Finger on The Button (FOTB) Training

This training program was developed, launched autumn 1996, following three years preparatory work by pharmacists, clinical staff, scientists and trainers working in the health service, experienced training consultants and equipment manufacturers from the private sector. The program design comprises, open learning, study days, skills training and competence assessment.


FOTB training initially focuses on two key families of equipment, infusion and monitoring devices, each family having it's own learning pack. The main benefit of this system is its flexibility of use. The training program has been developed as a direct result of the experience of staff at the Hammersmith Hospital, London, who went through a risk management exercise culminating in the development of a strategy for the management of medical devices. Addressing training issues was seen as one of the main focus areas in responding to the risk assessment recommendations. At each stage in the program individuals are tested, who need to pass before moving through each stage. The result is a training program which has been designed to meet particular training objectives and satisfy operational requirements of staff working day to day with electronic medical equipment. Both packs cover four main phases of training;

  1. Preparation : this covers basic theory and operation, self assessment (diagnostic) and preparatory knowledge e.g. drug calculations and interactions.
  2. Study day : this includes an assessment to test self directed learning, universal housekeeping and safety issues and Device function issues.
  3. Equipment Training : this again includes demonstrations, supervised assembly, practice and assessment of learning.
  4. An on the ward assessment (OTWA) : Staff competencies are assessed in individuals' areas of work.

In evaluating the pilot at the Royal Victoria Infirmary, Newcastle, all participating staff found the learning process to be positive, in particular the design of the packs, which provide instant feedback and remedial suggestions. It was described as "user friendly" and "non threatening", apart from the evaluatory test on the study day, and was said to be "a very useful resource". Following the Pilot evaluation the Trust has decided to implement the FOTB training for all staff as part of a risk management drive.


There is no doubt that the FOTB training helped focus staff on a number of issues. Staff were unaware of the various classifications of IV devices, e.g. Neonatal, High and Low Risk Devices, and the significance of such. Devices are still appearing in circulation that are obsolete, and have had to be removed. The use of such devices would certainly increase the risk to patients if used inappropriately e.g. low risk classification devices used for high risk drug applications. Training has raised the awareness of staff in this respect. During the company training element of the FOTB training it became evident that staff did not fully understand the functions of one particular volumetric pump and the effect that it had on a pressure occlusion alarm. One nurse did not understand the anti free flow function on another, they thought that it was just a simple line clamp and in practice did not fit it to the pump. There is no doubt that these sessions highlighted that staff knowledge prior to training was incomplete.


The fact that a focus has been given to staff through training has led them to question other aspects of their practice in relation to national and local guidelines. Listed are some of the initiatives that the project group are addressing in relation to the recommendations being made. Medical Devices Agency DB 9504 (The Scottish Office Home and Health Department) "The Management of Infusion Systems" Appendix 7 of this report summarises the recommendations of details to be recorded at the start of an infusion, and at each check. The project group looking at how best to address this, agreed that where possible current practice should be adapted rather than introducing new practices. To this end the current additive label was redesigned with the introduction of a carbon copy top piece which can be placed in the patient records as an auditable record of both device and drug.


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