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RN Competency Form: Emergency 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. References IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following: Follow ENA standards Triage patients per protocols -determine priority of care -use tools needed to assess chief complaint -target assessment to triage quickly -perform required screening -initiate established protocols 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 setting & that mode is appropriate for condition -troubleshot alarms to correctly intervene -extubate a patient safely Integrate ABG results into care (RN only) -interpret results correctly -act to correct abnormalities Initiate care of patient with cardiac emergency per protocols/pathways 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 IA 3 IA 4 IA 5 IA 6 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 Competency Form: Emergency Room Required Competencies Identify ischemia, injury or infarct on a 12 lead ECG IA 7 Care for client with transcutaneous pacemaker per policy (RN only) -demonstrate setting rate and sensitivity and stimulation thresholds -identify complications Use bedside and central monitors for all pertinent functions IA 8 Manage invasive lines (RN only) -zero and calibrate -troubleshoot waveforms -intervene as needed Apply interventions for sepsis as needed per policy IA 10 Provide initial interventions for shock per protocol IA 12 Provide initial treatment for environmental emergencies per protocols IA 13 Manage initial care for abdominal emergencies per protocols IA 14 Manage initial care of pediatric emergencies with age specific interventions and equipment IA 15 Integrate measures to ensure patient safety in high risk setting IA 16 Apply interventions for neurologic emergencies per protocols IA 17 Manage initial care for OB emergencies per protocols IA 18 Manage initial care of trauma patient per protocols IA 19 Manage initial care of patient with dental, ENT, ophthalmic or GU emergency per protocol IA 20 IA 9 IA 11 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 Competency Form: Emergency Room Required Competencies Ensure patient, staff & visitor safety during mental health emergency IA 21 Manage care of confused patient per guidelines IA 22 Coordinate emergency response per protocols IA 23 IA 24 IB. The learner will incorporate relevant A & I skills in delivery of medications, IV’s & blood to include the following: Administer IV drips (RN only) -calculate drip rate correctly -titrate drip per orders/need -wean drips per protocols IB 1 Correlate clinical condition with drug indications, desired effects, dosage and contraindications for commonly given high risk medications (RN only) IB 2 Optimize patient comfort with sedation, pain control and paralytics as indicated (IVP & PCA dose changes RN only) -use sedation and & pain scales correctly -evaluate effectiveness of paralytics using peripheral nerve stimulator -ensure adequate sedation & pain control with paralytic use -administer sedation per protocols -wean meds per pharmacy protocol, orders and patient tolerance IB 3 IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include: Perform nursing role during a procedure -set up for procedure -provide nursing assistance during procedure -monitor patient during and after for complications Manage chest drainage system -describe chambers and normals -assess patient and system -identify any deviations from the norm Operate specialty equipment per manuals and policies IC 1 IC 2 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 3 References Provide employee health procedures 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 Competency Form: Emergency Room Required Competencies IC 4 Section II. The learner will incorporate relevant communication skills in all interactions to include the following: Manage patient flow -transfer/discharge as soon as possible -document without delay -inform patients/families of plan/delays -provide ongoing patient observation II 1 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 4 Competency Form: Emergency Room 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 Follow ENA standards Read and Review current ENA standards IA 2 Triage patients per protocols Review policies and procedures related to triage IA 3 Initiate care for patient in respiratory distress or failure Review policies, procedures and equipment for emergency respiratory management Review emergency airways: ETT, cricothyrotomy, tracheostomy For infant/peds, review equipment size differences, lung volumes, pediatric code management Review treatment protocols for bronchospasm, asthma, croup, hemo & pneumothorax, COPD IA 4 Provide Care for intubated patient (RN only) Review ventilator and intubation protocols, equipment, standing orders, and troubleshooting Review initiation and indications for jet vent if applicable Review SVO2 monitoring, set up and data analysis if done in unit. IA 5 Integrate ABG result into care (RN only) Review ABG norms and interpretation of changes Complete checklist for drawing ABGs if applicable IA 6 Initiate care of patient with cardiac emergency per protocols/pathways Review protocols for initial chest pain management, dysrhythmias, significant BP change, CHF or pulmonary edema, cardiogenic shock, cardiac arrest, code cart management, etc. IA 7 Identify ischemia, injury or infarct on a 12 lead ECG Review ECG interpretation IA 8 Care for client with transcutaneous pacemaker per policy (RN only) Review equipment, manufacturers recommendations, safety considerations, how to operate the pacer, pacing modes Review complications: failure to pace, failure to sense, failure to capture, dysrhythmias, burns & pain IA 9 Use of bedside and central monitors for all pertinent functions Review setting parameters, calculating functions, changing modules and troubleshooting. IA 10 Manage invasive lines (RN only) Practice with equipment Review policies and manuals IA 11 Apply interventions for sepsis as needed per policy Review protocols, fever reduction methods, circulatory support including vasoactive drips Include infant/pediatric protocols IA 12 Provide initial interventions for shock per protocol Review types of shock and any standing orders, protocols, guidelines for treatment IA 13 Provide initial treatment for environmental emergencies per protocols Review procedures and initial burn management protocol, fluid replacement protocol, wound management and transfer criteria/procedure Review care of hypothermia, frostbite and chemical burns IA 14 Manage initial care for abdominal emergencies per protocols Review sources of abdominal pain and injuries, mobilizing the surgical team and other protocols 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 Competency Form: Emergency Room LEARNER GUIDE: Reference items in right-hand column that needs review. IA 15 Manage initial care of pediatric emergencies with age Review age specific equipment, interventions, communication techniques and specific interventions and equipment family care IA 16 Integrate measures to ensure patient safety in high risk setting Review visitor policy/teaching, equipment safety, spinal precautions (collar fit, back boards, alignment, turning & transferring), domestic violence screening and sexual assault protocol IA 17 Apply interventions for neurologic emergencies per protocols Review pathophysiology and treatment of CVA, subarachnoid, subdural/epidural hemorrhage, trauma damage and swelling, HA evaluation, dementia, seizure, spinal cord injury Review radiology and neurology resources Review coma scale & interventions Review policies and guidelines IA 18 Manage initial care for OB emergencies per protocols Review identification and treatment of PIH, abruption placentae, precipitous childbirth, bleeding, ectopic pregnancy, pain, and other pregnancy related complications Review how to obtain fetal heart tones and norms IA 19 Manage initial care of trauma patient per protocols Review protocols for trauma management, rewarming, forensics, trauma scale, orthopedic, bites IA 20 Manage initial care of patient with dental, ENT, ophthalmic or GU emergency per protocol Review policies and protocols, contacting specialists Review most common injuries in the area: nose bleed, acute peritonsillar abscess, ARP, testicular torsion, ocular injury IA 21 Review protocols for managing violent and suicidal behaviors IA 22 Ensure patient, staff & visitor safety during mental health emergency Manage care of confused patient per guidelines IA 23 Coordinate emergency response per protocols Review policy and role in emergency response throughout hospital, for local disaster and trauma response Review s/s electrolyte imbalance, fever, medication side effects and dementia Review safety protocols IB. The learner will incorporate relevant A & I skills in delivery of medications, IV’s & blood to include the following: IB 1 Administer IV drips (RN only) Review all related policies, protocols and standing orders for commonly used IV drips IB 2 Correlate clinical condition with drug indications, desired effects, dosage and contraindications for commonly given high risk medications (RN only) Review the following medications: dopamine, dobutamine, norepinephrine, epinephrine, nitroglycerine, nitroprusside, diltiazem, lidocaine, amiodarone, thrombolytics, procainamide, potassium, aminophylline, heparin, insulin, octreotide, TPA, and others as applicable IB 3 Optimize patient comfort with sedation, pain control and paralytics as indicated (IVP & PCA dose changes RN only) Review sedation and pain scales and interventions Review use of and interpretation of results from peripheral nerve stimulator Review policy for moderate sedation and complete any facility required training and/or checklists 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 Competency Form: Emergency Room IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include: IC 1 Perform nursing role during a procedure Review procedure, equipment &risks of: thoracotomy, thoracentesis, pericardiocentesis, gastric/peritoneal lavage, suturing, casting, vaginal exams, lumbar puncture including pediatrics, central line insertion, arterial line insertion/monitoring, Sengstaken-Blackmore tube, Cardioversion, external pacing, endoscopy IC 2 Manage chest drainage system Review P & P (include auto transfusion) Talk through drainage system with preceptor – simulate if have no patients with chest tubes. IC 3 Operate specialty equipment per manuals and polices Review manuals and facility policy for fluid/blood warmer, rapid transfuser, hypo/hyperthermia blanket, adult traction and other splints, sizing and teaching re: crutch use, crash carts, emergency kits/packs, etc. IC 4 Provide employee health procedures Review employee injury and other employee health protocols Section II. The learner will incorporate relevant communication skills in all interactions to include the following: II 1 Manage patient flow Review room assignment and flow pattern, triage system, transfer guidelines, traffic control 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 Competency Form: Emergency 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