Download Pediatric Competency - Alaska State Hospital and Nursing Home

RN Competency: Pediatric
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.
References
IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following:
Initiate life-saving/emergency measures consistent with
patient needs and protocols
set up for emergency airway
implement relevant protocols consistent with patient
status
Manage chest drainage system
describe chambers/normal
assess patient and system
identify any deviations from the norm
Learning Guide #
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Preceptor initials
Verification method
& facility specific requirements
Learner initials
Required Competencies
Main categories followed by associated competencies
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.
IA 1
IA 2
Apply interventions for sepsis per protocols
IA 3
Manage care of child with cerebral deficit
IA 4
Integrate developmental and age specific needs in
approach to and delivery of care
IA 5
Use equipment based on age, weight and need
IA 6
Implement measures and precautions to insure patient
safety and well-being
IA 7
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
RN Competency Form: Pediatric
Maintain spinal precautions as ordered
check for proper collar fit
maintain alignment with turning/transferring
IA 8
IB. The learner will incorporate relevant A & I skills in delivery of medications, IV’s & blood to include the following:
Apply pediatric protocols to medication management
implement safe practice with high risk medication
implement the “rights” of med administration
state indications, contra-indications and side effects
(may use reference)
administer IVPB solution
administer IV push/bolus med (RN only)
Calculate doses correctly based on weight
Verify pediatric med doses with pharmacist or
another nurse
Manage peripheral IV care consistent with protocols
verbalize pediatric and volume and dosage
precautions
obtain IV access per protocol
Manage central/PICC line consistent with protocols
use correct flush solution and technique
apply policy for clotted line
assess site for complications
NOTE: LPN’s limited to specific training per state regs
IB 1
IB 2
complete PICC competency if
required
IB 3
Administer blood/blood products (RN only) per protocol
IB 4
Perform venipuncture on an adult &/or child or infant
heel stick as applicable
IB 5
Optimize patient comfort with sedation and pain control
as indicated (IVP & PCA dose)
evaluate patient using age appropriate sedation &
pain scales
administer sedation per protocols
wean medications per protocols and patient
tolerance
IB6
Administer chemotherapy safely (RN only)
IB7
IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include:
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: Pediatric
Feed child per protocol
position for safety
ensure proper placement for tube feeding
IC 1
Perform point of care testing per lab and unit protocols
by completing all required competencies
IC 2
Utilize protocols and other references for unfamiliar or
infrequently used procedures and equipment
IC 3
Section ID The learner will incorporate teaching skills in delivery of all nursing care to include the following:
Educate patients and families with consideration for age,
culture, educational background and home environment
or setting
Provide education to complete a successful patient
discharge per policy
ID1
ID2
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/orientee
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: Pediatric
LEARNER GUIDE: Reference items in right-hand column that needs review.
IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following:
IA 1
Initiate life-saving/emergency measures consistent with
Review procedures for:
patient needs and protocols
-Correct response for all codes
-Obtaining/interpreting an ECG
-Emergency airways: ETT, cricothyrotomy, tracheostomy
-Pediatric equipment size differences, lung volumes, code management
-Practice with bulb and Delee suction, peak flow meter and interpretation
-Set up/care for patient in croup tent and patient with apnea monitor
-Allergic reaction (also latex allergy)
-Seizure precautions including patient positioning/padding
-Hyper and hypoglycemic episodes
-Hyper and hypothermic episodes
--Reporting abuse/neglect
-Use of emergency equipment
--Poison/overdose management
IA 2
Manage Chest Drainage System
Review the following:
-P&P and equipment management
Talk through drainage system with preceptor-simulate if no patients with chest
tubes
IA 3
Apply interventions for sepsis per protocols
Review protocols, fever reduction methods, circulatory support
IA 4
Manage care of child with cerebral deficit
Review policy and pathophysiology and treatment of children with cerebral
deficits due to acute or chronic conditions (hemorrhage, trauma, Down’s,
etc.)
Review radiology and neurology resources
Review come scale and interventions
IA 5
Integrate developmental and age specific needs in
approach to and delivery of care
Review the following:
-VS parameters
-Communication techniques
-Physical, developmental, spiritual & emotional needs
IA 6
Use equipment based on age, weight and need
Review the use of equipment (scales, pumps, restraints, lifts, etc.) in regards to
age and weight.
IA 7
Implement measures and precautions to insure patient
safety and well-being
Review the following:
-Fall prevention protocols
-Patient identification measures
--Infection control policy including hand hygiene, personal protective
equipment, patient isolation (respiratory, wound, neutropenia, etc.) and
contaminated waste policies
-Nosocomial risks: catheter infections, central line infections, pressure ulcers,
etc.
-Review teaching/learning principles for children
-Unusual occurrence reports
IA 8
Maintain spinal precautions as ordered
Review policies and equipment, skin assessment
-turning/positioning/transfer, how to “clear patient from precautions
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: Pediatric
LEARNER GUIDE: Reference items in right-hand column that needs review.
IB. The learner will incorporate relevant A & I skills in delivery of medications, IV’s & blood to include the following:
IB 1
Apply pediatric protocols to medication management.
Review medication administration policies and reference materials including
med reconciliation and narcotic accounting
Introduce to pharmacist and review pharmacy role and availability
Must pass unit/hospital medication test if required before allowed to administer
meds
Review limits to medication administration (formulary, restricted meds, high
alert meds)
Review weight based dosing and pediatric dosing
IB 2
Manage peripheral IV care consistent with protocols
Practice with related equipment (syringe pump, IV pump and corresponding
supplies)
Review policies re: preparing IV meds, approved IV medication list per unit
Review pediatric considerations re: volume and dosages
Review appropriate IV sites for all ages
Review administration of fluids including amount and types of fluids commonly
used.
IB 3
Manage central/PICC line consistent with protocols
NOTE: LPN’s limited to specific training per state statutes
Review policies on flushing, drawing blood, declotting, dressing change,
removal and general care of all central catheters used in the facility (PICC,
triple lumen, groshong, portacath, etc.)
Complete any specialty line competencies as required
IB 4
Administer blood/blood products (RN only) per protocol
Review blood bank and nursing policies and procedure for transfusion of blood
products
Review actions to take if suspected reaction occurs
Review massive transfusion, autologous transfusion and giving uncrossmatched blood policies
IB 5
Perform venipuncture on an adult &/or child or infant heel
stick as applicable
Review lab and nursing policies related to blood sampling
Review blood culture protocol
IB6
Optimize patient comfort with sedation and pain control
Review pediatric sedations and pain scales and interventions
Review policy for moderate sedation and complete any facility required training
and/or checklists
IB7
Administer chemotherapy safely (RN only)
Review P&P and complete facility competency if applicable
IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include the following:
IC 1
Feed child per protocol
Review feeding policies for breast, bottle and tube feeding, teaching parents,
-position for safety
I&0 measurement
-ensure proper placement for tube feeding
Review procedure for tube feeding in children, dietician’s role, type of solutions
and tubes
IC 2
Perform point of care testing per lab and unit protocols by
completing all required competencies
Review testing and quality control for the following as apply: rapid strep,
glucometer, urine chemistry strip, occult blood, , iStat
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: Pediatric
LEARNER GUIDE: Reference items in right-hand column that needs review.
IC 3
Utilize protocols and other references for unfamiliar or
Review how and where to access all procedures, manuals and instructions.
infrequently used procedures and equipment
Infrequent procedures may include post-mortem care, organ donation, and
many others
Equipment may include heating or cooling devices, fluid warmers, and many
others
ID The learner will incorporate teaching skills in delivery of all nursing care to include the following:
ID1
Educate patients and families with consideration for age, Review teaching principles and local culture and resources
culture, educational background and home environment
or setting
ID2
Provide education to complete a successful patient
Identify community resources for the patient
discharge per policy
Identify parent support and resources
Review discharge policy and procedures (pharmacy, standardized teaching
materials, etc.)
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 6
RN Competency Form: Pediatric
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 7