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 ID: 556861
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Slide1
How To Develop & Implement a Practical Staff Competency Plan
Pat Comoss RN, BS, MAACVPR
Nursing Enrichment Consultants, Inc. Slide2
Financial Disclosure
I have no financial relationships to discloseSlide3
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 & PRSlide4
Staff Competencies in Rehab
Not New, Revisit
WHAT
WHY
WHEN
WHO
HOW Slide5
WHY Staff Competencies
Intrinsic Philosophy:
desire for continuous learning to
be
the best rehab practitioner you can be Slide6
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 Slide7
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 Slide8
TJC: Standard HR 01.06.01
The
hospital
Defines the competencies it requires of staff who provide patient care
/ treatment/servicesSlide9
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 Slide10
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 Slide11
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 Slide12
TJC: Standard HR 01.06.01
Staff
competence is assessed &
documented
once
every 3 years
or
more often per hospital
policy Slide13
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 disciplineSlide14
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 Slide15
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 Slide16Slide17
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: 2-10Slide18Slide19
WHAT Staff Competencies
Similar
Categories for Staff Competencies CR & PR:
Patient Assessment
Exercise Training
Psychosocial Management
Tobacco Cessation
Emergency PlanningSlide20
WHAT Staff Competencies
Cardiac Rehab
Blood pressure management
Lipid management
Diabetes
management
Weight management
Pulmonary Rehab
Dyspnea assessment & management
Oxygen assessment & management
Collaborative self-managementSlide21
WHAT NOT Staff Competencies
Discipline-specific hospital/department required competencies:
Cardiology RNs = conscious sedation
Respiratory RTs = precautions to prevent ventilator acquired pneumonia (VAP)Slide22
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. Slide23
HOW Staff Competencies
1.
Choose skills that need to be learned, reviewed, or updated because they are:
NEW/CHANGED
HIGH RISK
LOW VOLUME
PROBLEMATIC Slide24
HOW Staff Competencies
Categories
Patient Assessment
Exercise Training
Psychosocial Management
Tobacco Cessation
Emergency
Planning
Etc.
Criteria
NEW/CHANGED
HIGH RISK
LOW VOLUME
PROBLEMATIC Slide25
HOW Staff Competencies
2. Sources of choices:
INSIDE - OUT
Use Core Competency documents for
staff
self-assessment
=
Identify strengths & weaknesses Slide26
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 Slide27
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. Slide28
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 Slide29Slide30
HOW Staff Competencies
2. Source of choices:
OUTSIDE - IN
Use authoritative external information for competency ideas =
Identify need to update/upgrade program Slide31
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 bulletsSlide32
Pulmonary Rehab Example
NEW/CHANGED:
Need to update PR policy & practice to incorporate latest evidence-based recommendations for this important outcome measure Slide33
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 significantSlide34
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 Slide35Slide36Slide37Slide38Slide39
Cardiac Rehab Example
NEW/CHANGED:
Need to update CR policy & practice to incorporate latest evidence-based recommendations for this important outcome measure Slide40
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 Slide41
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 outcomesSlide42Slide43Slide44Slide45
HOW Staff Competencies
WHAT
WHY
WHEN
HOW
WHOSlide46
WHEN Staff Competencies
Schedule
an in-service presentation and/or practice session
Annually
Quarterly Slide47Slide48
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 Slide49
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, LASlide50
Pulmonary Rehab –
PREVIEW
PR Core Competency document
will be basis for new CPRP certification!
Now in development!!Slide51
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.Slide52
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.Slide53
Staff Competencies in Rehab
Thank You!
Good luck with planning & documenting your
program’s staff competencies!!
patcomoss@comcast.net
Slide54
Staff Competencies in Rehab
Q
& A
? ? ?