Download PACU Competency - Alaska State Hospital and Nursing Home

RN Competency Form: PACU
Competence Verification & Learning Guide: Facility
Name (learner)
Date Initiated
Unit
☐RN  ☐LPN  ☐Recent Graduate  ☐Experienced Nurse  ☐New to Specialty  ☐Traveling Nurse 
Note: for LPN practice guidelines, see state nursing statutes & regulations
The preceptor will initial each competency when he/she, as preceptor and colleague, feels safe in allowing the learner to deliver this aspect of
care without direct supervision.
Self-Assessment: 1 – Identified Limitation (little or no experience); 2 – Capable (familiar but may need assistance); 3 – Independent - can
perform these tasks safely; 4 – Proficient - extensive experience *For further information, see instruction sheet at end of this form.
IA. The learner will incorporate relevant assessment and intervention (A & I) skills in caring for the intra-operative patient::
Provide for intra-operative safety
check identity/correct site
follows universal protocol
complete accurate sponge, needle and instrument
counts
track key times (tourniquet, birth, etc.)
check patient record for completeness and
complicating factors
prevent OR complications
coordinate ID and handling of specimens
assist with intraoperative radiology
Use PACU equipment per manuals and policy
IB. The learner will incorporate relevant A & I skills in caring for the intra/post-operative patient:
Provide systematic & continuous patient assessment
identify changes in patient status promptly
take corrective action as needed
Provide care for patient undergoing anesthesia
anticipate assessment findings
intervene for complications
Integrate ABG results into care (RN only)
interpret results correctly
act to correct abnormalities
Learning Guide #
Preceptor initials
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Learner initials
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Date all met
Self-assessment
Learning Guide follows competency pages and contains items for each competency that need to be reviewed based on learner’s experience and unit
need, they include reminders of important teaching points that may otherwise be missed.
Required Competencies
Verification method
References
Main categories followed by associated competencies
& facility specific requirements
IA 1
IA 2
IB 1
IB 2
IB 3
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 1
References
Learning Guide #
Preceptor initials
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Learner initials
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Verification method
& facility specific requirements
Date all met
Self-assessment
RN Competency Form: PACU
Required Competencies
Initiate care for patient in respiratory distress or failure
set up for emergency airway
implement relevant protocols consistent with
patient status
Provide care for intubated patient (RN only)
monitor tolerance (volume, pressure, synchronicity
and oxygenation)
maintain patent airway by positioning, suctioning,
checking and securing
check ventilator settings & that mode is
appropriate for condition
troubleshot alarms to correctly intervene
extubate a patient safely
Provide care for client with neurologic crisis per
protocols
IB 4
Initiate care of patient with cardiac emergency per
protocols
IB 7
Provide care for client with transvenous or
transcutaneous pacemaker per policy (RN only)
demonstrate setting rate and sensitivity and
stimulation thresholds
identify complications
IB 8
IC. The learner will incorporate relevant A & I skills in caring for the post-operative patient:
Administer IV drips (RN only)
calculate drip rate correctly
titrate drip per orders/need
wean drips per protocols
IB 5
IB 6
IC 1
Optimize patient comfort with sedation and pain control
as indicated (IVP & PCA dose changes RN only)
evaluate patient using sedation & pain scales
evaluate effectiveness of paralytics
ensure adequate sedation & pain control with
paralytic use
administer sedation per protocols
wean meds per pharmacy recommendations and
patient tolerance
Correlate clinical condition with drug indications, desired
effects, dosage and contraindications for commonly
given high risk medications
IC 2
Manage care of patient with malignant hyperthermia per
protocol - extubate a patient safely
IC 4
IC 3
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 2
RN Competency Form: PACU
Comments/alternative learning plans:
All preceptors are to sign & initial below. Ideally new graduates should have only one to two preceptors for the entire orientation.
Preceptor Signature
Initials
Preceptor Signature
Initials
Signatures at completion of preceptorship/orientation:
Preceptee/learner
Date
Primary Preceptor
Date
Manager
Date
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 3
RN Competency Form: PACU
LEARNER GUIDE: Reference content in the right-hand column that needs to review.
IA. The learner will incorporate relevant assessment and intervention (A & I) skills in caring for the intra-operative patient:
IA 1
Provide for intra-operative safety
Review all intra-operative policies and procedures
- check identity/correct site
Review OR complication prevention methods:
- follows universal protocol
- dipersive electrocautery pad
- complete accurate sponge, needle and instrument
- check limb CMS
counts
- assess CV, respiratory, renal and nutritional status
- track key times (tourniquet, birth, etc.)
- provide for privacy, warmth, etc.
- check patient record for completeness and complicating - properly position, pad, restrain
factors
- protect airway
- prevent OR complications
- minimize distractions
- coordinate ID and handling of specimens
- assist with intraoperative radiology
IA 2
Use PACU equipment per manuals and policy
Review cleaning, storage and troubleshooting of the following equipment:
electrocautery, infant warmer and cart, suction curettage, beds/patient
positioning devices, autoclave and other sterilizers, ECG, cardiac monitor,
bedside and central monitors, cold therapy/elevation, laser, invasive lines
including calibration, tubes and drains/expected function
IB. The learner will incorporate relevant A & I skills in caring for the intra-operative patient::
IB 1
Provide systematic & continuous patient assessment
Review assessment concerns for : level of consciousness, airway, cardiac
- identify changes in patient status promptly
rhythm and effectiveness, fluid balance including bladder distention, neuro
- take corrective action as needed
assessment, vital signs, pain and nausea, circulation, mobility & sensation
checks (extremity pain, pulse, paresthesia, paralysis), dressings and drains,
bleeding, fundal checks & massage post C-section, sedation scale, coma
scale, temperature control
IB 2
Provide care for patient undergoing anesthesia
Review expected effects, risks and reversal agents for all commonly used
- anticipate assessment findings
general, regional, epidural, spinal, local, nerve block & MAC anesthetic
- intervene for complications
agents
Review teaching/communication techniques for children
Review age specific response for elders and pediatrics
IB 3
Integrate ABG results into care (RN only)
Review ABG norms and interpretation of changes
- interpret results correctly
Complete checklist for drawing ABGs if applicable
- act to correct abnormalities
IB 4
Initiate care for patient in respiratory distress or failure
Review policies, procedures and equipment for emergency respiratory
- set up for emergency airway
management
- implement relevant protocols consistent with patient
Review emergency airways: ETT, cricothyrotomy, tracheostomy
status
For peds, review equipment size differences, lung volumes, pediatric code
management
IB 5
Provide care for intubated patient (RN only)
Review ventilator and intubation protocols, equipment, standing orders, and
- monitor tolerance (volume, pressure, synchronicity and
troubleshooting
oxygenation)
Review initiation and indications for jet vent if applicable
- maintain patent airway by positioning, suctioning,
Review SVO2 monitoring, set up and data analysis if done in unit
checking and securing
- check ventilator settings & that mode is appropriate for
condition
- troubleshot alarms to correctly intervene
- extubate a patient safely
IB 6
Provide care for client with neurologic crisis per protocols Review measures to decrease intracranial pressure, seizure and stroke
management
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 4
RN Competency Form: PACU
LEARNER GUIDE: Reference content in the right-hand column that needs to review.
IB 7
Initiate care of patient with cardiac emergency per
Review the following unit protocols
protocols
- initial chest pain management
- dysrhythmias
- significant BP change
- CHF or pulmonary edema
- cardiogenic shock
- cardiac arrest
- code cart management
IB 8
Provide care for client with transvenous or
Review equipment, manufacturers recommendations, safety considerations,
transcutaneous pacemaker per policy (RN only)
how to operate the pacer, pacing modes
- demonstrate setting rate and sensitivity and stimulation Review complications: failure to pace, failure to sense, failure to capture,
thresholds
dysrhythmias, burns & pain (with transcutaneous)
- identify complications
IC. The learner will incorporate relevant A & I skills in caring for the post-op patient:
IC 1
Administer IV drips (RN only)
Review all related policies, protocols and standing orders for commonly used
- calculate drip rate correctly
IV drips.
- titrate drip per orders/need
- wean drips per protocols
IC 2
Optimize patient comfort with sedation and pain control
Review sedation and pain scales and interventions including emergency
as indicated (IVP & PCA dose changes RN only)
equipment standby
- evaluate patient using sedation & pain scales
Review use of and interpretation of results from peripheral nerve stimulator
- evaluate effectiveness of paralytics
Review policy for moderate sedation and complete any facility required training
- ensure adequate sedation & pain control with paralytic
and/or checklists
use
- administer sedation per protocols
- wean meds per pharmacy recommendations and
patient tolerance
IC 3
Correlate clinical condition with drug indications, desired
Review the following medications: dopamine, dobutamine, norepinephrine,
effects, dosage and contraindications for commonly
epinephrine, nitroglycerine, nitroprusside, diltiazem, lidocaine, amiodarone,
given high risk medications
thrombolytics, procainamide, potassium, aminophylline, heparin, insulin,
octreotide
IC 4
Manage care of patient with malignant hyperthermia per
Review protocol
protocol - extubate a patient safely
Other facility specific items to cover:
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 5
RN Competency Form: PACU
REQUIREMENTS: All nurses will complete these competencies upon hire. Some competencies may be reviewed annually. This form
follows the Competency Outcomes and Performance Assessment (COPA) model.
PRECEPTEE/LEARNER INSTRUCTIONS:
Complete self-assessment: Rate your skill in each area to identify the areas where you need additional experience, access to
teaching resources, and/or lab practice. Discuss your results with your preceptor to help establish a plan and goals for your learning
experience and to aid in choosing patient assignments. Scoring per instructions at the top of page 1.
PRECEPTOR INSTRUCTIONS:
A. Review self-assessment with preceptee/learner to establish plan.
B. Required Competencies: The specialty area competency forms are required for independent practice on this unit. This column
represents the Alaska Statewide required competencies per ACE-HC and should not be altered. The preceptor will sign each one off
when he/she, as preceptor and colleague, feels safe in allowing the preceptee/learner to deliver this aspect of care without
direct supervision.
C. Verification Method & Agency Specific. Document comments/check marks for the competency and any agency specific
requirements. Verification methods include:
1. Demonstration – Preceptor watches learner perform task/procedure in safe, capable manner in a simulated lab or computer
setting or as part of direct care performance. The expectation for new graduates is that they demonstrate as many of the
competencies as possible.
2. Test – Learner passes a test provided by the facility to measure competence for this skill. (Minimum passing grade indicated.
Initial only after test passed.)
3. Module –Learner has completed a training tool (computerized or written module, class, video, etc.) provided by the facility to
measure competence for this skill.
4. Verbalization - Learner explains to the preceptor the process and/or planning that evidences safe, reliable knowledge base.
This may include case scenarios, discussion, and/or description of plan.
NOTE: some competencies may have the verification method specified per facility guidelines (e.g. “test only”)
Record N/A and initials only for items that never apply to this learner’s role or performance.
D. Sign-off: Sign and date when all elements of the competency are met. If unable to sign off an area due to patient population issues
or learner needs more time, document a plan in the comments section at the end of the form. Discuss alternative ways of meeting
the requirement(s) as well as any additional time needed with the nurse manager and/or nurse educator. All preceptors assisting in
orientation of a new staff member/intern must sign and initial in the signature chart at the end of this document.
E. References: Competencies should be met in accordance with these. Add your facility approved references here.
F. Learning Guide: These are memory ticklers. The amount of time spent on each of them depends on the learner’s experience. New
graduates will likely need time on almost all of the areas listed.
REFERENCES COLUMN: List foundational documents to support the learning experience and to use as the official measure by which
the competencies are assessed. The ACE-HC group recognizes the following as sources for evidence based practice that can be
included in the reference list along with local policies, procedures and forms: Perry & Potter, Elsevier/Mosby, Lippincott, Kozier & Erb,
ANA, nationally recognized hospital related regulatory organizations (CLIA, CDC, CMS, JC, etc.), and specialty nursing organizations’
scope, standards and core curricula. This column’s content may be changed to be facility specific.
NOTE: ACE-HC competency forms are intended to be used between facilities within Alaska.
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 6