How To Develop amp Implement a Practical Staff Competency Plan Pat Comoss RN BS MAACVPR Nursing Enrichment Consultants Inc Financial Disclosure I have no financial relationships to disclose Staff Competencies in Rehab ID: 768824
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How To Develop & Implement a Practical Staff Competency Plan Pat Comoss RN, BS, MAACVPR Nursing Enrichment Consultants, Inc.
Financial Disclosure I have no financial relationships to disclose
Staff Competencies in Rehab Upon completion of this activity, participants will be able to: Discuss why an annual staff competency plan is important for rehab personnel Identify criteria that are useful when choosing competency topics List acceptable methods for evaluating a staff member’s competency Match selected competencies to AACVPR’s published Core Competencies for CR & PR
Staff Competencies in Rehab Not New, Revisit WHAT WHY WHEN WHO HOW
WHY Staff Competencies Intrinsic Philosophy: desire for continuous learning to be the best rehab practitioner you can be
WHY Staff Competencies Intrinsic Philosophy = desire for continuous learning to be the best rehab practitioner you can be Extrinsic Expectation: Hospital requirement Joint Commission standard AACVPR Program Certification criteria
WHY Staff Competencies The Joint Commission “Competence assessment lets the hospital know whether its staff have the ability to use specific skills and to employ the knowledge necessary to perform their jobs.” Human Resources chapter: 2015 Hospital Accreditation Standards
TJC: Standard HR 01.06.01 The hospital Defines the competencies it requires of staff who provide patient care / treatment/services
TJC: Standard HR 01.06.01 Uses assessment methods to determine competence in the skill being assessed Test taking Return demonstration Simulation/role play Observation of actual patient care
TJC: Standard HR 01.06.01 An individual with the educational background, experience, or knowledge related to the skills being reviewed assesses competence: Instructor Preceptor Coworker
TJC: Standard HR 01.06.01 The hospital can utilize: An outside individual Such as: guest speaker , consultant Competency guidelines from an appropriate professional organization Such as: AACVPR Core Competencies
TJC: Standard HR 01.06.01 Staff competence is assessed & documented once every 3 years or more often per hospital policy
WHY Staff Competencies AACVPR Program Certification CR & PR: Requirement #1 = Staff Competencies Individuals should possess a common core of professional & clinical competencies, regardless of academic discipline
WHY Staff Competencies AACVPR Program Certification CR & PR: Requirement #1 = Staff Competencies A program must provide evidence of annual assessment of clinical/professional staff competency
AACVPR Program Certification PULMONARY REHAB Program Certification: Four assessed competencies MUST be specific to Clinical Competency Guidelines for Pulmonary Rehabilitation Professionals 2014 Collins EG, Bauldoff G, Carlin B, et al . JCRP 2014; 34: 291-302
AACVPR Program Certification CARDIAC REHAB Program Certification: Four assessed competencies MUST be specific to Core Competencies for Cardiac Rehabilitation/ Secondary Prevention Professionals: 2010 Update Hamm L, Sanderson B, Ades P, et al JCRP 2011; 31: 2-10
WHAT Staff Competencies Similar Categories for Staff Competencies CR & PR: Patient Assessment Exercise Training Psychosocial Management Tobacco Cessation Emergency Planning
WHAT Staff Competencies Cardiac Rehab Blood pressure management Lipid management Diabetes management Weight management Pulmonary Rehab Dyspnea assessment & management Oxygen assessment & management Collaborative self-management
WHAT NOT Staff Competencies Discipline-specific hospital/department required competencies: Cardiology RNs = conscious sedation Respiratory RTs = precautions to prevent ventilator acquired pneumonia (VAP)
WHAT NOT Staff Competencies Initial/Orientation checklist for new employees often emphasize mechanical functions within dept vs. specific clinical patient care Hospital-wide required competencies e.g. HIPAA rules, safety/security color-codes, etc.
HOW Staff Competencies 1. Choose skills that need to be learned, reviewed, or updated because they are: NEW/CHANGED HIGH RISK LOW VOLUME PROBLEMATIC
HOW Staff Competencies Categories Patient Assessment Exercise Training Psychosocial Management Tobacco Cessation Emergency Planning Etc. Criteria NEW/CHANGED HIGH RISK LOW VOLUME PROBLEMATIC
HOW Staff Competencies 2. Sources of choices: INSIDE - OUT Use Core Competency documents for staff self-assessment = Identify strengths & weaknesses
HOW: Inside - Out Examples NEW = BODE Index calculation (PR), MET-minutes calculation (CR) HIGH RISK = diabetic exercise management (blood sugar testing, high & low cut-offs) LOW VOLUME = tobacco cessation
HOW Staff Competencies Cross reference to Core = Smoking Cessation Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals: 2010 Update – pg 7 Tobacco cessation; Knowledge 1-7, Skills 1-3. Pulmonary Clinical Competency Guidelines : 2014 Update - pg. 299, Tobacco cessation; Knowledge 1-7, Skills 1-2.
HOW: Inside - Out Challenge: find resources to teach the topic/skill to rehab staff in rehab context Within facility or external expert? PROFESSIONAL DEVELOPMENT OPPORTUNITY = elect a staff member to study/research the topic & become the rehab expert
HOW Staff Competencies 2. Source of choices: OUTSIDE - IN Use authoritative external information for competency ideas = Identify need to update/upgrade program
HOW: Outside - In Challenge: make sure chosen topic/skill is within the scope of Core Competencies expectations Where does the new interest match document? PROFESSIONAL DEVELOPMENT OPPORTUNITY = elect a staff member to track connections between chosen topics & competency bullets
Pulmonary Rehab Example NEW/CHANGED: Need to update PR policy & practice to incorporate latest evidence-based recommendations for this important outcome measure
Pulmonary Rehab Example Changes to 6MWT Performance 2015: For initial assessment, do 2 walks & take best result as baseline measure Use patient's own oxygen equipment & usual O2 flow = DO NOT TITRATE O2 Allow O2 sat to drop to low value cut-off of 80% saturation For exit evaluation, look for change of at least 30 meters/100 feet to be clinically significant
Pulmonary Rehab Example Exercise Testing p.298 Use of field testing (6MWT, shuttle walk) as outcome measure Complete 6MWT using ATS criteria Appropriately monitor responses Develop ExRx on basis of results as appropriate
Cardiac Rehab Example NEW/CHANGED: Need to update CR policy & practice to incorporate latest evidence-based recommendations for this important outcome measure
Cardiac Rehab Example Changes to BP Management 2015: New target value for secondary prevention of cardiac events = 140/90mmHg Much lower is not necessarily better & may contribute to side effects or complications Decreased coronary or cerebral perfusion Orthostatic problems DBP less than 65mmHg should be avoided in older patients
Cardiac Rehab Example BP Management p.6 Normal range of BP at rest & with exercise; Current BP targets for secondary prevention Accurate determinations Recognition of deviations from range Measurement of outcomes
HOW Staff Competencies WHAT WHY WHEN HOW WHO
WHEN Staff Competencies Schedule an in-service presentation and/or practice session Annually Quarterly
Staff Competencies: SUMMARY WHAT = documentation of staff knowledge, skill, & ability WHY = improve quality of program; requirement for TJC & AACVPR WHEN = 4 each year for cert/recert HOW = learn, practice, demonstrate, document WHO = staff member, outside expert
Cardiac Rehab - SPECIAL NOTE Core Competency document is basis for new CCRP certification! Professional certification exam to be given at this AACVPR National Meeting: September 7, 2016 New Orleans, LA
Pulmonary Rehab – PREVIEW PR Core Competency document will be basis for new CPRP certification! Now in development!!
References Hamm LF et al. Core Competencies for Cardiac Rehabilitation Professionals: 2010 Update . JCRP 2011;31: 2-10. Collins EG et al. Clinical Competency Guidelines for Pulmonary Rehabilitation Professionals . JCRP 2014; 34: 291-302.
References Holland AE et al. An official European Respiratory Society/ American Thoracic Society technical standard: field walking tests in chronic respiratory disease . Eur Respir J 2014; 44: 1428-1446. Rosendorff C et al. Treatment of Hypertension in Patients with Coronary Artery Disease . Circulation 2015; 131: e1 – e36.
Staff Competencies in Rehab Thank You! Good luck with planning & documenting your program’s staff competencies!! patcomoss@comcast.net
Staff Competencies in Rehab Q & A ? ? ?