I find that many hospitals use the same checklist for a new PICC nurse for yearly compentencies. There are some available on this site under the Resources tab. I am happy to send you the checklist that Arrow provides with its PICC Fundamentals program as an intial competency checklist, you can email me at [email protected]
Chris, if this is the case, then they are not conducting their yearly competencies according to the what is recommended. Competency validation is not merely repeating performance of the same task each year. There are no time intervals for competency validation to be repeated, although yearly has become a common practice. The issue is tying competency validation to clinical outcomes. So outcomes of infection within the first week of dwell would indicate a need to focus on competency with sterile technique, skin antisepsis, glove use, US and sterility, etc. Thrombosis rates that are high would drawn ones attention to choice of catheter sizes, insertion technique and tip location and tip migration issues. So competencies and therefore the checklist should be changing on a periodic basis. Lynn
I am replying to an old post (My apologies, I am fairly new to the site), but I am working an SOP and Competency checklist and I got a question related to how often should competency be documented. I am also used to the idea of yearly reassessment. Is this something adequate? Does anyone out there have some literature to establish something different? I tend to believe that it should be done at the same time the SOP is for revision, which in most cases is 3 years. What is the latest on this topic? Thanks for your help in advance and HAPPY NEW YEAR to all.
First, I would direct you to the 2016 INS Standards of Practice Competency Assessment and Validation with the references through the end of 2014. Competency is divided into 2 parts - initial and ongoing. Your checklists would be for the initial competency when a new person is hired or their job changes or new practices are added. Ongoing competency is done based on your clinical outcomes and the identified needs for improvement. So the exact same process and checklist used for the initial competency is not used for ongoing competency. It is a waste of time to have a clinician who is routinely placing short PIVCs, or PICCs to repeat a demonstration in a simulated setting when they do this every day. Use your QA/QI data to identify problems then alter your ongoing competencies toward improving those outcomes. Frequency is not defined by research, although it is frequently done on an annual basis. Differences would be special circumstances. For example, a rural hospital with very few patients having implanted ports may need to have competency for accessing these ports done on every 6 months so it remains fresh in their minds. 3 years is far too long to go between assessing ongoing competencies.
Lynn, Thank you for your reply. Your suggestions opened up more possibilities and as a result the SOP and Competency checklist suffered some important changes. I read the 2016 INS Standard 5 again and complied the references. (I am in the process of reading them). Now, there is something interesting and surprising that I find in the literature (my research for the SOP, not the references for the INS Standard 5). They talked about performing 4 (four) US PIV insertions per year to "maintain competency". At first I found the number to be extremely low. Now I the INS standard says the following:
Clinical performance with the procedure under
supervision until an objective level of competency
has been reached (ie, all steps performed successfully).
There is no set number of times for performing a
procedure that will ensure competency. 17-20 (IV)
How do we reconcile this? What is your opinion regarding what I find in the literature? Is it your opinion that 4 insertions per year is too low?
What is the type of article that you found? A well conducted research study? A how-to article? A report of the policy chosen by a specific hospital. Use the INS Grading Scale in the front of the SOP to determine what is the level of evidence for what you have found. What is the date on this publication? If later than late 2014, it would not have been included in the 2016 INS SOP but could be used as evidence if it is a research study. If is not a research study, I would use great caution in applying it as gospel to your practice. Without knowledge of patient populations, data on outcomes, etc. it is not generalizable to other locations.
Sorry, I just saw this message. I worked on the Competency SOP for 2016 and I am now in the process of repeating the process of the 2021 edition. There are no magic numbers that will equal competency for any procedure. I am unclear from your message about where you found the number of 4, but I have not seen anything like this. Each person learns at their own pace, so each person will require a different number. you need an objective form and preceptor and allow as many procedures as each person needs to meet the criteria on your checklist or global rating scale. Again there is no numbers to recommend.
I find that many hospitals use the same checklist for a new PICC nurse for yearly compentencies. There are some available on this site under the Resources tab. I am happy to send you the checklist that Arrow provides with its PICC Fundamentals program as an intial competency checklist, you can email me at [email protected]
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Chris, if this is the case, then they are not conducting their yearly competencies according to the what is recommended. Competency validation is not merely repeating performance of the same task each year. There are no time intervals for competency validation to be repeated, although yearly has become a common practice. The issue is tying competency validation to clinical outcomes. So outcomes of infection within the first week of dwell would indicate a need to focus on competency with sterile technique, skin antisepsis, glove use, US and sterility, etc. Thrombosis rates that are high would drawn ones attention to choice of catheter sizes, insertion technique and tip location and tip migration issues. So competencies and therefore the checklist should be changing on a periodic basis. 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
Hi all,
I am replying to an old post (My apologies, I am fairly new to the site), but I am working an SOP and Competency checklist and I got a question related to how often should competency be documented. I am also used to the idea of yearly reassessment. Is this something adequate? Does anyone out there have some literature to establish something different? I tend to believe that it should be done at the same time the SOP is for revision, which in most cases is 3 years. What is the latest on this topic? Thanks for your help in advance and HAPPY NEW YEAR to all.
Heriberto
First, I would direct you to the 2016 INS Standards of Practice Competency Assessment and Validation with the references through the end of 2014. Competency is divided into 2 parts - initial and ongoing. Your checklists would be for the initial competency when a new person is hired or their job changes or new practices are added. Ongoing competency is done based on your clinical outcomes and the identified needs for improvement. So the exact same process and checklist used for the initial competency is not used for ongoing competency. It is a waste of time to have a clinician who is routinely placing short PIVCs, or PICCs to repeat a demonstration in a simulated setting when they do this every day. Use your QA/QI data to identify problems then alter your ongoing competencies toward improving those outcomes. Frequency is not defined by research, although it is frequently done on an annual basis. Differences would be special circumstances. For example, a rural hospital with very few patients having implanted ports may need to have competency for accessing these ports done on every 6 months so it remains fresh in their minds. 3 years is far too long to go between assessing ongoing competencies.
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
Lynn, Thank you for your reply. Your suggestions opened up more possibilities and as a result the SOP and Competency checklist suffered some important changes. I read the 2016 INS Standard 5 again and complied the references. (I am in the process of reading them). Now, there is something interesting and surprising that I find in the literature (my research for the SOP, not the references for the INS Standard 5). They talked about performing 4 (four) US PIV insertions per year to "maintain competency". At first I found the number to be extremely low. Now I the INS standard says the following:
Clinical performance with the procedure under
supervision until an objective level of competency
has been reached (ie, all steps performed successfully).
There is no set number of times for performing a
procedure that will ensure competency. 17-20 (IV)
How do we reconcile this? What is your opinion regarding what I find in the literature? Is it your opinion that 4 insertions per year is too low?
Thanks,
Heriberto Leon MSN Rn
What is the type of article that you found? A well conducted research study? A how-to article? A report of the policy chosen by a specific hospital. Use the INS Grading Scale in the front of the SOP to determine what is the level of evidence for what you have found. What is the date on this publication? If later than late 2014, it would not have been included in the 2016 INS SOP but could be used as evidence if it is a research study. If is not a research study, I would use great caution in applying it as gospel to your practice. Without knowledge of patient populations, data on outcomes, etc. it is not generalizable to other locations.
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
Sorry, I just saw this message. I worked on the Competency SOP for 2016 and I am now in the process of repeating the process of the 2021 edition. There are no magic numbers that will equal competency for any procedure. I am unclear from your message about where you found the number of 4, but I have not seen anything like this. Each person learns at their own pace, so each person will require a different number. you need an objective form and preceptor and allow as many procedures as each person needs to meet the criteria on your checklist or global rating scale. Again there is no numbers to recommend.
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
When the 2016 INS Standards came out, we did a n annual competency on "Nerve Injuries" because it was a new addition to the standards.