I am seaching for any guidelines to help establish our hospital policy on the maintainance of competency, I was assigned this task as part of our group. INS makes no statement, I haven't been able to find anything in AVA. I have written AVA and as of yet have not gotten an answer. I have spoken to a couple of people I respect and they have said they know of no guidelines but say some should be established. I found a couple hospital policies when I searched the internet. One said 4 PICCs a year (I thought you have got to be kidding, unless they are only doing overflow in a room right next to the IVR doctors). The other said 25 PICCs a year that sounded better but still only 2 a month. Our team is independant and I usually alone and personally place around 180 a year for inpatients only and after 6 years I still have occassional challanges. I don't think it is necessary to do that volume to keep up "competency" and I know there are many of you that do way more than I do.
Has anyone got any suggestions that I could make that seem reasonable? How do you back up the reason for the number you choose? If I can't find any I am leaning toward approximately 50 a year (average of 4 a month/ 1 a week) for our facilities that work independantly. Any thoughts about that?
Our group had quite a heated discussion on the matter when the director who gave me this task was not present. Some of the nurses have insisted that NO ONE is going to tell them whether they are competent or not. They backed that up with the story that one nurse had been away from practice for several years and jumped right back in. I asked if they let her go off on her own when she came back. They admitted that they didn't. They oriented her to the new equipment and followed her for several PICC placements. I said that was the point. No one is saying that you AREN'T COMPETENT but if you have been away from practice for a significant time due to whatever that someone just needs to bring you up to date with new policies etc and follow you for however many PICCs you need to feel comfortable again. That number could be different for different people. Policy might specify a minimum number but we all know that people vary just as new orientees vary in their needs. I am trying to make every one see that this is not an insult.
I like the forum. I am new to it, I have learned a lot and appreciate everyone's input and comments.
Mary
I am writing this both from my background as an infusion nurse specialist and as a nursing professional development specialist. I also hold a masters in adult education. I was assigned to research and write the INS standard on competence and competency assessment. I also recently gave a webinar through TargetBSI on this topic. So all this means I have been through the literature thoroughly and have searched for that magic number you are trying to find. I can unequivocally tell you that this number does not exist for PICC insertion or for any procedure. Competency assessment is required at 2 points - 1) intitially when one enters a practice setting or changes or expands their scope of practice and 2) on a periodic ongoing basis for those in the specific area of practice. Joint Commission requires competency assessment but they do not state what it must include or how frequently it is performed. The best competency assessment programs are linked to your clinical outcomes. This is all discussed in my webinar and I am trying to find a link to it rather than repeating it all here. I will post that link when I get it. But you are searching for a number that does not exist. So I would not waste my time. I would focus on an initial and ongoing competency assessment program. One other suggestion is to do a search of this site for previous discussions about this issue. 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
Thank you very much for your comments Lynn. I appreciate it very much. It is item 2 I was looking for. All of our policies and procedures as far as PICCs go have gone out the window. I have not had anything done in the way of an annual competency check since my 1st year. We have NO policies or procedures at all anymore and I am very concerned. I was given this piece to work on. I would appreciate greatly the link when you can. I am doing my best to promote best practice and best outcomes. I have listened to you speak at AVA many times and enjoyed greatly.
Mary
I know there are no regulatory or professional agencies that set any guidelines for compentency of PICC placement or any other type of procedure. Just curious, does your hospital have a competency guideline for MDs, ARNPs or PAs placing acute CVC's? After the intiial proficency period it is rare to find any hospital that does. Why shoudl PICC RNs be any different? What are your outcomes? These show proficency for your team--what are your phlebitis, infiltration, true thrombosis (not just who goes for a doppler with symptoms) rates? Your infection rates?
If you have a nurse who has poor outcomes, they are likely in need of some additional training.
I have been away from direct patient care for 5 years as a clinical specialist. I did precepting at the bedside, but no actual placements myself. I returned to the bedside and had no problem placeing PICCs, PIVs and Midlines. I have not done 25, 50 or any per year, but that does not mean my skills are gone, or I don't know how to be successful in avoiding complications. When you teach, it is like doing it yourself to some respects.
Rather than struggle to assign some arbitrary number, let your outcomes speak for the skill of the team. Consider mirroring whatever process your hospital uses for the MDs who place VADs. Good luck
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
I know there are no regulatory or professional agencies that set any guidelines for compentency of PICC placement or any other type of procedure. Just curious, does your hospital have a competency guideline for MDs, ARNPs or PAs placing acute CVC's? After the intiial proficency period it is rare to find any hospital that does. Why shoudl PICC RNs be any different? What are your outcomes? These show proficency for your team--what are your phlebitis, infiltration, true thrombosis (not just who goes for a doppler with symptoms) rates? Your infection rates?
If you have a nurse who has poor outcomes, they are likely in need of some additional training.
I have been away from direct patient care for 5 years as a clinical specialist. I did precepting at the bedside, but no actual placements myself. I returned to the bedside and had no problem placeing PICCs, PIVs and Midlines. I have not done 25, 50 or any per year, but that does not mean my skills are gone, or I don't know how to be successful in avoiding complications. When you teach, it is like doing it yourself to some respects.
Rather than struggle to assign some arbitrary number, let your outcomes speak for the skill of the team. Consider mirroring whatever process your hospital uses for the MDs who place VADs. Good luck
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Thank you for all of the input. It will help. Chris I appreciate your point about being away from direct patient care but in a teaching, preceptoring position you would be staying up to date on best practice and helping to problem solve even if you weren't actually theading the PICC itself. Not necessarily so with an RN who just dropped out for a couple of years. You are correct that teaching reinforces it in yourself. I found throughout my school life that the more willing I was to help others that were struggling with concepts the better I learned it and the better grades I got. When you can teach it to some one else you really have it firm in mind. When I taught lamaze classes for childbirth I felt more adequately prepared to deal with labor than I ever did but the person I chose to help me (another instructor) suggested I take another class, mostly for the sake of my husband. I had him listen in on a class I taught. We did just fine. She was able to guide him where he forgot a little and we prepared together.
Its just that the form suggests a number and I have been asked what to put there. I know I have used the analogy with my sister in law whose first brain surgery didn't get all of the tumor and she and her husband were trying to decide on whether to change to a university affiliated specialist with a dedicated team, do you want a doctor who only does this once or twice a month and has to find others to work with him or one who does it everyday and already has a team he is accustomed to work with? (by the way she is getting much better care and many more options) While this is not brain surgery, I know my personal competence in dealing with issues has grown immensely over the past 6 years. That wouldn't happen doing just a couple PICCs a month. It is now very rare that I need to stick a patient more than once, even in a very dehydrated patient I did just the other day which took me more than one stick when I started. Where we practice there is usually only one PICC nurse to care for patients and IVR provides very little back up.
Here is the website for the webinar I gave about competency a few months ago. It is not ready for viewing
Webinar - Reducing Infection Risks Related to Vascular Access Devices: A Focus on Personnel Competency and Training - TargetBSI
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
Thanks Lynn for the Webinar information. I missed the original showing but will catch up with it when it is archived. I rarely get a chance to watch the webinars live. It's real difficult when there is usually only one Vascular Access Nurse on at a time.
Mary Penn