Appendix 3. On Call Physiotherapy Competency Framework

Transcription

1 Appendix 3 On Call Physiotherapy Competency Framework 1

2 Contents Introduction... 3 Using this package... 3 On call courses... 3 On call preparation... 4 Infection control... 4 Competency Levels... 4 Self Assessment... 5 Competency 1 - Respiratory Assessment... 7 Competency 2 - Respiratory Techniques Competency 3 - Airway Management Competency 5 - Non-invasive Ventilation Competency 6 Tracheostomy Care Competency 7 - Suctioning

3 Introduction Respiratory care is a core physiotherapy skill however there are many challenges associated with treating respiratory patients out of hours. The patient can often be unwell; you may be in an unfamiliar environment or you may not regularly work with respiratory patients. This competency package is designed to support you in this situation and aims to enhance your learning by identifying key competencies that are required in order to deliver safe and effective patient care. Using this package As healthcare professionals we are responsible for updating and maintaining our skills. Supported by the senior respiratory physiotherapy team, this package will provide you with the resources needed to highlight and support your ongoing learning and development. The package has been divided into essential and optional skills denoted by a **. We would ask you to complete the self assessment grid on pages 4 and 5. If you identify a learning need, please contact the medical/surgical physiotherapy team on the following numbers: Emma Humberstone Bleep 1102 Helen Redford / Jenna Nixon Bleep 1628 Naomi Roberts Bleep 1627 Leah Gallon Bleep 1462 They will identify when there is an opportunity for that learning need to be met and book this with you. Subjects will be covered in various training options, these include in-service training sessions, shadowing a senior respiratory physiotherapist and the on call courses which run annually. On call courses As part of the new on call policy, there will be on call courses run annually which all physiotherapists on call must attend. There will be three courses run each year, allowing choice of which course you are able to attend due to departmental work pressures. It is mandatory that all on call physiotherapists attend one course per year and maintain their competence for being on call. 3

4 The courses will cover core subjects for the on call physiotherapist and you will be provided with a comprehensive handbook to use as a resource, to help you prepare for your on call and maintain competence and confidence. On call preparation This is covered in the on call policy please be familiar with this prior to your on call. Infection control In terms of infection control, physiotherapists whether on call or not follow the trusts infection control policy and as a member of this trust you should be familiar with this policy. Competency Levels You will be assessed during various teaching and learning experiences. All physiotherapists on the on call rota must have completed the competency framework unless they are a senior respiratory physiotherapist within the trust. During the on call courses your competencies will be reviewed and signed off as able by the senior respiratory physiotherapy team. Any areas needing ongoing work will be addressed with booking time with the senior respiratory physiotherapy team. All of your competencies need to be signed off at level 4 or 5 for you to be deemed competent to undertake on call. It is not acceptable for you to not do on calls because you are not competent, there are numerous opportunities for these learning needs to be met, so your participation in the on call rota will be ongoing. 4

5 Self Assessment Competency section Competency 1 Patient history Patient assessment Auscultation findings Communication Documentation ABG interpretation CXR interpretation Competency 2 ACBT Positioning MT Assisted cough Postural drainage Manual hyper-inflation Training required Update required Preferred method of learning i.e. Personal reading, shadowing, teaching sessions Yes No Yes No 5

6 Competency section Competency 3 Airway management Competency 4 Oxygen and humidification Competency 5 IPPB** CPAP BiPAP Modes of Ventilation Competency 6 Tracheostomy care Competency 7 Nasophanageal suction Oral suction Tracheostomy suction Closed suction via ETT ** Optional skills Training required Update required Preferred method of learning i.e. Personal reading, shadowing, teaching sessions Yes No Yes No 6

7 Competency 1 - Respiratory Assessment Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step 1 instruction Observable criteria Circle Date Assessors assessment Signature outcome Patient History 1. Able to obtain and document HPC, PMHx, DHx, SHx and understand the significance of it. 2. Aware and able to explain the difference between subjective and objective assessment findings. 3. Aware to document information received from other sources, such as nursing staff. Patient Assessment 1. Gains consent from the patient to assess and treat. 2. Evaluates and comments on the patients airway. 3. Evaluates and comments upon the patients RR, breathing pattern and work of breathing. 4. Able to explain signs of respiratory distress which the patient may be showing. 7

8 5. Able to comment on the patients ventilatory support, including oxygen amount and saturation levels. 6. Ability to recognise and understand the significance of the patients last CXR. 7. Understands and evaluates the importance of the latest ABG result. 8. Evaluates and comments on the patients cardiovascular system, including BP, HR and Temp. 9. Comments on the patients fluid balance. 10. Refers to the patients medication chart and understands the relevance and significance of this 11. Refers to the patients pain assessment score (if indicated) 12. Able to assess for responsiveness using AVPU or GCS level. Auscultation findings 1. Can identity normal breath sounds. 2. Can discuss the significance of bronchial breath sounds. 3. Can discuss the significance of absent breath sounds. 4. Can discuss the significance of crackles and their location. 5. Can the discuss the significance and what different conditions can cause wheeze. 8

9 Arterial blood gas interpretation 1. Able to list the normal ABG parameters ph Pa0 2 PaC0 2 HCO 3 Base excess O 2 saturations 2. Able to discuss the causes of acidosis and alkalosis ** 3. Able to interpret an ABG result and suggest if NIV is indicated and which type of NIV - CPAP or BiPAP CXR interpretation 1. Describe the indication for a chest X-ray 2. Able to discuss the differences and clinical significance of interpreting a PA, AP, erect and supine film 3. Able to Identify: Lung margins Heart Aortic arch Pulmonary trunk Diaphragm Horizontal fissure 4. Able to comment on: Rotation Penetration Lung fields 9

10 Heart size and shape Mediastinum Diaphragm Costophrenic angles Trachea Bone and soft tissue 5. Demonstrates a systematic interpretation of a chest X-ray Communication 1. Maintains patient dignity. 2. Explains each and every procedure to the patient and gains consent each time. 3. Demonstrates the ability to effectively communicate with members of the multi-professional team 4. Demonstrates the ability to prioritise care and act on findings Documentation 1. Demonstrates the ability to produce accurate, clear and legible patient records as per the CSP and trust guidelines. 10

11 Learning log To be completed by the assessor when all the sections above have been signed confirming that the above named person has been assessed at level 4 or above and is therefore competent. Assessment outcome: Pass Refer Assessed by: Name: Grade: Date: Trainee s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team. 11

12 Competency 2 - Respiratory Techniques Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step 1 instruction Observable criteria ACBT (active cycle of breathing technique) 1. Can discuss the indications for using ACBT 2. Positions the patient for optimum treatment benefit 3. Explains the procedure and gains the patients consent 4. Demonstrates the correct technique 5. Demonstrates how to adjust and modify the therapy to the patients condition 6. Assesses the patients response to therapy MT (manual techniques) 1. Can discuss the indications for using MT 2. Can discuss the precautions and contra-indications for using MT 3. Positions the patient for optimum treatment benefit 4. Explains the procedure and gains the patients consent Circle assessment outcome Date Assessors Signature 12

13 5. Demonstrates the correct technique 6. Demonstrates how to adjust and modify the therapy to the patients condition 7. Assesses the patients response to therapy Assisted cough 1. Can discuss the indications for using the assisted cough 2. Can discuss the precautions and contra-indications for using the assisted cough 3. Positions the patient for optimum treatment benefit 4. Explains the procedure and gains the patients consent 5. Demonstrates the correct technique 6. Demonstrates how to adjust and modify the therapy to the patients condition 7. Assesses the patients response to therapy Postural drainage 1. Can discuss the indications for using postural drainage techniques 2. Can discuss the precautions and contra-indications for using postural drainage techniques 3. Positions the patient for optimum treatment benefit 13

14 4. Explains the procedure and gains the patients consent 5. Demonstrates the correct technique 6. Demonstrates how to adjust and modify the therapy to the patients condition 7. Assesses the patients response to therapy Manual hyperinflation (bagging) 1. Can discuss the indications for bagging 2. Can discuss the precautions and contra-indications for bagging 3. Positions the patient for optimum treatment benefit 4. Able to demonstrate how to set up the circuit correctly including a manometer 5. Explains the procedure and gains the patients consent (if able) 6. Demonstrates the correct technique 7. Demonstrates how to adjust and modify the therapy to the patients condition 8. Able to explain specific observations post MHI which need to be observed. 14

15 Learning log To be completed by the assessor when all the sections above have been signed confirming that the above named person has been assessed at level 4 or above and is therefore competent. Assessment outcome: Pass Refer Assessed by: Name: Grade: Date: Trainee s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team. 15

16 Competency 3 - Airway Management Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step 1 instruction Observable criteria Circle assessment Date Assessors outcome Signature Airway Management 1. Discusses the common causes of partial airway obstruction 2. Discusses the common causes of total airway obstruction 3. Can list the signs and symptoms of airway obstruction. 4. Is able to explain the technique for securing an airway and who to contact if an airway is not patent. 16

17 Learning log To be completed by the assessor when all the sections above have been signed confirming that the above named person has been assessed at level 4 or above and is therefore competent. Assessment outcome: Pass Refer Assessed by: Name: Grade: Date: Trainee s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team. 17

18 Competency 4 Oxygen and Humidification Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step 1 instruction Observable criteria Circle assessment Date Assessors outcome Signature Oxygen and humidification 1. Is able to explain the different oxygen delivery systems 2. Is able to explain the differences between high and low flow oxygen 3. Is able to recognise when a patient is not on the correct oxygen amount and how to correct this 4. Is able to explain the importance of pre-oxygenation prior to suctioning 5. Able to articulate the limit on flow rates for nasal cannulae 6. Able to recognise when oxygen should be humidified 7. Able to explain the different humidification systems available 8. Demonstrates knowledge of precautions with oxygen therapy with some patient groups 18

19 Learning log To be completed by the assessor when all the sections above have been signed confirming that the above named person has been assessed at level 4 or above and is therefore competent. Assessment outcome: Pass Refer Assessed by: Name: Grade: Date: Trainee s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team. 19

20 Competency 5 - Non-invasive Ventilation Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step 1 instruction Observable criteria Circle assessment outcome IPPB (intermittent positive pressure breathing) 1. Can discuss the indications for using IPPB 2. Can discuss the precautions and contra-indications for using IPPB 3. Can demonstrate how to set up the machine** 4. Demonstrates how to establish the patient onto IPPB** 5. Demonstrates how to adjust and modify the settings accordingly 6. Assesses the patients response to therapy CPAP (continuous positive airway pressure) 1. Is able to define the term CPAP 2. Is able to explore the physiological effects of PEEP 3. Is able to discuss the indications for CPAP 4. Is able to discuss the precautions and contraindications for CPAP BiPAP (Bi-level positive airway pressure) 1. Is able to define the term BIPAP Date Assessors Signature 20

21 2. Is able to explore the physiological effects of EPAP 3. Is able to explore the physiological effects of IPAP 4. Is able to discuss the indications for BIPAP 5. Is able to discuss the precautions and contraindications for BiPAP Modes of Ventilation (including the oscillator) 1. Is able to explain what controlled ventilation means 2. Can explain what is meant by pressure support 3. Can explain the differences between PS and P-SIMV 4. Is able to explain what the oscillator is and why a patient may be on one 21

22 Learning log To be completed by the assessor when all the sections above have been signed confirming that the above named person has been assessed at level 4 or above and is therefore competent. Assessment outcome: Pass Refer Assessed by: Name: Grade: Date: Trainee s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team. 22

23 Competency 6 Tracheostomy Care Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step 1 instruction Observable criteria Circle assessment Date Assessors outcome Signature Tracheostomy care 1. Define the term tracheostomy 2. Discuss the difference between a tracheostomy and laryngectomy 3. Discuss the indications for a tracheostomy tube 4. Identify the essential bedside equipment 5. Discuss two different types of tracheostomy tubes used in the Trust 6. Explain the function of the inner tube and relate this to suctioning 7. Explain the function of the cuff 8. Explain why a patient may be unable to speak 9. Discuss the different methods of achieving effective communication 10. Discuss the signs and symptoms of respiratory distress in a patient with a tracheostomy 11. Identify 3 complications that may 23

24 occur immediately after insertion 12. Identify 3 complications that may occur after 36 hours of insertion 24

25 Learning log To be completed by the assessor when all the sections above have been signed confirming that the above named person has been assessed at level 4 or above and is therefore competent. Assessment outcome: Pass Refer Assessed by: Name: Grade: Date: Trainee s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team. 25

26 Competency 7 - Suctioning Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step 1 instruction Observable criteria Assessment Date Assessors outcome Signature Suctioning 1. Discuss the clinical indications for suctioning 2. Demonstrate knowledge of what techniques should be tried prior to suctioning 3. Able to explain the different routes in which suctioning can be done 4. Able to explain to the patient the procedure with relevant information 5. Able to set the correct suction pressure 6. Is able to discuss the indications for the insertion of a nasopharyngeal airway 7. Is able to discuss the precautions and contraindications for the insertion of a nasopharyngeal airway 8. Demonstrates the correct 26

27 selection of a nasopharyngeal airway 9. Demonstrates the correct insertion technique for a nasopharyngeal airway 10. Is able to list precautions and contraindications for each type of suctioning 11. Demonstrates the correct oral suctioning technique using a yankeur 12. Demonstrates the correct suctioning technique for a nasopharyngeal airway 13. Demonstrates the correct suctioning technique using a closed suction unit via an ETT or tracheostomy 14. Demonstrates the correct technique for suctioning via a tracheostomy 15. Is able to evaluate the effectiveness of suctioning 16. Is able to identify and discuss complications that may associated with suctioning 17. Is aware and able to discuss the infection control policy 27

28 Learning log To be completed by the assessor when all the sections above have been signed confirming that the above named person has been assessed at level 4 or above and is therefore competent. Assessment outcome: Pass Refer Assessed by: Name: Grade: Date: Trainee s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team. 28