How To Develop & Implement a Practical Staff Competency Plan
Pat Comoss RN, BS, MAACVPR Nursing Enrichment Consultants, Inc. I have no financial relationships to disclose
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 members competency Match selected competencies to AACVPRs 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 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 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: guestspeaker, 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: 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 pressuremanagement 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: Collins EG et al. Clinical Competency Guidelines for Pulmonary Rehabilitation Professionals. JCRP 2014; 34: 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: 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 programs staff competencies!! Staff Competencies in Rehab
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