Are you talking about the competency of insertion or some other aspects of PICC care and maintenance?
The best approach to competency is to look at your clinical outcomes. What problems do you have in your facility? Then design your competency assessment programs to address those specific problems. So a form that works in one place will not be what another place actually needs.
Competency is more than just marking off a checklist that you can perform a simulation of a procedure in a model. That is a waste of time for nurses who routinely do PICC insertion. So look at your outcomes first. Lynn
I'm in agreement about needing to tailor your competencies. Here is what we do:
I tailor the competency for the "high volume low risk or high volume high risk" skills for our team who have a lot of experience and just need to demonstrate didactic/theoretical understanding of the principles. Included in these are JCAHO/National Quality targets, e.g. reducing CR-BSI's (our PICC rates are very low).
We also gather data for individual PICC RNs and the whole PICC team on insertion success rates (malpositions, cannulation, etc.), and infection rates. I give the stats to our Nurse Manager, and he gives each RN their stats during their annual evaluation - or on demand - confidentially. It's helped each nurse set goals for themselves, and be empowered by good clinical practice.
For clinical review on PICC placement, we use peer review based on standards from INS, AVA, VIR (our IV department is under radiology, and our Nurse Manager is an IR nurse) - developed by senior IV RNs and our Professional Practice Council. Two RN's will often work together placing a PICC, and if a particular RN is challenged by some aspect of PICC placement, we schedule him/her with a PICC preceptor for assistance. We don't document these sessions, but it would be an excellent idea - another way to demonstrate competency evaluation.
For PICC nurses we have a sterile technique mandatory, and have begun an annual mandatory inservice on sterile technique. It's a great opportunity for the team to have peer dialogue.
Finally- - I am in the process of developing a checklist for PICC placement based on the IHI bundle (100,000 Lives campaign to reduce CR-BSI): One person (RN or MA) works with the PICC RN, and checks off that the PICC RN followed each step (golden moment, maximum barrier, etc). This document goes in the patient record, and the process is also a competency tool.
As far as supporting nurse practice, these tools work well. As far as demonstrating competence to accreditors - it's easy to show the paper or electronic trail.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Are you talking about the competency of insertion or some other aspects of PICC care and maintenance?
The best approach to competency is to look at your clinical outcomes. What problems do you have in your facility? Then design your competency assessment programs to address those specific problems. So a form that works in one place will not be what another place actually needs.
Competency is more than just marking off a checklist that you can perform a simulation of a procedure in a model. That is a waste of time for nurses who routinely do PICC insertion. So look at your outcomes first. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I'm in agreement about needing to tailor your competencies. Here is what we do:
I tailor the competency for the "high volume low risk or high volume high risk" skills for our team who have a lot of experience and just need to demonstrate didactic/theoretical understanding of the principles. Included in these are JCAHO/National Quality targets, e.g. reducing CR-BSI's (our PICC rates are very low).
We also gather data for individual PICC RNs and the whole PICC team on insertion success rates (malpositions, cannulation, etc.), and infection rates. I give the stats to our Nurse Manager, and he gives each RN their stats during their annual evaluation - or on demand - confidentially. It's helped each nurse set goals for themselves, and be empowered by good clinical practice.
For clinical review on PICC placement, we use peer review based on standards from INS, AVA, VIR (our IV department is under radiology, and our Nurse Manager is an IR nurse) - developed by senior IV RNs and our Professional Practice Council. Two RN's will often work together placing a PICC, and if a particular RN is challenged by some aspect of PICC placement, we schedule him/her with a PICC preceptor for assistance. We don't document these sessions, but it would be an excellent idea - another way to demonstrate competency evaluation.
For PICC nurses we have a sterile technique mandatory, and have begun an annual mandatory inservice on sterile technique. It's a great opportunity for the team to have peer dialogue.
Finally- - I am in the process of developing a checklist for PICC placement based on the IHI bundle (100,000 Lives campaign to reduce CR-BSI): One person (RN or MA) works with the PICC RN, and checks off that the PICC RN followed each step (golden moment, maximum barrier, etc). This document goes in the patient record, and the process is also a competency tool.
As far as supporting nurse practice, these tools work well. As far as demonstrating competence to accreditors - it's easy to show the paper or electronic trail.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center