advanced developmental passport for nurses caring for ... 5 developmental... · acute medicine...

Advanced Developmental

Passport for Nurses Caring for Cardiac Patients

Name ……………………………………………………………………………………………. Ward / Department………………………………………………………………………………

Acute Medicine Development Passport – specialist and advanced competencies V1.1 July 2013 due to review July 2015 2

Advanced Developmental Passport for Nurses Caring for Cardiac Patients

Guidance Notes.

This Advanced Developmental Passport has been developed to be used by Staff Nurses caring for cardiac patients within Acute Medicine and Coronary

Care Unit (CCU) at the Royal Berkshire NHS Foundation Trust and is to be completed in addition to the Core Competencies in the Developmental

Passport for Band 5 Staff Nurses.

The document includes generic statements which reflect the knowledge and skills which the Trust expects of all Staff Nurses caring for cardiac patients

within Acute Medicine/CCU.

The document outlines competence at two levels, that of the Competent Nurse and that of the Experienced / Proficient Nurse. It is recognised that all

Band 5 Nurses are competent on qualification; however, the Competent Nurse as referred to in this document is also competent to work within the policies

and protocols of the Royal Berkshire NHS Foundation Trust. It is expected that the Competent Nurse statements will be achieved within six months of

completing the core competencies. The Experienced / Proficient Nurse statements reflect a wider exposure and level of competence and may take longer

to complete.

It is the responsibility of the individual Staff Nurse to ensure that evidence to support the assessment is collected and used to build a professional

portfolio. Examples of such evidence are completed assessment forms and copies of completed incident reports. All evidence must have details of the

patient removed prior to its use in order to maintain confidentiality.

Assessment of competence can be undertaken by the following: Ward Manager, band 6’s and 7’s who hold a teaching and assessing qualification e.g.

SLICE, Mentorship Preparation or band 5 nurses who have been signed off as experienced/proficient in these competencies and who hold a teaching and

assessing qualification. Those involved in undertaking assessment of competence must complete record of signatures table on page 3.

This documentation will be expected to be presented during your appraisal and may be used as evidence towards Knowledge and Skills Framework.


Record of signatures

Name Job Title Signature Initials


Topic Competent Nurse Proficient / Experienced Nurse Self Assessment

Mentor Assessment

Competent Nurse

Proficient / Experienced

Nurse

Competent Nurse


Nurse

Cardiac Monitoring (Using bedside monitor)

1. Demonstrates the ability to use the

basic functions of the bedside cardiac monitor.

2. Demonstrates the ability to change

Echocardiogram (ECG) leads and recognises when leads are misplaced.

3. Demonstrates the ability to

troubleshoot when any problem with ECG leads.

4. Demonstrates the ability to use the

auto and manual Blood Pressure (BP) settings appropriately.

5. Demonstrates the ability to position

the SpO2 finger probe appropriately.

6. Demonstrates the ability to safely

change the parameters of the alarm settings in view of rate, rhythm, NEWS and diagnosis.

7. Demonstrates the ability and

consistently checks the respiratory rate manually.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Cardiac Monitoring (Using bedside monitor cont.)

8. Demonstrates the ability to change the monitoring of the patient to telemetry mode.

9. Demonstrates the ability to correctly monitor a patient using a portable device.

10. Understands and can discuss the significance of the red and blue alarms at the bedside.

11. Understands and can discuss when it is safe to pause / silence the alarms and is aware of the implications to further cardiac rhythm changes.

12 Lead ECG 1. Has attended the ECG training day.

2. Has attended the ECG equipment

training. 3. Demonstrates the ability to

correctly place all the electrodes prior to performing ECG.

4. Understands and can discuss ECG

speed and why the speed might be changed.

5. Understands and can discuss ECG

height and why the speed height might be changed.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

12 Lead ECG (cont.)

6. Understands and can discuss the risks associated with altering these parameters. Consistently demonstrates the ability to label the ECG correctly using the appropriate demographics.

CARDIAC ANATOMY & PHYSIOLOGY Cardiac blood flow

1. Understands and can describe the cardiac cycle (systole/diastole)

2. Demonstrates understanding and

can discuss/label: a. The great cardiac

vessels b. The chambers and

valves of the heart c. The names and

position of the coronary arteries and territory of myocardium they supply

d. The blood flow through the heart

e. Preload f. Afterload g. Stroke volume h. Total peripheral

resistance i. Left ventricular and

diastolic pressure j. Pulseless paradoxus k. Pulseless alternans



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Electrical conduction system

1. Demonstrates the ability to label the main anatomical components of the conduction pathway to include:

a. SA node b. AV node c. Bundle of His d. Left and right bundle branches e. Purkinjie fibres

2. Demonstrates knowledge and can describe

the journey of electrical impulses through the heart and link this to the cardiac cycle.

3. Understands and can discuss the relationship

between conduction pathway and how this is represented on an ECG/cardiac monitor.

4. Understands and can describe depolarisation,

repolarisation and automacity. 5. Understands and can describe the term

‘action potential’ in relation to the cardiac cycle.

6. Understands and can describe the action

potential of the SA node.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Rhythm Strip Analysis

1. Demonstrates the ability to recognise and can

discuss the following arrhythmias and heart blocks:

a. Sinus rhythm b. Sinus tachycardia c. Sinus bradycardia d. Atrial fibrillation e. Atrial flutter f. Atrial tachycardia g. Supra ventricular tachycardia h. Junctional rhythm and accelerated

junctional rhythm i. Broad complex tachycardia j. Ventricular tachycardia k. Torsade’s de points l. Ventricular fibrillation m. Asystole and pulseless electrical

activivty (PEA) n. P wave asystole o. 1st degree AV block, Wenckebach,

Mobitz type 2 p. 3rd degree heart block/complete heart

block

ECG Recognition

Ischaemia, injury and necrosis

1. Demonstrates the ability to recognise and can

discuss ischaemic changes on an ECG. 2. Demonstrates the ability to recognise and can

discuss injury changes on an ECG.

3. Demonstrates the ability to recognise and can discuss necrotic changes on an ECG.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

ECG Recognition (cont.)

Ischaemia, injury and necrosis

4. Demonstrates sound knowledge of Non-ST

Segment Elevation Myocardial Infarction (NSTEMI) and can clearly recognise NSTEMI changes on an ECG.

5. Demonstrates sound knowledge of ST

Segment Elevation Myocardial Infarction (STEMI) and can clearly recognise STEMI changes on an ECG.

6. Demonstrates the ability to identify unipolar

leads on the ECG. 7. Demonstrates the ability to identify bipolar

leads on the ECG. 8. Understands and can explain Einthoven’s

Triangle and lead polarity. 9. Demonstrates the ability to relate lead polarity

to heart territories. 10. Understands and can identify the heart

territories, to include: a. Inferior territory b. Anterior territory c. Lateral territory d. High lateral territory e. Posterior territory f. Combined territories



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

ECG Recognition

Bundle Branch Blocks, Axis Deviation

1. Understands and can discuss normal and abnormal R wave progression.

2. Demonstrates the ability to recognise Left Bundle Branch Block (LBBB) and can describe the pathway of conduction in LBBB.

3. Understands and can identify the causes of

LBBB and its clinical significance. 4. Demonstrates the ability to recognise Right

Bundle Branch Block (RBBB) and can describe the pathway of conduction in RBBB.

5. Understands and can identify the causes of

RBBB and its clinical significance.

6. Understands and can recognise bi- fascicular and tri-fascicular blocks and discuss its clinical significance.

7. Understands and can explain the meaning of

axis deviation and relate this to fasicule

blocks

8. Demonstrates the ability to work out the

degree of axis ( left axis deviation and right

axis deviation).

9. Demonstrates the ability to recognise left axis

deviation and right axis via the leaving and

reaching (quadrant ) method



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Cardiac Medications

1. Understands and can clearly explain the indications, contraindications and side effects of the medications below:

a. Aspirin b. Clopidogrel / Prasugral c. Beta Blockers d. ACE inhibitors e. Stains f. Fragmin(subcutaneous) g. Heparin(subcutaneous) h. Calcium channel blockers i. Oral anti arrthymics j. Digoxin k. Oral Nitrates l. Oral Diuretics

2. Has been assessed as competent to

administer Intravenous (IV) Medication and has completed IV workbook.

Assessment of Chest Pain

1. Consistently records an accurate 12 lead ECG immediately on transfer from trolley to CCU bed (in absence of active resuscitation)

2. Demonstrates the ability to identify acute

cardiac chest pain, assessing the patient using verbal and non-verbal cues.

3. Understands the importance and consistently alerts senior colleagues-co-ordinator when acute myocardial infarction (AMI) is suspected (without pre-alert).

4. Demonstrates the ability to provide timely, efficient and sensitive nursing interventions for patient with chest pain.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Assessment of Chest Pain (cont.)

5. Demonstrates the ability to provide support to

patients and family members on moving patient from CCU to Jim Shahi Unit (JSU) for

Primary Percutaneous Coronary Intervention (PPCI)

6. Demonstrates sound knowledge of and

considers all potential non-ischaemic sources of chest pain and is able to discuss the symptoms. To include:

a. Pulmonary embolism b. Pneumonia c. Chest infection d. Pericarditis e. Costchondritis f. Chest wall / muscular pain g. Asthma / COPD

7. Demonstrates the ability to accurately assess

chest pain using Trust Pain Assessment Tool.

8. Demonstrates the ability to administer and evaluate the effectiveness of prescribed, appropriate and timely analgesia.

9. Demonstrates the ability to offer reassurance

if a definitive course of treatment can not be identified.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Arrthymia Management

Bradycardia : 1. Recognises and can explain the adverse

signs of a patient with compromised bradycardia.

2. Demonstrates the ability to recognise all heart blocks.

3. Demonstrates the ability to identify causes of bradycardia and further treatment plans.

4. Understands and can discuss the first line treatment for the patient with compromised bradycardia

Narrow Complex : 1. Recognises and can explain the adverse

signs of the patient with a Narrow Complex Tachycardia

2. Understands and can discuss the causes of Narrow Complex Tachycardia and the rational for the treatment plans for these patients.

3. Understands and can discuss the first line treatment for the patient with Narrow Complex Tachycardia.

4. Demonstrates the ability to instruct the patient how to perform vagal manoeuvres.

5. Understands and can discuss the use of Adenosine and is aware of the monitoring requirements.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Arrthymia Management (cont.)

Broad Complex Tachycardia : 1. Understands and can explain the term

Ventricular Tachycardia.

2. Understands and can discuss the causes of Broad Complex Tachycardia and the rational for the treatment plans for these patients.

3. Recognises and can discuss the adverse signs of the patient with Broad Complex Tachycardia.

4. Understands and can discuss the first line treatment for the patient with Broad Complex Tachycardia

5. Demonstrates the ability to identify ECG charachteristics of Ventricular Tachycardias to include:

a. Fusion beats

b. Capture beats

c. Concordens

d. Extreme left axis

e. Independent P waves

6. Recognises and can discuss the treatment of Sinus Ventricular Tachycardia (SVT) with aberrancy



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Arrthymia Management (cont.)

Atrial fibrillation (AF) : 1. Understands and can explain the term AF.

2. Recognises and can explain the adverse signs of the patient with AF.

3. Understands and can discuss the first line

treatment for the patient with AF.

4. Understands and can discuss the causes of AF and the rational for the treatment plans for these patients.

5. Understands and can discuss the risk to patients with AF of clot formation and the appropriate treatment plan.

5. Demonstrates the ability to identify when a patient in AF will need cardioversion or rate control.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Direct Current (D/C) Cardioversion and general arrthymia competencies

D/C Cardioversion

1. Understands and can clearly identify those patients that require emergency cardioversion.

2. Understands and can clearly identify those patients that require elective cardioversion.

3. Demonstrates the ability to safely prepare a patient for cardioversion.

4. Understands and can discuss the meaning of ‘sync’ and demonstrate its use on the defibrillator.

5. Demonstrates understanding and can explain

the protocol for DC cardioversion on CCU. 6. Demonstrates understanding of the

appropriate dosing of Midazolam and how it is administered.

General arrhythmia competences

1. Understands the term ‘ablation’ and can discuss the implications for it.

2. Understands and can discuss the effect of the thyroid on the heart with regards to arrhythmia.

3. Understands and can discuss Wolf Parkinson White Syndrome.

4. Demonstrates the ability to explain the ECG changes associated with Wolf Parkinson White Syndrome.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Cardiac Pacing

1. Demonstrates understanding and can describe the following procedures:

a. External transthoracic pacing

b. Temporary transvenous pacing

c. Percussion pacing

2. Demonstrates the ability to competently use transthoracic pacing.

3. Has completed medical equipment assessment for temporary pacing boxes

4. Understands and can identify correct pacing

spikes on the cardiac monitor and can trouble

shoot failure to capture or inappropriate

pacing.

5. Demonstrates the ability to check sensing and

pacing thresholds and documents accurately.

6. Understands and can explain the common pacing abbreviations VVI, DDD, DDDr.

7. Understands and can clearly describe the complications associated with pacing wires and their removal.

4. Understands and can describe the procedure for removal of a pacing wire.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Invasive Monitoring Central Venous Pressure (CVP)

CVP - only after completion of IV study days

1. Understands and can discuss the normal and

abnormal CVP parameters.

2. Demonstrates the ability to set up a

transducer for CVP monitoring.

3. Demonstrates the ability to set up and obtain a CVP reading on both the bedside and transfer monitor.

4. Demonstrates the ability to perform double transducing on the monitors in the female, male and acute bays.

5. Understands and can interpret the changes in CVP in relation to hydration, pre-load/after-load, sepsis and medical condition.

6. Has been assessed as competent to remove CVP line using an aseptic technique.

3. Understands and can discuss the use of

appropriate dressing to prevent side effects of

removal of CVP line.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Invasive Monitoring Arterial Line

Arterial Line

1. Demonstrates awareness of the Trust policy regarding the management of arterial lines.

2. Has been assessed as competent using Trust approved assessment form regarding the management of arterial lines.

3. Demonstrates the ability to set up a transducer for arterial line monitoring.

4. Demonstrates the ability to set up and obtain an arterial reading on both the bedside and transfer monitor.

5. Demonstrates the ability to perform double transducing on the monitors in the female, male and acute bay.

4. Has been assessed as competent to remove the arterial line using an aseptic technique as per the Trust policy.

Resuscitation Skills

1. Has completed Immediate Life Support (ILS) training and has been assessed as competent.

2. Has been assessed as competent to perform manual defibrillation using Trust approved assessment form.

3. Demonstrates the ability to communicate effectively using SBAR (Situation, Background, Assessment, and Recommendation) communication tool.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Resuscitation Skills (Cont)

4. Demonstrates the ability to accurately record the appropriate Early Warning Score and consistently acts on deteriorating trends according to Trust policy.

Cardiac Rehabilitation / Patient Education

1. Demonstrates the ability to provide accurate, timely information to patients and relatives regarding nursing care and medical diagnosis.

2. Understands and can discuss the contents of all the information booklets / media provided to patients and relatives, including Trust and British Heart Foundation (BHF) booklets.

3. Understands and can discuss all stages of cardiac rehabilitation.

4. Demonstrates the ability to deliver Stage one cardiac rehab- to include the following personalised advice:

a. Risk factor modification b. Discharge activity c. Psycho, social, sexual issues d. Medications (also use of GTN) e. Diabetes f. Lifestyle changes g. Specific questions h. Driving

Date observed at giving advice, please insert below:

…………………………………………….


Topic

Competent Nurse

Proficient / Experienced Nurse

Self Assessment

Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Angiography / Angioplasty/ Primary Percutaneous Coronary Intervention (PPCI)

1. Demonstrates the ability to accurately use

and complete all procedural care pathways.

2. Has been assessed as competent in sheath

pulling on JSU using Trust approved

assessment form.

3. Understands and can describe the management of a radial ‘band’ post procedure.

4. Understands and can discuss the process and

rationale for obtaining consent.

5. Understands and can explain the rationale for safety checks required in preparation for the procedure.

6. Demonstrates the ability to give appropriate patient information both written and verbal regarding all aspects of pre and post procedure care.

7. Has observed an angiogram and an angioplasty.

8. Demonstrates the ability to use the ‘femstop’ and manage post procedure complications including:

a. Haematomas b. Suspected retrograde bleeding c. Dissection d. Failure of angioseal


Topic

Competent Nurse

Proficient / Experienced Nurse

Self Assessment

Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Angiography / Angioplasty/ Primary Percutaneous Coronary Intervention (PPCI)

9. Understands and can explain how to activate the team when a PPCI has been called.

10. Demonstrates the ability to set up the lab ready fro PPCI.

11. Demonstrates the ability to act as a runner in the laboratory after completing the stage cardiac drugs assessment.

Left Ventricular Failure / Heart Failure

1. Demonstrates knowledge and can discuss

the altered pathophysiology of the patient in Left Heart Ventricular Failure (Acute and Chronic).

2. Understands and can explain the blood tests required for the patient in heart failure.

3. Understands and can explain the Heart

Failure Scoring Classification. 4. Demonstrates sound knowledge of the care

given to the patient in heart failure and can discuss the rationale for the care.

1. Demonstrates understanding and can discuss

the medication options available to patients in heart failure.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Acute Coronary Syndrome

1. Understands and can define Acute Coronary Syndrome (ACS)

2. Understands and can describe coronary artery occlusion, acute thrombus formation and atherosclerosis.

3. Understands and can explain the acronym MONA in relation to ACS.

4. Demonstrates sound knowledge and can

discuss pain relief options for a patient in ACS.

5. Understands the diagnosis of STEMI and can

explain the treatment plan. 6. Understands the diagnosis of NSTEMI and

can explain the treatment plan.

7. Understands and can explain the difference between unstable angina and stable angina (not an ACS).

8. Understands and can discuss the treatment

plan for a patient with unstable angina. 9. Understands and can discuss the indications

for exercise testing.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Pulmonary Embolism (PE)

1. Has completed cardiac drug assessment for Thrombolytic Drugs / Heparin

2. Understands and can explain the

physiological aspects of a PE. 3. Understands and can describe the treatment

options for a PE and the implications for nursing care.

4. Demonstrates the ability to use bed side

invasive monitoring as required. 5. Understands and can discuss the common

side effects of Heparin and Thrombolytic therapy.

6. Demonstrates the ability to teach a patient to

self administer Low Molecular Weight Heparin subcutaneously as prescribed.

7. Demonstrates the ability to support the ward pharmacist in delivery of Anti-coagulation therapy advice, and referral to clinic.



Mentor Assessment

Competent Nurse


Nurse

Competent Nurse


Nurse

Other cardiac conditions

1. Demonstrates sound knowledge and can describe the following cardiac conditions:

a. Marfans Disease

b. Takosubo Syndrome

c. Brugada Syndrome

Pericardiolcentesis

1. Understands and can explain the meaning of

pericardial effusion and cardiac tamponade

2. Understands and can explain the diagnosis of

pericardial effusion and cardiac tamponade.

3. Understands and can explain the treatment

options for both pericardial effusion and

cardiac tamponade.

4. Demonstrates the ability to assist the medic

when inserting a pericardial drain.

Clinical Audits 1. Understands and can complete the following clinical audits appropriately in an accurate and timely manner:

a. Myocardial Ischaemia National Audit Project (MINAP).

b. Care bundles

c. Think Glucose

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