Establishing and Maintaining Nurse

CompetencyCompetencyLou Anne Epperson, MSN, RN

Coram Specialty Infusion Services, Denver, CO

Debra Moll, RN, BSNCommunity Surgical Infusion, Toms River, NJ

T Thi K f CETop 5 Things to Know for CE:M k BADGE IS SCANNED h ti t i t• Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance.

• Carry the Evaluation Packet you received on registration with you to EVERY session. If ’ t l i f CE till t t h f ! Y• If you’re not applying for CE, we still want to hear from you! Your opinions about our conference are very valuable.

• Pharmacists, Pharmacist Technicians and Nurses need to track their hours on the Statement of Continuing Education Certificate form as they gothey go.

• FOR CE: At your last session, total the hours and sign your Statement of Continuing Education Certificate form.

– Keep the PINK copy for your records. Place the YELLOW and WHITE copies in your Evaluation packetyour Evaluation packet

– Make sure an evaluation form from each session you attended is completed and in your Evaluation packet

– Put your name and unique member ID number (six digit number on the bottom of your badge) on the outside of the packet, seal it, and drop it in the drop boxes in the NHIA registration area at the convention centerin the NHIA registration area at the convention center

Di lDisclosuresLou Anne Epperson and Debra Moll declare no conflicts of interest or financial interest in any service or product mentioned in this programservice or product mentioned in this program.

Cli i l t i l d ff l b l ill t bClinical trials and off-label uses will not be discussed during this presentation.

Obj iObjectives• Define competency• Define competency• Determine a process for establishing and

updating validated competencies for homeupdating validated competencies for home infusion nurses and home health nurses

• Delineate options for assistingDelineate options for assisting patients/caregivers to achieve maximal independence with their home infusion therapy

• List valuable tools and references that facilitate delivery of home infusion nursing education

Fiscal Challenges in Home InfusionInfusion

Rising Per Diem Costs– Salaries and benefits– Pump and supply costs– Cost of delivery– Additional staff for insurance and admissions

functions

Fiscal Challenges in Home InfusionInfusion

Rising Ancillary Costs– Mileage and travel– Training

• Home health agency• Infusion staff RNs

– Certification and recertification

Other Challenges in Home Infusion• Pharmacist Shortage• Nursing Shortage• Nursing Shortage

– Smaller pool of infusion specialists/home careI d b f R l f l• Increased number of Rural referrals

• Specialty Drugs• Aging Population• Increase in Medicare ReferralsIncrease in Medicare Referrals

Effective Resource Management

• Where can we leverage efficiencies?• Must be based on strategic

tactical plan

• Crucial to fiscal, quality and operational successsuccess

N i R MNursing Resource Management

• Human resource management• Fiscal resource managementg

• Outcomes management

H R MHuman Resource Management• Decreased pool of experienced nurses• Decreased pool of experienced nurses• Compete with HHAs for same staff• Salary competition• Future competitionp

– CRNI®• Managing evolving infusion skills and• Managing evolving infusion skills and

knowledge bases

Fi l R MFiscal Resource Management• Nursing is a cost center• Nursing is a cost center• Cost per visit• Cost per patient per month• Cost as a % of net revenue• Hospital pre-discharge• Future pricing challenges• Future pricing challenges

O MOutcomes Management• Quality as well as cost effectiveness• Quality as well as cost-effectiveness• Competency required

Ch i d t• Changes in products• Who offers the best outcomes:

– Home infusion nurses– Trained home health nurses

B th?– Both?• Future: New therapies in the pipeline

HHA St t i R l ti hiHHA Strategic Relationships

Strategic tactical plan derived from• Strategic tactical plan derived from resource challenges

• Can benefit both the home infusion providers and agencies– Infusion RNs– Subcontracted RNs– CHHA RNs

A AAgency Assessment• Geography• Geography• Accreditation• Competency

– How do they measure competency?– Skill and experience of staff– Knowledge of infusion devices/supplies and g pp

lines– RN vs. LPN/LVN

Wh i C ?What is Competency?• Validation of skills and knowledge• Validation of skills and knowledge

– Based on learning modulesD t ti d ti li d l– Demonstration and practice – live or model

– Performance-related• Measurement of patient outcomes

– True measure of competency– Determines organizational quality– Objective data for patients and payorsj p p y

C CCore Competency• Hiring criteria must be aligned changes• Hiring criteria must be aligned – changes• Infusion specialty – evolved from patient

needsneeds• Autonomy and accountability

K l d f t d h i l• Knowledge of anatomy and physiology• Specific knowledge of vascular system• Attainment of skills needed for

administration of infusion therapies

CRNI® C C t iCRNI® Core Competencies• Technology and clinical applicationgy pp• Fluid and electrolyte balance• PharmacologyPharmacology• Infection control• Pediatrics• Pediatrics• Transfusion therapy

A ti l ti th• Antineoplastic therapy• Parenteral nutrition• Performance improvement

D l C C iDevelop Core Competencies• From Novice to ExpertFrom Novice to Expert

– Competent vs. Proficient

IV “ kill ” t h• IV “skills” not enough – Application in various scenarios needed– Higher level of problem-solving and knowledgeg p g g– Autonomy in home care

• Patient education requires knowledge of adult• Patient education requires knowledge of adult learning principles

Competence vs. ConfidenceConfidence plays a role with patientConfidence plays a role with patient

education and satisfactioni t timpacts outcomesimpacts nurse retention

Ad lt L i P i i l fAdult Learning Principles – for both patients and RNsboth patients and RNs

• Cognitive Domain

• Affective Domain

• Psychomotor Domainsyc o o o o a

E bli hi C i fEstablishing Competencies for HHA StaffHHA Staff

• Rely upon the adult learning principlesy p g p p• Determine competencies for specific

patient populationspatient populations– Disease state information

Vascular access principles– Vascular access principles– Equipment management

Case scenario discussions/problem solving– Case scenario discussions/problem-solving• Emergency back up plans

H D W E t bli hHow Do We Establish Competencies for Agencies?Competencies for Agencies?

1:1 Education• Training by manager or preceptorTraining by manager or preceptor

– Return demonstration– Case scenario discussion

Patient education protocols– Patient education protocols• Written SOPs• Equipment operation and troubleshootingqu p e t ope at o a d t oub es oot g• Strategic plan for ongoing education of staff• Mentoring

Ob l i h 1 1 Ed iObstacles with 1:1 Education• Time involvement• Time involvement• Proximity to infusion branch• Number of branch agencies• New staff competencyp y• New product utilization• New patient type/therapies• New patient type/therapies• Ongoing competency assessment

How Do We Establish Competencies for Agencies?Competencies for Agencies?

Other Modalities• Learning management systems • Secured web and social network media • Professional organizations specific to home

infusion infusion nursing and disease statesinfusion, infusion nursing and disease states• Ongoing mentoring programs

Learning Management Systems• Multiple modalities• Multiple modalities

– Discussion forums– FAQs– FAQs– Captivate capabilities

• Learner modulated skills testingLearner modulated skills testing

• Conducive to adult learner– Post testing opportunitiesPost testing opportunities– Multiple opportunities to review– Verbal and visual

Secure Web and Social Media SitesSites

• Easily accessibleUtilization capabilities• Utilization capabilities

• Download information• World wide data base• Time efficient• Access to Target Audience

P f i l O i iProfessional Organizations• Networking access for educational• Networking access for educational

opportunities I d t t d d• Industry standards

• Core competency standards

O i M iOngoing Mentoring• Teacher and guide• Teacher and guide• Problem-solving opportunities• Specific timeframe for follow up• Guide through complicated casesg p

Patient/Caregiver Education • Assist patients/caregivers to achieve• Assist patients/caregivers to achieve

maximal independence with their home infusion therapyinfusion therapy

• Adult learning principles again• Learning readiness and education level

P i /C i Ed iPatient/Caregiver Education

• Active listening• Working from patient’s agenda• Working from patient s agenda• Identifying patient beliefs and values

V lid i f C iValidation of Competencies

• Skills ChecklistsC i di i• Case scenario discussions

• Demonstration of knowledge/skill• *Patient Outcomes*• *Patient Outcomes*• Online programs with testing• On site supervisory visits• On site supervisory visits• Teleconferences

T l A il blTools Available• Manufacturer websites• Manufacturer websites• Patient/staff teaching tools• E- or online learning & blended education• Weekly conferencesy• Skills testing – realistic simulations• Pump teaching programs (Healthstream)• Pump teaching programs (Healthstream)• SOPs

M d lModels• Computerized mannequins• Computerized mannequins• Infusion models• INS competency tapes• Specific developed learning modulesp p g

R A il blResources Available

HandoutHandout

In Summary• Discussion of meeting objectives• Discussion of meeting objectives• Define competency• CRNI competencies• Adult learning both for patient and RNg p• Challenges• Obstacles• Obstacles• Importance of patient outcomes