ATP back office procedures

CET: ATP Back Office

Authority to Practice Assessments at Wellington Free Ambulance

Back Office/Administrative Guide

Authority to Practice (ATP) ATP is the term used to describe the current practice level of a Paramedic. ATP is the nationally agreed term for this. WFA has traditionally used the term right of practice, or ROP. The two terms are interchangeable, but ATP is the nationally agreed term and as

training materials are updated there will be further references to ROP.


Version Control

Change Added by Date Intern RCC overview Todd Mushet 01 Feb 2012


On Road Assessments On road assessments are the last opportunity for WFA to ensure the safety of Paramedics who are challenging higher Authority to Practice (ATP) levels. It is important that such assessments are approached consistently in order to ensure procedural fairness and transparency for Paramedics who are being assessed, and to ensure patient and organisational safety. The ATP process also involves several different business units (AS Operations, Training and Clinical) working together in process that can appear to be complicated to those involved - thus it is important to ensure that all contributors are aware of their roles and responsibilities

Roles and Responsibilities Paramedic The Paramedic requesting an ATP assessment is responsible for initiating the ATP request on AXIS and for working within the system rather than trying to circumvent it. The Paramedic must also take responsibility for not attempting an ATP assessment until adequately prepared both in terms of clinical consolidation, and in completing educational AXIS ATP Process: Initiate request, forward evidence to Clinical Educators. Team Manager Operations (TMO) TMOs have responsibility for ensuring that Paramedics are not put forward for assessments until they have had appropriate on road consolidation time, and for approving the AXIS ATP requests. It is a reasonable expectation that ATP requests will not be declined without TMOs counselling staff thoroughly on the rationale for this, and offering development goals, and a time frame before any further ATP requests will be entertained. While the assessment is in progress TMOs must ensure that dispatchers are aware that the crew is an assessment crew, and should not be split. AXIS ATP Process: Approve or decline request


Clinical Educators The Clinical Educators have oversight of the process and will problem solve any assessment issues. The Clinical Educators also moderate the assessment papers returned by assessors. Where the candidate is required to provide educational evidence for the ATP assessment this is forwarded to the Clinical Educators for review prior to the assessment. AXIS ATP Process: approve or decline assessor/Paramedic combination Roster Specialist The Roster Specialist role is pivotal in terms of tying the whole process together. The roster specialist will:

• Identify an approved assessor / candidate combination

• Trying to ensure that the assessment is triple crewed where possible (ILS and higher assessments especially)

• Make appropriate running sheet/roster changes

• Forward the combination to the Clinical educators for approval

Length of Assessment ATP Level Length of Assessment Triple Crewed Notes BLS 4 days No ILS 4-8 days Yes ALS A / ALS B 2 days Yes Obsolete from 2011

onwards ALS 4 days Yes Return to Practice 2-4 days Yes – desirable Length of Assessment

determined by Clinical Educators

NB: for the purposes of this table 1 day = one 11 or 13 hour shift.


Training Administrator This is again a pivotal role in terms of coordinating different aspects of the process. Once the assessor / Paramedic combination has been approved administrator take responsibility for:

- Sending out assessment materials to the assessor and Paramedic - Clicking on the calendar link in AXIS to give the date when the papers where

mailed out - Entering assessment dates in the “Training Shared” calendar on outlook.

AXIS ATP Process: Click on calendar link when assessment papers are mailed out, and again when assessment papers are received back. Assessors Assessors are responsible for carrying out a fair and objective assessment of the candidate. Remuneration is paid to assessors under the CEA for conducting an on road assessment. A variety of different evidence sources can be used:

- Viewing of Clinical Skills log - Feedback from colleagues/ mentors and trainers - Clinical skills lab assessment - On Job assessment

AXIS ATP Process: Assessors are responsible for completing the AXIS workflow relating to the assessment, clicking on a competent or not yet competent button and then on a calendar link when the assessment paperwork is sent to the training administrator.


WFA Approved Assessors Assessors are identified by the Clinical Educators and the Training Manager annually. This is a position of responsibility - thus Training Service and AS Operations reserve the right to use or not use any assessor for any assessment process. The essential person specification for assessors is set out below: Assessor Person Specification: Essential Characteristics

- CE Compliant - Hold ATP for the qualification being assessed - Have completed the WFA PACT mentoring course

Assessor Person Specification: Desirable Characteristics

- Hold US 4098: use unit standards to assess candidate performance

- Completing the National Certificate in Adult Education and Training (Level 5) Most importantly assessors must be capable of having an objective outlook relating to assessments, and must also have clinical credibility amongst colleagues. The list of approved assessors will be updated once a year and assessors must complete at least one assessment per year in order to remain current. AS operations have the ability to veto any assessor on the Assessor list. Triple Crewing Triple crewing or the provision of a driving officer for an assessment gives the candidate and the assessor the opportunity to completely focus on a thorough and fair assessment. Triple crewing also helps to protect WFA from any vicarious liability resulting from on road assessments. Triple crewing is therefore extremely desirable for all on road assessment from ILS and above – though this is subject to operational demand. Assessor ATP Levels Assessors can assess up to and including the level of their current ROP. In practise though, it is often desirable for candidates to be assessed by an assessor with an ATP one level higher than the level being assessed.


BLS Assessments BLS assessments are conducted by an approved assessor over a 4 day period. BLS assessment crews will remain on the deployment plan. These assessments may be double crewed, though it is desirable that BLS assessments are triple crewed where possible. Grandfathered ALS A and ALS B assessments There will still be a few Paramedics who have trained under the conventional vocational pathway, and need ATP assessments at ALS A and B. These assessments will be undertaken by an approved assessor as a 4 day assessment. Assessors for these assessments should hold ILS ATP. These assessments must be triple crewed, and these assessment crews will remain on the deployment plan. It is projected that no further ALS A and ALS B assessments will be need from January 2011 (as the transition over to the ILS pathway becomes complete). ILS Assessments ILS assessments involve the consolidation of a large number of interventions and medications – thus they will generally be undertaken by the Clinical Educators as an 8 day assessment. ILS assessment crews will remain on the deployment plan. ILS assessments must be triple crewed for at least the first 4 days of the assessment. In rare circumstances, the assessor can end the assessment after the first 4 days but will need to demonstrate that a high caseload with appropriate work was encountered. If the assessor is not able to give a competent grade to the student after 4 days of assessment and there is no triple crew available for the remaining 4 days the assessment needs to be stopped and then rescheduled. If the Clinical Educators are unavailable to complete the ILS assessment then assessor from the list of approved assessors may be used. ALS/ALS Assessments ALS assessments will be carried out by assessors selected by the Clinical Manager, and will be conducted over a 4 day period. Dependant on workload, and the evidence needed for the assessment ALS assessment crews may be removed from the deployment plan. These are summative assessments, and involve an ATP with a significant number of invasive skills – thus ALS assessments must always be triple crewed.


Driving Assessments All driving assessments will be undertaken by the WFA Driving Educator. Candidates complete a 4 day driving course, and then an urgent driving assessment 3 months after initially qualifying. Candidates should contact the Driving Educator directly to organise these assessments. Manual Handling Trainers These Paramedics have completed a manual handling train the trainer course and are accredited to deliver initial manual handling training, conduct assessment centres and remedial training as appropriate.




Appendix 1: Assessor Briefing

Assessor Information Firstly thank you for agreeing to complete this assessment. WFA relies on approved assessors such as you to complete most ATP assessments, and your efforts are very much appreciated! It is important before beginning the assessment to outline some roles and expectations, and to answer some frequently answered questions (FAQ). Fairness and Objectiveness It is expected that approved assessors will approach each assessment with the aim of facilitating learning experiences – and ensuring safety to practice at the desired ATP level. Remember that candidates have already done the hard work! - Most non clinical assessments (station scenarios, skills labs) should take place in daylight hours when candidates and assessors are best placed to participate. Fatigue and other factors can be counterproductive if these assessments are carried out overnight. The clinical demands of night shift are enough without the added stressors of in depth theoretical discussions! Triple Crewing Most ATP assessments are now triple crewed – this is to ensure a fair, objective and above all safe assessment. The expectation is that given that you are being paid to complete this assessment you will be in the patient compartment with the candidate, either helping with patient care or assessing further. Delegated Authority to Practice Most candidates will be challenging for an ATP higher than their current level. This means that you will still have overall clinical responsibility for the care being delivered. This means that when the candidate is providing skills and interventions for the higher ATP they:

- Must always be under your direct supervision - Must have proof of sign off from a Clinical educator or Degree Lecturer - Must have you sign for PRFs where they have exceeded their current ATP

Do I need to see them do every skill from the ATP they are going for?


No, but you need to be satisfied that they can safely deliver the skills and medications from the desired ATP. You can use various form of evidence for this – including:

- Log books - Skill sessions - Station Scenarios - Feedback from mentors and colleagues

I have not seen enough to safely assess the candidate - what now? If you feel that you cannot safely pass the candidate due to workload or cases seen then you have to assess them as not yet competent (NYC) and explain why. In most cases the candidate can simply complete a shorter assessment period and demonstrate competency from this additional assessment period. Do I have to do all this paperwork? Yes. Start the paperwork early on and complete it progressively throughout the shift – this way there is not as much to do at the conclusion of the shift. We need as much detail in the assessment paperwork as possible – because these are audited. Remember to sign and date the paperwork, and indicate the result of the assessment! Sending the paperwork in promptly means the candidate gets their ATP quickly! What about the AXIS workflow? Simply click on the competent or not yet competent box as appropriate. Remember to click on the calendar box so that the training administrator knows when the paperwork was sent back in. Please do not send assessment paperwork back through the internal mail system – use the provided SAE. Skills Lab Sessions Contact the Clinical Educators, or your TMO to access skills lab equipment. Airway training equipment is available at JVL, PAS, PPM and LHAS.


Measurement, Reporting and Audits

Records Kept: N/A Destroyed: 3 years Analysed By: Training Manager Reported On: N/A Internally Audited: This is not a process, therefore does not require any

auditing. Document Review: annually (Last review May 25 2012)

Documents

ATP back office procedures