Developments in patient care with focussed, point of care ultrasound

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Recent technological advancements and improvements have resulted in ultrasound machines evolving into smaller, more portable and affordable devices. Consequently, the application of focussed, or Point of Care Ultrasound (POCUS) by a broader range of medical and allied health professionals has become widespread, writes Tanya Carleton.

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As the Peak Body for Ultrasound in Australia and New Zealand, the Australasian Society for Ultrasound in Medicine (ASUM) has a core purpose to promote the highest possible standards of medical ultrasound and meets this responsibility through delivery of the Certificate of Clinician Performed Ultrasound (CCPU) and Certificate of Allied Health Performed Ultrasound (CAHPU) Programs. Units within these programs qualify clinical competency in medical and allied health professional use of POCUS and result in industry recognised certification.
Since the 2013 article, The Speed of Ultrasound, was published in Australian Hospital and Healthcare Bulletin, ASUM’s level of engagement through membership and enrolment in the CCPU has significantly increased, which reflects the growth in the widespread application of POCUS. Additionally, the CAHPU has been implemented to parallel the CCPU while specifically addressing the needs of allied health professionals using ultrasound in their workplace. The CAHPU has been rolled out with exceptionally positive acceptance and engagement throughout the allied health professional community.
One of ASUM’s primary roles is to set appropriate standards of practice for the ultrasound profession and to advise government and statutory authorities on aspects of ultrasound practice. In response to the growth in POCUS, ASUM has advised the Federal Government that the CCPU and CAHPU programs ensure safe and effective practice and quality patient care through a national framework of standards that reflect excellence in education, training, benchmark standards, credentialing and recertification requirements.
ASUM’s benchmark standards for all accredited course providers include:

• A minimum standard for machine: participant ratio of 1:5


• A minimum standard for instructor: participant ratio of 1:5


• The presence of a clinician (who has experience performing the techniques being taught) as faculty


• Teaching (including practical) hours should meet or exceed those published in the CCPU syllabus that the course aligns with


• The provision of pre and post-course tests


• The provision of learning material


• The provision of appropriate models and patients (simulators to demonstrate some pathologies)


• Course feedback forms that include the following two comments:
  
  
  
  1. ‘Did the faculty clinician adequately address   your clinical concerns?’
  
  
  2. ‘Please contact ASUM about any concerns with this course.’
  
  
  
  

Since ASUM has introduced these benchmark standards, the number of accredited course applications has skyrocketed. ASUM has approved 13 course applications since the beginning of 2014 alone! The successful implementation of the Vascular Access, E-FAST, Basic Monitoring the Fetus (2nd and 3rd Trimester), Soft tissue for Nurses and Soft Tissue for Physiotherapy, Introduction to Neonatal Ultrasound and Advanced Neonatal Ultrasound units in the CAHPU program has led to a decision that ASUM will now develop two more CAHPU units: Early Pregnancy and Follicular Tracking for IVF nurses.
ASUM is the national leader in developing educational and training resources to meet the needs of emergency nurses, nurse midwives, physiotherapists, podiatrists, neonatal nurse practitioners, paramedics and other allied health professionals using POCUS and recognises the important role that allied health professionals play in delivering patient care. ASUM places a priority on the continual development of professional relationships with allied professional organisations including the Australian College of Midwives and the Australian College of Nurse Practitioners, The Australian Physiotherapy Association and the Australian Podiatry Council. ASUM recently held its first introduction to the CAHPU program in Perth for nurse midwives in Western Australia. This event was attended by more than 35 midwives, many who work in rural and remote communities. It introduced the Basic Monitoring the Fetus (2nd and 3rd Trimester) unit for midwives. This unit provides education and skills training for midwives in the effective use of ultrasound to assist in evaluating fetal lie, fetal heartbeat and amniotic fluid. There is a unique need for the application of ultrasound by midwives in rural and remote communities where distance may be a barrier to urgent and specialised patient care. ASUM is now developing and early pregnancy unit for midwives which will further serve the needs of midwives in pregnancy dating and viability.

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“ASUM is the national leader in developing educational and training resources to  meet the needs of emergency nurses,  nurse midwives, physiotherapists, podiatrists, neonatal nurse practitioners, paramedics and other allied health professionals using POCUS and recognises the important role that allied health professionals play in delivering patient care.”
TANYA CARLETON

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Other developments in training include the integration of simulator training stations with live patient models at clinical training courses to demonstrate some hard-to-see pathologies and clinical conditions such as ectopic pregnancies and the practice of neonatal ultrasound on infants.
ASUM aligning CCPU units with the curriculum of medical colleges
Some medical colleges are migrating to a perspective  that views ultrasound as a requirement of medical practice. As an example, the College of Intensive Care Medicine (CICM) has introduced the Focused Cardiac Ultrasound (FCU) requirement in the Intensive Care syllabus. The FCU will be a mandatory requirement for CICM trainees in order to obtain their Fellowship of CICM. In response to this, ASUM has reviewed its Rapid Cardiac Assessment unit and re-crafted it into the Rapid Cardiac Echocardiography unit which aligns with the CICM’s FCU requirement in the Intensive Care syllabus.
Scholar, ASUM’s free e-learning resource
Scholar is a free e-learning portal available for ASUM members to access at their convenience. Members can earn Continuing Professional Development (CPD) credit by participating in case studies and short quizzes in the following specialty areas:  Abdomen, cardiac, lung, renal, gynaecology, obstetrics, ocular, small parts, musculoskeletal, neonatal and vascular. Participation in The Australasian Journal of Ultrasound in Medicine (AJUM) Journal Club also earns members CPD credit. In addition to these CPD opportunities, other e-learning resources include: a variety of ASUM scientific conference lectures from 2011 to the present as well as lectures, tutorials and presentations in point of care ultrasound, physics and image optimization; a clinical handbook with clinical guides, and finally, links to other ultrasound resources. ASUM welcomes contributions of case studies, lectures and other presentations to Scholar by all qualified users of ultrasound.
Eligibility for the CCPU and CAHPU programs
The CCPU and CAHPU are both available to suitably qualified members of ASUM. Candidacy for the CCPU is open to medical practitioners who are practising and registered with their national medical registration authority e.g. Australian Health Practitioner Regulation Agency (AHPRA), New Zealand medical council, etc. whereas candidacy for the CAHPU is open to Allied Health practitioners who are practising and registered with their national medical registration authority e.g. Australian Health Practitioner Regulation Agency (AHPRA), The Nursing Council of New Zealand, The Midwifery Council of New Zealand and The Physiotherapy Board of New Zealand.
Recognition of Prior Ultrasound Learning (RPL)
ASUM has seen an influx of applications for recognition of prior ultrasound learning (RPL) from practitioners in emergency medicine from the United Kingdom and the United States. ASUM has researched international standards and recognises educational equivalencies to promote the continuing education of migrating/international professionals. ASUM uses a combination of theoretical and practical assessment along with assessing professional references, academic writing and teaching experiences, before awarding RPL to applicants in these situations. An award of RPL is combined with the expectation of continued practice through the performance of ultrasound scans, which are recorded in a logbook and assessed, in order to complete the requirements of a complete CCPU unit.
Tanya Carleton
M Ed (Hons), Grad Dip TCM, B Sc (Business Admin)
ASUM Education Project Manager, CCPU and CAHPU Manager
Tanya has more than 17 years of experience in the international healthcare and education sectors, having worked in both the United States and Australia in these fields Tanya has a Master’s of Higher Education in Curriculum, Instruction and Assessment. Tanya’s role requires her to design, develop, implement and manage the Certificate of Clinician Performed Ultrasound  and Certificate of Allied Health Performed Ultrasound (CAHPU) educational programs. These programs serve the educational needs of medical and allied health users of ultrasound. In addition, Tanya works to design and develop revisions to ASUM’s Diploma of Medical Ultrasonography (DMU) program which educates and trains sonographers in Australia and New Zealand.  These initiatives support ASUM in maintaining  the industry standard in ultrasound education in Australia and  New Zealand.