Home Health & Hospice

Insider's Scoop | Assessing clinical competencies: Gastrointestinal skill checklist

Homecare Insider, November 16, 2015

Editor’s note: This week’s Insider’s Scoop was adapted from one of HCPro’s classic home health & hospice titles, Home Health Competency Management System: A Toolkit for Validation and Assessment,which saves home health providers the time and hassle of measuring and documenting the skills of their clinicians and aides. The complete system provides competency management program tips and detailed skill and performance assessments for nursing, therapy, and home health aides, as well as general skills that all clinicians need to embody your agency’s high care standards for patients and family members. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com

No matter what changes in homecare, there will always be the need to validate clinician competencies. It is not sufficient to send clinicians into the field assuming that they are proficient simply based on their licensure. It is up to agencies to verify that clinicians remain current and proficient in their skills.
Due to home health regulations from both federal and state governing bodies, agencies must be able to produce documentation that demonstrates the competencies of clinicians in their job duties. This also helps to protect both the agency and clinicians in today’s age of increasing litigation. For clinicians, signing a document verifying their competency gives them ownership of the responsibilities associated with the com­petency. It gives the agency tools to identify clinician deficiencies early during the orientation process, saving time and resources.
 
Home health is evolving into a more complicated level of care. Without the availability of immediate support, as found in the hospital setting, clinicians must function at a higher level of independence and skill. It is up to the management staff and specialists within the agency to ensure that clinicians can perform at this higher level. Standard, written competencies serve as an effective way to document and validate this level of performance.
 
The following gastrointestinal competency checklist can be used for both registered nurses and licensed practical nurses based on the allowances of the state in which they practice and the specific policies within the homecare agency. The competency has been constructed in a generic fashion to accommodate variances in policies or protocol between agencies. This also allows for changes within policies or protocols without having to revise the competencies.
 
Directions: To assess a clinician’s proficiency in the competency, take the following steps:
  1. Place a check mark next to the category in which the clinician has demonstrated proficiency, an ‘X’ next to the ones in which he or she has failed, and an ‘N/A’ next to those that are not applicable
  2. Indicate whether, overall, the clinician is proficient in the given competency and able to perform it independently, or whether the clinician needs further instruction/observation
  3. Record any related comments or action plan items
  4. Indicate the method of validation (e.g., direct observation, simulation, verbalization, or documentation)
  5. Indicate the type of validation (e.g., annual competency, procedure check-off, or orientation)
  6. Sign and date the form, indicating that you are the supervising clinician
  7. Ask the clinician under assessment to sign and date the form
Gastronomy tube replacement
  1. Verifies orders
  2. Uses two patient identifiers
  3. Explains procedure to patient/caregiver
  4. Performs hand hygiene according to agency policy/protocol
  5. Maintains bag technique per agency policy/protocol throughout procedure
  6. Utilizes standard precautions and aseptic technique throughout procedure
  7. Sets up supplies
  8. Dons personal protective equipment as appropriate for procedure
  9. Positions patient
  10. Removal procedure:
    1. Connects syringe into balloon port and removes fluid
    2. Gently removes old gastrostomy tube
    3. Verbalizes/demonstrates actions for difficulty removing gastrostomy tube
  11. Reinsertion procedure:
    1. Cleanses stoma site per agency policy/protocol and/or physician orders
    2. Applies water-soluble lubricant to gastrostomy tube tip and/or stoma
    3. Gently inserts gastrostomy tube into stoma
    4. Inflates balloon according to manufacturer’s recommendation
    5. Gently pulls gastrostomy tube so that it rests against the inside of stomach
    6. If disk present, slides down against skin, allowing sight in and out
    7. Verifies placement:
      1. Aspirates for stomach contents
      2. Injects air while auscultating for sound
    8. Applies dressing and securement device as per agency policy/protocol and/or physician orders
  12. Cleans equipment/environment post-procedure
  13. Provides education to patient/caregiver per assessed needs
  14. Maintains safe environment for the patient throughout procedure
  15. Utilizes OSHA standards for disposal of hazardous materials and waste
  16. Performs hand hygiene according to agency policy/protocol
  17. Documents procedure per agency policy/protocol
  18. Takes appropriate actions for abnormal findings or observations

 

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