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Simulation for Infusion-

Related Competency

Assessment

Theresa Ann Chavez MSN,BS,RN-

BC NPD

Objectives

• Discuss simulation as an educational and competence assessment process

• Identify opportunities for simulation use in the development of infusion-related knowledge and competence assessment

Staff education as compared

to competency assessment

Education:

• the act or process of imparting or acquiring particular knowledge or skills, as for a profession.

• the process of receiving or giving systematic instruction,

Merriam-Webster dictionary

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Staff education as compared

to competency assessment

Competency:

• The knowledge, skills, abilities and behaviors needed to carry out a job.

(Wight,2006)

• The ability to perform a task with desirable outcomes under the varied circumstances of the real world

(Benner,1982)

• We do competency assessments to assure that we are giving the best possible care to our patients, and other customers and at the same time shine in our surveys from outside agencies—Donna Wright

• Measuring competency focuses on the verification or demonstration of knowledge, skill, behavior and attitude.

• Education in and of itself is not a measure of competency; it may be a part of the competency process to help the individual achieve the desired competency outcome

• Demonstrating or verifying you have the knowledge, skill or ability is the focus of competency

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Competency is a continuum

Hire Initial On going

Licensure What is needed Annual

Certifications in the first 6 mos., professional growth

• Competency verification needs to capture all 3 domains – therefore a variety of methods should be used

• Checklist

• Tests

• Simulation

Simulation use in health

care settings• Trainers—Skills-Muscle memory and

psychomotor skills

• Scenarios-Manikins and Standardized patients

• On boarding new staff

• Mock codes

• High stakes testing

• Process improvements- work flows

• Practice procedures

• Roll out of new equipment and procedures

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• Simulation can provide an opportunity to develop a process of decision making through critical thinking skills, abstract knowledge, technical skills and self-confidence within a safe and controlled environment

• Debrief sessions have been identified as the most important part of the simulation experience because reflection on the simulation experience occurs,

Simulation utilization to educate

and assess infusion related

skills

• At any one time 9% of patients have an infection acquired in the hospital

• 30-80% of patients admitted to the hospital are likely to receive therapy via an intravenous device

Preventive Measures

• Hand washing

• Preparation of the insertion site

• Cannulation technique

• Dressing the site

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Simulation utilization

• Skills validation

o Simulated trainers- arms , Chester Chests

oChecklists- Policies and procedures

• Competency

o Scenarios

oCase studies

• Checklists are used to standardize assessments

• Use evidence based practice standards

• Sequential steps

• Determine critical steps- essential to include

CRITICAL BEHAVIORS CVC dressing

Verify physician order, verify patient using two identifiers, explain procedure, and perform hand hygiene before and after

procedure.Weight

MetRemediate

1st 2nd

Apply face mask to self and patient ----- P, CK, CP15

Remove old dressing with clean gloves, biopatch, and statlock. CK, P,

5

Remove clean gloves and perform hand hygiene then apply sterile gloves using sterile technique. CK,, P

15

Clean site and catheter with 2% chlorhexidine-based preparation. P, CK

30

Apply (Biopatch) impregnated sponge, then securement device (if appropriate for patient), apply transparent dressing P, CK, DM,

20

Change needless connectors using sterile technique and place disinfected caps on connectors CK, P

15

� PASSED VALIDATOR:

� ACTION PLAN DATE:

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CRITICAL BEHAVIORS PIV

Verify physician order, verify patient using two identifiers, explain procedure, and perform hand hygiene before and after

procedure.Weight

MetRemediate

1st 2nd

Applies tourniquet, identifies vein, removes tourniquet P,DM10

Prepares site with 30 second chlorhexidine scrub P, CK 10

Reapplies tourniquet and inserts catheter, advances catheter and removes stylet P, DM 20

Confirms placement by blood return P, DM 10

Releases tourniquet after stabilizing the catheter P 10

Applies intermittent infusion device and flushes P, CK 10

Applies transparent adhesive dressing and tape avoiding taping over insertion site P, CK 10

Labels site with date, time, gauge and Lawson number P 10

Discontinues IV and applies pressure to site. P, DM, 10

� PASSED VALIDATOR: ___________

� ACTION PLAN DATE:

Most missed step

• PIV

New Grad RN--

• Labels site with date, time, gauge and Lawson number -85%

• Applies transparent adhesive dressing and tape

avoiding taping over insertion site- 74%

Experience RN--

• Applies transparent adhesive dressing and tape

avoiding taping over insertion site-57%

• Applies tourniquet, identifies vein, then removetourniquet -61%

Most missed step

• CVC Site/ dressing care

New Grad RN --

Change caps using sterile technique and place disinfectant caps on connectors -91%

• Experience RN--

Change caps using sterile technique and place

disinfectant caps on connectors-80%

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• Scenarios

– Technical, Critical Thinking, Interpersonal

– Real life situations

• Debriefing

– Often most important part of the simulation

– Self reflective

• Simulation is an investment in patient safety, through increasing the knowledge base of the providers while giving them opportunities for further development

References• Benner, P. (2001). From Novice to expert: excellence and power in clinical nursing

practice. Upper Saddle River, NJ: Prentice Hall.

• Hindley, G. (2004). Infection control in peripheral cannulae. Nursing Standard. 18,(27),37-40

• Jarvis, Michelle (2014). Campus Clinical. Simulation-Based Curriculum Design to Meet Clinical Course Learning Outcomes. Nurse Educator. 39(4) 179-183.

• Kuehster, Christina., Hall, Carla (2010). Simulation. Learning From Mistakes While Building Communication and Teamwork. Journal For Nurses In Staff Development. 26(3), 123-127

• Leigh, Gwen (2011). The Simulation Revolution. What Are the Implications for Nurses in

Staff Development? Journal For Nurses In Staff Development. 27(2), 54-57

• Meyer, Mary, Connors, Helen, Qingjiang, Hou, Gajewski, Byron. (2011). The Effects of Simulation on Clinical Performance : A junior Nursing Student Clinical Comparison Study.

Journal of the Society for Simulation in Healthcare. 6(5)269-277.

• Onge, Judith., Hodges,Tracey., McBride, Marilyn., Parnell, Robin., (2013) . An Innovative Tool for Experiential Learning of Nursing Quality and Safety Competencies. Nurse

Educator. 38(2) 71-75

• Wright, Donna (2006). The Ultimate Guide to Competency Assessment in Health Care

• Zingg, Walter (2009). Peripheral venous catheters: an under-evaluated problem. International Journal of Antimicrobial Agents 34S , S38-S42.

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