical device training passport could improve identification of training needs, further research should be conducted with a larger sample, a wider range of bands and in different clinical areas to fully assess its effectiveness.

Conclusion

This pilot study explored whether using an electronic medical device training passport could improve the identification of training needs for ICU nurses working in a multi-unit critical care department.

The quantitative findings suggested that there was an overall improvement in nurses’ identification of their training needs. However, the qualitative findings indicated that there may be issues related to nurses’ behaviours and expectations, particularly that staff do not always recognise their need for training even when this information is presented to them clearly.

Despite these issues, the findings of this pilot study suggest that the electronic medical device training passport could improve identification of training needs if implemented in practice.

References

  1. Black Country Partnership NHS Foundation Trust (2019) Standard Operating Procedure 4 (SOP 4). Training - User Training on Medical Devices. http://www.bcpft.nhs.uk/documents/policies/m/919-medical-devices-sop-4-training-user-training-on-medical-devices/file (Last accessed: 29 November 2021.)
  2. Brand D (2012) Just a piece of equipment? The importance of medical device education. Journal of Perioperative Practice. 22, 12, 380-382. doi: 10.1177/175045891602201202
  3. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology. 3, 2, 77-101. doi: 10.1191/1478088706qp063oa
  4. Care Quality Commission (2017) Staff Skills and Knowledge (Healthcare Services). http://cqc.org.uk/guidance-providers/healthcare/staff-skills-knowledge-healthcare-services (Last accessed: 29 November 2021.)
  5. Clarkson DM (2017) Medical Device Guidebook: a browser information resource for medical device users. Medical Engineering & Physics. 41, 97-102. doi: 10.1016/j.medengphy.2017.01.013
  6. Ericole A, Dean P (2019) Guidelines for the Provision of Intensive Care Services. Faculty of Intensive Care Medicine and Intensive Care Society, London.
  7. Ewertsson M, Gustafsson M, Blomberg K et al (2015) Use of technical skills and medical devices among new registered nurses: a questionnaire study. Nurse Education Today. 35, 12, 1169-1174. doi: 10.1016/j.nedt.2015.05.006
  8. Hickerson K, Terhaar MF, Taylor LA (2016) Preceptor support to improve nurse competency and satisfaction: a pilot study of novice nurses and preceptors in a pediatric intensive care unit. Journal of Nursing Education and Practice. 6, 12, 57-62. doi: 10.5430/jnep.v6n12p57
  9. Intensive Care Society (2021) Guidelines. http://ics.ac.uk/Society/Guidance/Guidance (Last accessed: 29 November 2021.)
  10. Maxwell-Murphy H (2018) Obtain and retain: the potential implementation and use of a neonatal nurse passport to improve training, competency, recruitment and retention. Journal of Neonatal Nursing. 26, 6, 287-342. doi: 10.1016/j.jnn.2018.05.006
  11. McKew M (2017) Competency ‘passport’ aims to cut training and transition times between jobs. Cancer Nursing Practice. 16, 8 , 8-9. doi: 10.7748/cnp.16.8.8.s8
  12. Medical Device Driving Licence (2019) Medical Device Driving Licence. http://web.archive.org/web/20190128051438/http:/www.mddl.org.uk/mddl (Last accessed: 29 November 2021.)
  13. Medicines and Healthcare products Regulatory Agency (2014) Devices in Practice: Checklists for Using Medical Devices. http://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/403401/Devices_in_practice.pdf (Last accessed: 29 November 2021.)
  14. NHS Wales (2003) All Wales Manual Handling Training Passport & Information Scheme. http://wales.nhs.uk/documents/nhs_manual_handling_passpor.pdf (Last accessed: 29 November 2021.)
  15. Nursing and Midwifery Council (2019) Revalidation: How to Revalidate with the NMC. http://nmc.org.uk/globalassets/sitedocuments/revalidation/how-to-revalidate-booklet.pdf (Last accessed: 29 November 2021.)
  16. Read TE (2017) Clinical skills passport: a method to increase participation in clinical skills by medical students during a surgery clerkship. Journal of Surgical Education. 74, 6, 975-979. doi: 10.1016/j.jsurg.2017.05.015
  17. Thomas AN, Roberts JC (2019) Standard for Equipment in Critical Care. Intensive Care Society, London.
  18. UK Oncology Nursing Society (2018) Systemic Anti-Cancer Therapy (SACT) Competency Passport: Oral, Intravenous, Subcutaneous and Intramuscular SACT Administration for Adult Patients. http://ukons.org/site/assets/files/1138/ukons_sact_passport.pdf (Last accessed: 29 November 2021.)
  19. World Health Organization ( 2021) Medical Devices. http://who.int/health-topics/medical-devices (Last accessed: 29 November 2021.)

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