Download OR Competency (Word 2003) - Alaska State Hospital and Nursing

RN Competency Form: Operating Room
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.
I A. The learner will incorporate relevant assessment and intervention (A & I) skills in caring for the peri-operative patient:
Manage patient flow
complete room turnover promptly
set up room using preference cards and standards
Manage patients undergoing procedural sedation
IB. The learner will incorporate relevant A & I skills in caring for the intra-operative patient::
Maintain sterile field
prepare and protect field
gown and glove self & others
perform surgical scrub & draping
Provide for intra-operative safety
check identity/correct site
universal protocols
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 OR equipment per manuals and policy
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
Circulate for the following surgical procedures:
general open
general laparoscopic
OB/GYN open
urology
ophthalmology
ENT
orthopedic
vascular/thoracic
endoscopic
dental
neurology
Scrub/assist with the following surgical procedures:
general open
general laparoscopic
OB/GYN open
urology
opthamology
ENT
orthopedic
vascular/thoracic
endoscopic
dental
neurology
IC. The learner will incorporate relevant A & I skills in caring for the intra/post-op patient:
Provide systematic & continuous patient assessment
identify changes in patient status promptly
take corrective action as needed
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: Operating Room
Required Competencies
IB 4
IB 5
IC 1
Provide care for patient undergoing anesthesia
anticipate assessment findings
intervene for complications
IC 2
Initiate care for patient in respiratory distress or failure
set up for emergency airway
implement relevant protocols consistent with patient
status
IC 3
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
IC 4
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
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: Operating Room
Required Competencies
Integrate ABG results into care (RN only)
interpret results correctly
act to correct abnormalities
IC 5
Initiate care of patient with cardiac emergency per
protocols
IC 6
Provide care for client with transvenous or
transcutaneous pacemaker per policy (RN only)
demonstrate setting rate and sensitivity and
stimulation thresholds
identify complications
Provide care for client with neurologic crisis per
protocols
IC 7
ID. The learner will incorporate relevant A & I skills in caring for the post-op patient:
Administer IV drips (RN only)
calculate drip rate correctly
titrate drip per orders/need
wean drips per protocols
IC 8
ID 1
Optimize patient comfort with sedation and pain control
as indicated (IVP & PCA dose change 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
ID 2
Manage care of patient with malignant hyperthermia per
protocol
ID 4
ID 3
Comments/alternative learning plans:
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: Operating Room
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 4
RN Competency Form: Operating Room
LEARNER GUIDE: Reference content in the right-hand column that need review.
IA. The learner will incorporate relevant assessment and intervention (A & I) skills in caring for the peri-operative patient:
IA 1
Manage patient flow
Review discharge criteria, report and transfer processes
- complete room turnover promptly
Review room set up and turnover process for all parts of OR suite
- set up room using preference cards and standards
IA 2
Manage patients undergoing procedural sedation
Review policy and complete procedural sedation competency as required by
the organization and regulations.
IB. The learner will incorporate relevant A & I skills in caring for the intra-operative patient::
IB 1
Maintain sterile field
Review protocols
- prepare and protect field
- gown and glove self & others
- perform surgical scrub & draping
IB 2
Provide for intra-operative safety
Review all intra-operative policies and procedures
- check identity/correct site
Review OR complication prevention methods:
- complete accurate sponge, needle and instrument
- dipersive electrocautery pad
counts
- check limb CMS
- track key times (tourniquet, birth, etc.)
- assess CV, respiratory, renal and nutritional status
- check patient record for completeness and complicating - provide for privacy, warmth, etc.
factors
- properly position, pad, restrain
- prevent OR complications
- protect airway
- coordinate ID and handling of specimens
- minimize distractions
- assist with intraoperative radiology
IB 3
Use OR 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 4
Circulate for the following surgical procedures:
Review protocols for each type of case
- general open
- general laparoscopic
- OB/GYN open
- urology
- ophthalmology
- ENT
- orthopedic
- vascular/thoracic
- endoscopic
- dental
- neurology
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: Operating Room
LEARNER GUIDE: Reference content in the right-hand column that need review.
IB 5
Scrub/assist with the following surgical procedures:
Review protocols for each type of case
- general open
- general laparoscopic
- OB/GYN open
- urology
- opthamology
- ENT
- orthopedic
- vascular/thoracic
- endoscopic
- dental
- neurology
IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include the following:
IC 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
IC 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
IC 3
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
IC 4
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
IC 5
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
IC 6
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
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: Operating Room
LEARNER GUIDE: Reference content in the right-hand column that need review.
IC 7
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 8
Provide care for client with neurologic crisis per protocols Review measures to decrease intracranial pressure, seizure and stroke
management
ID. The learner will incorporate relevant A & I skills in caring for the post-op patient:
ID 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
ID 2
Optimize patient comfort with sedation and pain control
Review sedation and pain scales and interventions including emergency
as indicated (IVP & PCA dose change 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
ID 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
ID 4
Manage care of patient with malignant hyperthermia per
Review protocol
protocol
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 7
RN Competency Form: Operating Room
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 8