ANNUAL CORE COMPETENCY SELF-STUDY GUIDEharborucla.org/library/users/DHS 2010 Annual Core Competency...

County of Los Angeles Department of Health Services


INPATIENT

Annual Core Competency Performance Stations

(Nursing)

2010 (Unlicensed Staff

Direct & Non-Direct Care Providers*)

* Staff who work in patient care areas

Annual Core Competency Performance Stations (Nursing - Unlicensed Staff – Direct & Non-Direct Care Providers) 1


ANNUAL CORE COMPETENCY PERFORMANCE STATIONS (NURSING VIDERS)

his packet is designed to provide the unlicensed workforce member the information necessary to prepare

e

he following table describes which workforce members must complete the testing requirements for

Workforce Member Testing Requirements

– UNLICENSED STAFF - DIRECT & NON-DIRECT CARE PROPREFACE

Tfor DHS annual core competency testing. Non-direct care unlicensed staff required to complete the competencies identified in this study guide are clerical/secretarial workforce members who work in apatient care area. Unlicensed clerical/secretarial workforce members who do not work in a patient cararea complete the competencies identified in the “Licensed & Unlicensed Staff - Non-Direct Care Provider” self-study guide. Tnursing department unlicensed direct care and non-direct care providers.

Performance C(

i

ance Checklist hecklist PerformPatient Identification, Role

n an Emergency, Safety withTubes)

(Patient Identification, Role in an Emergency)

Direct care unlicensed staff

ts

ical assistants

--- including: • Nursing attendan• Student nurse workers • Technicians • Hospital med

X

Non-direct care unlicensed staff who

kers ciates (eg,

--- X work in patient care areas† including: • Unit clerks • Secretaries • Student wor• Unit support asso

Escort)

your position is not listed in the table or you are not sure in which category you belong, consult your

UCTIONS

. Review the content in this packet as applicable to your requirements as indicated above.

. Review the learning activities as described on the applicable clinical competency descriptions.

. Clinical Nurse Specialists, Clinical Nurse Educators, Nursing Instructors, and Nurse Managers

Ifimmediate supervisor. INSTR 1 2 3

are available to answer any questions you may have regarding the content.

† Unlicensed clerical/secretarial workforce members who do not work in a patient care area complete the competencies identified in the “Licensed & Unlicensed Staff - Non-Direct Care Provider” self-study guide.



ANNUAL CORE COMPETENCY PERFORMANCE STATIONS (NURSING - UNLICENSED STAFF)

TABLE OF CONTENTS Patient Identification (study material – for direct care and non-direct care staff) ........................................ 3 Unlicensed Direct Care Provider Competency Documents .................................................................... 5 Patient Identification

Clinical Competency Description - Unlicensed Direct Care Provider............................................. 6 Performance Checklist - Unlicensed Direct Care Provider.............................................................. 7

Role in an Emergency

Participant Handout ......................................................................................................................... 8 Clinical Competency Description - Unlicensed Direct Care Provider............................................. 9 Performance Checklist - Unlicensed Direct Care Provider............................................................ 10

Safety with Tubes

Participant Handout ....................................................................................................................... 11 Clinical Competency Description - Unlicensed Direct Care Provider........................................... 14 Performance Checklist - Unlicensed Direct Care Provider t ......................................................... 15

Unlicensed Non-Direct Care Provider Competency Documents .......................................................... 16 Patient Identification

Clinical Competency Description - Unlicensed Non-Direct Care Provider .................................. 17 Performance Checklist - Unlicensed Direct Non-Care Provider ................................................... 18

Role in an Emergency Participant Handout ....................................................................................................................... 19 Clinical Competency Description - Unlicensed Direct Care Provider........................................... 20 Performance Checklist - Unlicensed Direct Care Provider............................................................ 21



PATIENT IDENTIFICATION Objectives: Upon completion of this section, the workforce member will be able to: 1. Differentiate between patient identifier and source of patient identification. 2. Give examples of patient identifiers and examples of non-patient identifiers. 3. Identify the required number of patient identifiers. 4. Identify situations that require use of two patient identifiers. I. Definition

A. What are “patient identifiers”?

An identifier is a piece of information specific to the person, for example the patient’s name, medical record number (MRUN), telephone number, date of birth, social security number. An identifier is not the medium on which the information is kept (e.g., driver’s license, identification card) (Table 1). In other words, two patient identifiers could mean name and MRUN, name and social security number, but not identification card and bed card. The Joint Commission requires the use of at least two patient identifiers when providing care, treatment, and services.

1. For inpatients, medical record number and name are the usual patient identifiers. 2. For outpatients, name and birth date are the usual patient identifiers. Table 1. Patient Identifiers, Sources of ID, Non-Patient Identifiers

Patient Identifiers Examples

Sources of Identification Examples

NOT Patient Identifiers

• Name • Patient identification

number • Date of birth • Social security number • Address • Telephone number • Tag number (newborns and

mothers)

• Driver’s license • Patient ID card • Picture ID card • Passport • Alien registration

card

• Room number • Bed number • Diagnosis (the “gun

shot wound” in bed 3) • Organ of disease (the

“liver” in bed 5)

II. Purpose of using two patient identifiers

The purpose of using two identifiers is to 1) reliably identify the individual as the person for whom care, treatment, or service is intended and 2) to match the care, treatment, or service to that individual (Table 2). The two patient-specific identifiers must be directly associated with the individual and the same two identifiers must be directly associated with the care, treatment, or service. For example, the name and medical record number on the patient identification band must match the name and medical record number on the medication label, blood transfusion documents, and specimen tube label.



Table 2. Rationale for Using Two Identifiers Intent Action (Example)

Identify the individual as the person for whom the service or treatment is intended.

Check the order and compare the patient’s name and MRUN on the physician order sheet with the patient’s name and MRUN on the patient’s identification bracelet.

Match the service or treatment (e.g., medication administration) to that individual.

Check the medication administration record (MAR) and compare the patient’s name and MRUN on the MAR with the patient’s name and MRUN on the patient’s identification bracelet.

III. Patients without identification bracelets

Patients in the ambulatory care setting may not have armbands. For outpatients, name and birth date are the usual patient identifiers. When verifying the patient’s name, ask the patient to state their name, rather than asking the patient to answer a passive question such as, “Are you Juan Garcia?”

IV. Situations requiring use of two patient identifiers

Use two patient identifiers when providing care, treatment, and services. Examples of situation requiring use of two patient identifiers include: A. Administration of medication, blood, intravenous fluid B. Collecting blood samples and other specimens for clinical testing C. Labeling laboratory specimens D. Distributing diet trays E. Measuring vital signs F. Transporting patients to diagnostic/procedural areas G. Delivering diet trays H. Labeling allergies on patient chart, or armband I. Transcribing medications J. Transcribing orders (laboratory tests, x-ray, diets, etc) K. Ordering laboratory tests, diets, x-rays, consults

V. Safety risks related to discrepancies in patient identification

Services and treatments could be harmful if given to the wrong patient. A few examples of consequences of not accurately identifying patients include the following:

A. Wrong patient receives a treatment/procedure

1. Vital signs are obtained and documented on a wrong patient 2. A patient receives a medication or diet tray meant for another patient



3. Patient has allergic reaction because patient’s allergies documented on wrong patient

4. Blood is administered to a wrong patient 5. Prescriptions given to wrong patient 6. Expressed breastmilk given to the wrong baby

B. Wrong patient is sent for and receives a medical treatment/procedure (eg, xray)

1. Wrong patient is sent to radiology or other diagnostic procedure 2. Surgery is performed on the wrong patient 3. Wrong patient is discharged or transferred

C. Patient gets unnecessary treatment based on mislabeled laboratory specimen

VI. Steps to take if patient identifiers do not match up

Anytime there is a discrepancy in patient identifiers, or doubt about accurate patient identity, the first step is to stop the procedure. Unlicensed staff should notify the Registered Nurse. The procedure should not continue until patient identify can be verified. If the treatment, procedure, service has already been provided, personnel must follow facility specific policy related to reporting the error to supervisors and Risk Management.

VII. Conclusion

Services and treatments could be harmful if given to the wrong patient. It is imperative to accurately identify patients using two unique pieces of information about the person, called patient identifiers. Nurses must know the procedures they perform that require verification through the use of two patient identifiers. Whenever possible, patients must be actively included in the identification process.



UNLICENSED DIRECT CARE PROVIDER DOCUMENTS

Unlicensed direct care providers include nursing attendants, student nurse workers, and technicians (e.g., surgical, orthopedic)



Annual Core Competency Program (Nursing – Unlicensed Staff) PATIENT IDENTIFICATION

Clinical Competency Description - Direct Care Provider

Competency Statement: Discusses procedures related to patient identification and correctly identifies a patient.

Critical Behaviors Learning Activities Method of Evaluation Verbalizes the number of patient identifiers to use before performing patient related tasks. States acceptable patient identifiers. Describes purpose of using two patient identifiers. Identifies procedures that require use of two patient identifiers based on policy. Identifies potential safety risks related to discrepancies in patient identifiers. Discusses actions to take if patient identifiers do not match up. Demonstrates interventions designed to ensure accuracy of patient identification using two patient identifiers.

Reviews the Patient Identification study material in this packet. Reviews facility specific policies/procedures related to patient identifiers.

Completes Patient Identification performance checklist (direct care provider) with 100% accuracy.




Performance Checklist - Direct Care Provider Name _____________________________________ Pass / Fail

Performance Criteria Met Not Met Comments

Verbalizes the number of patient identifiers required by the Joint Commission to ensure accurate patient identification.

States the two patient identifiers approved for patient identification per facility protocol (e.g., name, MRUN, birthdate).

Describes purpose of using two patient identifiers.

Identifies two situations that require use of two patient identifiers.

Identifies two potential safety risks related to discrepancies in patient identification.

States what action to take if the patient identifiers do not match.

Given a medical record (chart) stamped with a patient’s identification card, selects the correct patient identification card and patient.

Signature of Evaluator: ____________________________________ Date: __________________



Annual Core Competency Program (Nursing – Unlicensed Staff) ROLE IN AN EMERGENCY

Participant Handout – Direct Care Provider Initial steps to take during a code blue 1. Establish unresponsiveness

• Shake and Shout (“Are you OK? Are you OK?”) If victim does not respond: 2. Call a Code Blue

• Yell, “Code blue, get the crash cart” • When calling a code blue, follow the procedure for calling a code blue at your facility

(e.g., do you push a button or call an operator, what extension do you call, what do you tell the operator?)

3. Return to patient and start CPR

• Open airway with head tilt-chin lift (be prepared to demonstrate). • Look, listen and feel for 5-10 seconds • If no signs of breathing, give two breaths and watch for chest rise • Start compressions (demonstrate proper hand placement for compressions). Place hands

on the center of the chest, between the nipple-line. How can the unlicensed direct care provider (e.g., NA) can help during a code blue? 1. Help put CPR board under patient 2. Obtain supplies 3. Remove unnecessary equipment 4. Offer comfort to other patients/family members 5. Maintain patient privacy 6. Take specimens to laboratory Opening the airway Adult, child, infant 1. Tilt the head back and lift the chin gently with your fingers while pushing down on the forehead

with the other hand. Proper hand placement for chest compressions Adult: 1. Place the heel of one hand on the lower half of the breastbone. 2. Place the heel of second hand on top of the first hand. Child 1. Place heel of one hand on the lower half of the breastbone (not over the very bottom of the

sternum). Infant 1. Place 2 or 3 fingers of one hand on the lower half of the infant’s breastbone about 1 finger’s

width below the imaginary nipple line.




Clinical Competency Description - Direct Care Provider

Competency Statement: Demonstrates understanding of the unlicensed direct care giver’s role during an emergency

Critical Behaviors Learning Activities Method of Evaluation

Verbalizes understanding of the following: • The initial steps to be taken in a

Code Blue. • How to call the Code Blue team. • Additional ways the unlicensed

direct care provider can assist during a Code Blue.

Demonstrates proper technique for opening the airway. Demonstrates proper hand placement for compressions.

Reviews the Role in an Emergency Participant Handout – Direct Care Provider. Reviews DHS and facility-specific policies/procedures related to Code Blue.

Completes Role in an Emergency performance checklist (direct care provider) with 100% accuracy.





Performance Checklist - Direct Care Provider

Name: _____________________________________ Pass / Fail


States initial steps to be taken during a Code Blue.

States how to call a Code Blue.

States three ways the unlicensed direct care provider can assist during Code Blue.

Demonstrates proper opening of the airway.

Demonstrates proper hand placement for compressions.

Signature of Evaluator: __________________________________ Date: _____________________


Annual Core Competency Program (Nursing – Unlicensed Staff) SAFETY WITH TUBES

Participant Handout

TUBE NAME PURPOSE SAFETY CONCERNS DO NOT DO!!! #1 = IV

IV

Tube for things to go into the body

Fluids/Nutrition Medications Blood

Report redness and swelling Prevent bending or twisting Report alarming IV pump Report if tube has been pulled on or

out Report if blood in tubing Report if patient complains of pain

at site

DO NOT . . .

Disconnect Clamp Shut off alarm on

IV pump

#2 = Feeding Tube

Feeding Tube NG Tube Other names Nasogastric Tube

Tube for things to go into the body

Fluids Nutrition (feeding) Medications

Tube for things to go out of the body

Suction stomach fluid

Protect patient from pulling tube Keep patient’s head of bed greater

than 30 degrees when feedings are running

Report alarming feeding pump Report if tube has been pulled on or

out

DO NOT . . .

Clamp Stop feedings Remove tube Shut off feeding

pump


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http://www.hame.ca/blog2/pictures/feedtube.jpg


TUBE NAME PURPOSE SAFETY CONCERNS DO NOT DO!!! #3 = Foley Catheter

Foley

Tube for fluid to go out of the body

Drain urine

Keep urine bag below level of

bladder Secure tube Empty drainage bag every shift Report and record I/O’s Prevent bending or twisting Protect tube from pulling Report if tube has been pulled on or

out Report bloody urine or bleeding

from tube NOTE: (This is the ONLY tube that unlicensed care providers can empty)

DO NOT . . .

Irrigate Clamp Insert

#4 = Chest Tube

Chest Tube

Tube for things to go out of the body

Drain air, fluid, or blood from the lung cavity

Protect tube from pulling Keep collection device in upright

position Report difficulty breathing Prevent bending or twisting Report if tube has been pulled on or

out

DO NOT . . .

Clamp Disconnect from

suction Lay collection

device on side


of Los Angeles Department of Health Services


TUBE NAME PURPOSE SAFETY CONCERNS DO NOT DO!!! #5 = Wound Tube

Wound Tube Other names JP Drain Jackson Pratt

Tube for fluids to go out of the body

Drain wound Help heal wound

Protect tubes from pulling Prevent bending or twisting Report if tube has been pulled on or

out

DO NOT . . .

Disconnect Clamp Disconnect from

suction Disconnect from

wound vac Irrigate

#6 = Tracheostomy

Trach Other names Breathing Tube Tracheostomy

Tube for things to go in and/or out of the body

Remove secretions by suctioning patient

Help breathe (air goes in and out)

Report difficulty breathing Report soiled or bloody dressing,

velcro strap (ties), or trach

DO NOT . . .

Suction trach Change dressings

County


Annual Core Competency Program (Nursing – Unlicensed Staff) SAFETY WITH TUBES

Clinical Competency Description Competency Statement: Provides safe and appropriate handling of various tubes.

Critical Behaviors Learning Activities Method of Evaluation Identifies and names each of the following tubes (by photo). a. IV b. Feeding tube c. Foley d. Chest tube e. Wound tube f. Tracheostomy States one purpose of each tube. States one safety concern for each tube.

Reviews the “Safety with Tubes” Participant Handout Reviews facility-specific policies/procedures related to various tubes.

Completes the Safety with Tubes Performance Checklist with 80% accuracy.



Annual Core Competency Program (Nursing – Unlicensed Staff) SAFETY WITH TUBES Performance Checklist

Name: _____________________________________ Pass / Fail


Names each of the following tubes (must answer correctly for 5 of the 6):a. IV b. Feeding tube c. Foley d. Chest tube e. Wound tube f. Tracheostomy

States one purpose of each of the following tubes (must answer correctly for 5 of the 6): a. IV b. Feeding tube c. Foley d. Chest tube e. Wound tube f. Tracheostomy

States one safety concern for each of the following tubes (must answer correctly for 5 of the 6): a. IV b. Feeding tube c. Foley d. Chest tube e. Wound tube f. Tracheostomy

Signature of Evaluator: _______________________________________ Date: _________________



UNLICENSED NON-DIRECT CARE PROVIDER DOCUMENTS

Unlicensed non-direct care providers include unit clerks and secretaries.




Clinical Competency Description – Non-Direct Care Provider Competency Statement: Discusses procedures related to patient identification and demonstrates application of two patient identifiers.

Critical Behaviors Learning Activities Method of Evaluation Verbalizes the number of patient identifiers to use before performing patient related tasks. States acceptable patient identifiers. Describes purpose of using two patient identifiers. Identifies procedures that require use of two patient identifiers based on policy. Identifies potential safety risks related to discrepancies in patient identifiers. Discusses actions to take if patient identifiers do not match. Demonstrates interventions designed to ensure accuracy of patient identification using two patient identifiers.

Reviews the Patient Identification study material in this packet. Reviews facility-specific policies/procedures related to patient identifiers.

Completes Patient Identification performance checklist (non-direct care provider) with 100% accuracy.




Performance Checklist – Non-Direct Care Provider

Name: _____________________________________ Pass / Fail


Verbalizes the number of patient identifiers required by the Joint Commission to ensure accurate patient identification.

States the two patient identifiers approved for patient identification per facility protocol (e.g., name, birth date, MRUN).

States the purpose of using two patient identifiers.

States two clerical situations that require use of two patient identifiers.

States one safety concern if patient identifiers are not utilized by clerical staff.

States the action to take if a lab was ordered on the wrong patient.

Given a medical record (chart) stamped with a patient’s identification card, selects the correct patient identification card and MAR for transcription.

Signature of Evaluator: ______________________________________ Date: _____________________




Participant Handout – Non-Direct Care Provider How to call the Code Blue team 1. Yell, “Code blue, get the crash cart” 2. When calling a code blue, follow the procedure for calling a code blue at your facility (e.g., do

you push a button or call an operator, what extension do you call, what do you tell the operator?) How can the unlicensed non-direct care provider (e.g., clerk) can help during a code blue? 1. Obtain supplies 2. Bring the crash car 3. Offer comfort to other patients/family members 4. Maintain patient privacy 5. Take specimens to laboratory 6. Call the clergy if necessary




Clinical Competency Description – Non-Direct Care Provider

Competency Statement: Demonstrates understanding of the clerk's role during an emergency

Critical Behaviors Learning Activities Method of Evaluation

Verbalizes understanding of the following:

• How to call the Code Blue team.

• Additional ways clerical staff may assist during the Code Blue.

Reviews the Role in an Emergency Participant Handout – Non-Direct Care Provider. Reviews DHS and facility-specific policies/procedures related to Code Blue.

Completes Role in an Emergency performance checklist (non-direct care provider) with 100% accuracy.




Performance Checklist – Non-Direct Care Provider

Name: _____________________________ Pass / Fail


Verbalizes how to call a Code Blue.

Verbalizes three additional ways clerical staff may assist during a Code Blue.

Signature of Evaluator: ___________________________________ Date: ________________ DHS_Annual_Core_Competency_SSG_2010_Unlicensed.doc Orig: 12/22/09; Rev 01/19/10 (RW)


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