Chapter 3C Specialty Nursing Competencies Kookaburra Ward

Transcription

1 Chapter 3C pecialty Nursing Competencies ookaburra Ward Nursing Competency Workbook, 7th Edition RCH Nursing Competency Workbook Chapter 3 Page 1

2 The Royal Children's Hospital (RCH) Nursing Competency Workbook is a dynamic document that will provide you with direction and assist you in your professional development as a nurse working at the RCH. The workbook also provides a record of your orientation and competency obtainment. Chapter 1 Includes resources for nurses and is complemented by the Royal Children s Hospital (RCH) New tarter Pack, Hospital Orientation and Nursing Orientation day, to provide an introduction to nursing at the RCH. Chapter 2 Generic Nursing Competency Assessment Forms Chapter 3 pecialty Nursing Competency Assessment Forms Appendix 1 Unit / Department Nursing Orientation All chapters and appendices are downloadable as pdfs from the Nursing Education Website. The RCH Nursing Competency Workbook developed by Nursing Education with input from specialist nurses at the RCH. For further information contact: Melody Trueman Director, Nursing Education T: (03) E: melody.trueman@rch.org.au Workbook Edition 7, January 2015 RCH Nursing Competency Workbook Chapter 3

3 Table of Contents Blood ampling from Central Venous Access Devices 1 Bone marrow aspirates and Lumbar Punctures (Oncology) 2 Chemotherapy (intramuscular administration) 3 Chemotherapy (intrathecal administration) 4 Chemotherapy (intravenous infusion) 5 Chemotherapy (intravenous push) 6 Chemotherapy (Management & upportive Care Theory) 7 Chemotherapy (oral administration) 8 Chemotherapy (afe handling) 9 Chemotherapy (subcutaneous administration) 10 Central Venous Access Device (Blocked) 11 Criteria Led Discharge (put in generic competency?) 12 Febrile Neutropenia 13 Hickman Catheter Removal 14 Infusion of Cryopreserved Haemopoietic Progenitor Cells (HPC) - Oncology 15 Infusion of Fresh Haemopoietic Progenitor Cells (HPC) - Oncology 16 Mucositis (Oncology) 17 Nutrition (Parenteral) 18 Pain (Analgesia Infusion) 19 Pain (Patient Controlled Analgesia) 20 Potassium Infusion (oncology) 21 Procedural edation nitrous oxide accreditation skill 22 Procedural edation nitrous oxide theory 23 ubcutaneous Catheter devices management (Infusion and BD at-t-intima ) 24 Competency Feedback & Reflection 25 RCH Nursing Competency Workbook Chapter 3

4 Blood ampling from Central Venous Access Devices ALERT: The Central Venous Access Device Management Competency should be completed prior to or in conjunction with this competency Competency tatement: The nurse can safely and effectively collect a blood sample from a central Venous Access Device (CVAD) 1. Describe the circumstances when bloods might need to be taken from a CVAD 2. Identify a. blood tests frequently taken from CVADs b. tubes required for tests identified above c. volumes required 3. Discuss when gloves would be worn for blood sampling from CVADs and why 4. Discuss safe handling procedures of blood specimens 5. Discuss the correct size syringe to take blood from a CVAD 6. Discuss, with regards to discarding blood: a. When a volume of blood should be discarded prior to the blood specimen being collected and why b. How much blood should be discarded c. In what circumstances a discard sample would be returned to the patient 1. Demonstrate education of the patient / family / carer regarding blood collection from a CVAD 2. Assemble correct equipment for the collecting a blood specimen from a CVAD 3. Demonstrate the procedure for taking blood from a single lumen CVAD 4. Demonstrate the procedure for taking blood from a multi lumen CVAD 5. Demonstrate correct labelling of blood specimens 6. Demonstrate correct completion of pathology forms RCH Nursing Competency Workbook Chapter 3 Page 1

5 Bone marrow aspirates and Lumbar Punctures (Oncology) Competency tatement: The nurse will safely and effectively care for a child with cancer requiring a bone marrow aspirate or lumbar puncture 1. Define: a. Bone Marrow Aspirate (BMA) b. Lumbar Puncture (LP) 2. Discuss the reasons for BMA and LP being performed on children with cancer 3. Discuss pre BMA and LP blood tests and range required in order for BMA or LP to proceed 4. tate potential complications and management of: a. BMA b. LP 5. Discuss required observations of patients post BMA or LP 6. Outline key considerations in the Intrathecal administration of drugs 1. Demonstrate location of most common site chosen for performing BMA and LP, including application of local anaesthetic cream 2. Demonstrate preparation of the patient for a a. BMA b. LP 3. Demonstrate education of the family regarding BMA and LP RCH Nursing Competency Workbook Chapter 3 Page 2

6 Chemotherapy (intramuscular administration) ALERT: The nurse must have completed the medication administration, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer chemotherapy via intramuscular injection RCH References: RCH Intranet Clinical Management Guidelines: Cytoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the cytotoxic agents to be administered 4. Outline the pre- chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of cytotoxic agent via intramuscular injection 8. Outline necessary monitoring of patient during / following administration of cytotoxic agents via intramuscular injection 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order 3. Demonstrate application of principles of safe handling in administration of cytotoxic agent via intramuscular injection 4. Demonstrate safe disposal of equipment used in administration of a cytotoxic agent via intramuscular injection RCH Nursing Competency Workbook Chapter 3 Page 3

7 Chemotherapy (intrathecal administration) ALERT: The nurse must have completed the medication administration, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse safely and effectively assists in the administration of intrathecal chemotherapy RCH References: RCH Intranet Clinical Management Guidelines: Cytoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. List the drugs that are administered intrathecally in the treatment of cancer 4. Discuss the dose calculation for cytotixic agents administered intrathecally 5. Identify the cytotoxic agents to be administered? 6. Outline the pre- chemotherapy investigations required for the particular cytotoxic agents being administered 7. Recall potential side effects and management of the cytotoxic agents being administered 8. Discuss antiemetic coverage required for cytotoxic agent being administered 9. Discuss principles of administration of intrathecal cytotoxic agent 10. Outline necessary monitoring of patient during / following administration of intrathecal cytotoxic agents 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order 3. Demonstrate application of principles of safe handling in assisting in the administration of intrathecal cytotoxic agent 4. Demonstrate safe disposal of equipment used in administration of an IV push of a cytotoxic agent RCH Nursing Competency Workbook Chapter 3 Page 4

8 Chemotherapy (intravenous infusion) ALERT: The nurse must have completed the medication administration, intravenous cannula management (peripheral), CVAD management, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer chemotherapy via intravenous infusion RCH References: RCH Intranet Clinical Management Guidelines: Cytoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the cytotoxic agents to be administered? 4. Outline the pre- chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of cytotoxic agents via IV infusion 8. Identify classification of cytotoxic agents being administered as non irritants, irritants or vesicants 9. Discuss management of cytotoxic drug extravasation 10. Outline necessary monitoring of patient during / following administration of cytotoxic agents via IV infusion 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order 3. Demonstrate application of principles of safe handling in administration of cytotoxic agent via IV infusion 4. Demonstrate safe administration of an irritant or a vesicant agent as an IV infusion 5. Demonstrate safe disposal of equipment used in administration of an IV push of a cytotoxic agent RCH Nursing Competency Workbook Chapter 3 Page 5

9 Chemotherapy (intravenous push) ALERT: The nurse must have completed the medication administration, intravenous cannula management (peripheral), CVAD management, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer chemotherapy via intravenous push RCH References: RCH Intranet Clinical Management Guidelines: Cytoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the cytotoxic agents to be administered 4. Outline the pre chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of cytotoxic agent via IV push 8. Identify classification of cytotoxic agents being administered as non irritant, irritant or vesicant 9. Discuss management of cytotoxic drug extravasation 10. Outline necessary monitoring of patient during / following administration of cytotoxic agents via IV push 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order 3. Demonstrate application of principles of safe handling in administration of cytotoxic agent via IV push 4. Demonstrate safe administration of an irritant or a vesicant agent as an IV push 5. Demonstrate safe disposal of equipment used in administration of an IV push of a cytotoxic agent RCH Nursing Competency Workbook Chapter 3 Page 6

10 Chemotherapy (Management & upportive Care Theory) ALERT: This competency is required for all nurses who care for a child receiving or who has received chemotherapy Competency tatement: The nurse has the requisite knowledge to provide supportive care to a patient receiving cytotoxic therapy. RCH References: RCH Intranet Clinical Management Guidelines: Cytoxic drugs The management of 1. Locate and read the references related to this competency 2. Identify resources available to access for information regarding cytotoxic agents (drug information and supportive care) 3. Describe the key elements of the chemotherapy protocol (MR 53B) 4. Outline the pre chemotherapy investigations required 5. Discuss side effects of administered cytotoxic agents 6. Outline management for potential immediate side effects 7. ummarise antiemetic options for the patient receiving cytotoxic agents. 8. Discuss nursing precautions, care and monitoring for a patient receiving chemotherapy including a. monitoring of urine output b. pre and post hydration c. line set up d. observations e. other medications (e.g. mesna, folinic acid) 9. Identify relevant tests patient may require whilst receiving cytotoxic agents 10. Discuss the management of cytotoxic drug extravasation 11. ummarise family understanding of treatment being delivered and areas for education Not Applicable RCH Nursing Competency Workbook Chapter 3 Page 7

11 Chemotherapy (oral administration) ALERT: The nurse must have completed the medication administration, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer oral chemotherapy RCH References: RCH Intranet Clinical Management Guidelines: Cytoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the oral cytotoxic agents to be administered? 4. Outline the pre chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of oral cytotoxic agents 8. Outlines necessary monitoring of patient during / following administration of oral cytotoxic agents 9. Establish a safe work environment 10. Demonstrate correct process to confirm accuracy of order 11. Demonstrate application of principles of safe handling in administration of oral cytotoxic agents 12. Demonstrate safe disposal of equipment used in administration of oral cytotoxic agents RCH Nursing Competency Workbook Chapter 3 Page 8

12 Chemotherapy (afe handling) ALERT: This competency is required for all nurses who care for a child receiving or who has received chemotherapy Competency tatement: The nurse safely and effectively handles cytotoxic agents and disposes of cytotoxic waste. RCH References: RCH Intranet Clinical Management Guidelines: Cytoxic drugs The management of 1. Locate and read the references related to this competency 2. Discuss safe transport and storage of cytotoxic agents from pharmacy to patient 3. Demonstrate set up of a safe working environment 4. Discuss correct use of personal protective equipment (PPE) required to a. administer cytotoxic agents b. dispose of cytotoxic waste i. equipment ii. excess cytotoxic agents iii. contaminated lined and clothing iv. patients personal waste (vomit, urine, faeces and blood) 5. tate action required if personal contamination with a cytotoxic agent occurs 6. Outline correct procedure to manage a cytotoxic spill 7. Discuss safe management/disposal of cytotoxic waste a. equipment b. excess cytotoxic agents c. contaminated linen and clothing d. patients personal waste (vomit, urine, faeces and blood) 8. ummarise information provided to children and families in regards to safe handling, including resources available Not Applicable RCH Nursing Competency Workbook Chapter 3 Page 9

13 Chemotherapy (subcutaneous administration) ALERT: The nurse must have completed the medication administration, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer chemotherapy via subcutaneous injection RCH References: RCH Intranet Clinical Management Guidelines: Cytoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the cytotoxic agents to be administered? 4. Outline the pre- chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of cytotoxic agent via subcutaneous injection 8. Outline necessary monitoring of patient during / following administration of cytotoxic agents via subcutaneous injection 9. Discuss the use and management of Insuflons in the administration subcutaneous cytotoxic agents 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order Demonstrate application of principles of safe handling in administration of cytotoxic agent via subcutaneous injection 3. Demonstrate safe disposal of equipment used in administration of a subcutaneous injection of a cytotoxic agent RCH Nursing Competency Workbook Chapter 3 Page 10

14 Central Venous Access Device (Blocked) ALERT: The Central Venous Access Device Management Competency should be completed prior to this competency Competency tatement: The nurse can safely attempt to unblock a central venous access device (CVAD) RCH References: RCH Intranet Clinical Management Guidelines: Anticoagulation Therapy 1. Locate and read the references related to this competency 2. List possible causes of CVAD occlusion 3. Discuss CVAD management to minimise the risk of occlusion 4. Describe a Fibrin heath? 5. Discuss rationale for syringe size selection in flushing CVADs 6. Discuss the steps to be taken in attempting to unblock a CVAD that has a. A blood related blockage b. A chemical related blockage 7. tate the length of time TPA should be left in the line 8. tate the documentation / communication required to alert others that TPA is in the line 9. Describe the potential side effects of TPA and HCl 10. Discuss management of a blocked CVAD in which initial attempts to clear the blockage have failed Not Applicable RCH Nursing Competency Workbook Chapter 3 Page 11

15 Criteria Led Discharge Competency tatement: The nurse safely and effectively discharges a child applying criteria led discharge process RCH References: RCH Policies & Procedures: Criteria Led Discharge 1. Locate and read the references related to this competency 2. Discuss the benefits of criteria led discharge (clinical practices guidelines) a. For the family b. For the organisation 3. Discuss the expectations of nursing staff within the criteria led discharge process 4. Discuss the required authorization from medical staff for criteria led discharge to occur and identify where this particular information is documented 5. Discuss the medical review requirements for a child who will have a criteria led discharge 6. Highlight some of the issues that may need addressing when discharging a patient via a criteria led discharge order 7. Discuss the discharge follow up required and how this is arranged 1. Demonstrate discussion with the family explaining the criteria led discharge process RCH Nursing Competency Workbook Chapter 3 Page 12

16 Febrile Neutropenia Competency tatement: The nurse will safely and effectively care for a patient with Febrile Neutropenia RCH References: RCH Intranet Clinical Management Guidelines: Febrile Neutropenia; epsis Assessment & Management 1. Locate and read the references related to this competency 2. tate the normal values a. Haemoglobin b. Platelets c. White Blood count d. Neutrophils 3. Describe the function of neutrophils 4. Define the term febrile neutropenia 5. Discuss the observations required during an admission for neutropenia 6. Discuss the actions to be taken where observations are outside the normal range for the child s age 7. Discuss the use of paracetamol and Ibuprofen in the care of children who have febrile neutropenia 8. Explain the rationale for the following investigations as part of a septic work up a. Blood cultures b. wabs nose / throat / CVAD c. Urine d. tool 9. Explain which blood cultures need to be taken and how much blood you would take for a child weighing 20kg 10. Discuss CVAD line set up for administration of antibiotics for the child with febrile neutropenia 11. Discuss the management of suspected febrile neutropenia on presentation to emergency 12. Discuss the management provided in the first 72 hours of admission for febrile neutropenia 13. tate the antibiotics and dosages used as first line treatment for febrile neutropenia. 14. tate the expected timeframe that the first dose of antibiotics should be given, and why 15. Discuss treatment options for patients with unresolved fever 16. tate the signs and symptoms of septic shock 17. Identify potential sources/portals/causes of infection in patients with neutropenia and discuss ways to minimise the risk 18. List ways in which staff/parents and children can help prevent infection 1. Discuss and demonstrate collection of blood cultures from a Central Venous Access Device 2. Demonstrate education of children and families about neutropenia and describe the key points that you would educate a family about febrile neutropenia. RCH Nursing Competency Workbook Chapter 3 Page 13

17 Hickman Catheter Removal Competency tatement: The nurse safely and effectively removes a Hickman Catheter 1. Discuss reasons for Hickman Catheter removal 2. Discuss strategies to minimise pain and distress during Hickman Catheter removal 3. Describe the steps in removing a Hickman Catheter a. sterile field b. Location of cuff c. Removal of stitches (if applicable) d. Pulling on Hickman catheter e. Pressure to neck scar f. Dressing 4. Describe observation and monitoring of patient post removal of Hickman Catheter 5. Discuss the education required by the family prior to discharge 1. Demonstrate preparation of the child and family for the removal of a Hickman Catheter a. Explanation of i. reason for removal ii. the process of removal iii. post removal care, b. Assemble required equipment c. Revise results of investigations to ascertain findings are within range for Hickman Catheter removal 2. Demonstrate removal of a Hickman Catheter RCH Nursing Competency Workbook Chapter 3 Page 14

18 Infusion of Cryopreserved Haemopoietic Progenitor Cells (HPC) - Oncology ALERT: The nurse must have completed the CVAD Management competency prior to completion of this competency Competency tatement: The nurse will safely and effectively administer cryopreserved haemopoietic progenitor cells (HPC) via intravenous infusion. RCH References: RCH Intranet Children s Cancer Centre - Haematopoietic tem Cell Transplant (HCT) Program Documents: Infusion of Cryopreserved Haemopoietic Progenitor Cells Clinical Work Instruction CL-W-001; Transplantation of Cryopreserved Haemopoietic Progenitor Cells Clinical Procedure CL-P-001; Adverse Reactions Associated with Haemopoietic Progenitor Cell Infusion Clinical Work Instruction CL-W Locate and read references related to this competency 2. Discuss the actions required the day prior to and the morning of the cryopreserved HPC infusion including a. Communication with the laboratory b. Orders required for premedication, IV hydration and cryopreserved HPC product 3. Identify premedications required prior to infusion of cryopreserved HPC and administer as prescribed 4. Identify hydration fluids required prior to and after infusion of a cryopreserved HPC product and administer as prescribed 5. Discuss the nursing care required post the HPC infusion 6. Outline 7. urine testing & output 8. monitoring for delayed reactions 9. Discuss the adverse reactions associated with HPC infusion and identify the documentation and actions required for a a. mild reaction b. moderate to severe reaction c. late reaction 10. Outline the education required for the patient and family undergoing a cryopreserved HPC transplantation 1. Demonstrate correct set up of IV lines and outline a. line/syringe required for HPC infusion (do not prime with HPC product) b. additional Normal aline line 2. Demonstrate the patient monitoring required prior, during and post the cryopreserved HPC infusion (including presence of medical staff) 3. Perform patient ID and HPC product checks according to clinical procedure 4. Demonstrate the correct procedure for administrating a cryopreserved HPC product via a. an IV line b. a syringe and outline a. blood filter to be used b. fluids that may run with HPC infusion c. amount of HPC product to infuse initially d. wait time required before proceeding with rest of HPC infusion (restart IV fluids to prevent blockage) e. recommended infusion times of HPC RCH Nursing Competency Workbook Chapter 3 Page 15

19 Infusion of Fresh Haemopoietic Progenitor Cells (HPC) - Oncology ALERT: The nurse must have completed the CVAD Management competency prior to completion of this competency Competency tatement: The nurse will safely and effectively administer fresh haematopoietic progenitor cells (HPC) via intravenous infusion RCH References: RCH Intranet Children s Cancer Centre - Haematopoietic tem Cell Transplant (HCT) Program Documents: Infusion of Fresh Haemopoietic Progenitor Cells Clinical Work Instruction CL-W-002; Transplantation of Fresh Haemopoietic Progenitor Cells Clinical Procedure CL-P-002; Adverse Reactions Associated with Haemopoietic Progenitor Cell Infusion Clinical Work Instruction CL-W Locate and read references related to this competency 2. Discuss the actions required the day prior to and the morning of the fresh HPC infusion including a. Communication with the laboratory (& valid recipient specimen) b. Orders required for premedication, IV hydration and fresh HPC product 3. Identify premedications required prior to infusion of fresh HPC and administer as prescribed for a. ABO identical or group compatible HPC product b. Minor ABO mismatch HPC product c. Major ABO mismatch HPC product 4. Identify hydration fluids required prior to and after infusion of a fresh HPC product and administer as prescribed for a. ABO identical or group compatible HPC product b. Minor ABO mismatch HPC product c. Major ABO mismatch HPC product 5. Discuss the nursing care required post the fresh HPC infusion and outline a. urine testing & output b. monitoring for delayed reactions 6. Discuss the adverse reactions associated with fresh HPC infusion and identify the documentation and actions required for a a. mild reaction b. moderate to severe reaction c. late reaction 7. Outline the education required for the patient and family undergoing a fresh HPC transplantation 1. Demonstrate correct set up of IV lines and outline a. Line/syringe required for HPC infusion (do not prime with HPC product) b. Additional Normal aline line 2. Demonstrate the patient monitoring required prior, during and post the fresh HPC infusion (including presence of medical staff) for a. ABO identical or group compatible HPC product b. Minor ABO mismatch HPC product c. Major ABO mismatch HPC product 3. Perform patient ID, donor ID and HPC product checks according to clinical procedure 4. Demonstrate the correct procedure and infusion rate for administrating a fresh HPC product via an IV line and outline: a. blood filter to be used b. fluids that may run with HPC infusion c. infusion rate at commencement of HPC infusion d. recommended infusion times of HPC product & use of frusemid RCH Nursing Competency Workbook Chapter 3 Page 16

20 Mucositis (Oncology) Competency tatement: The nurse safely and effectively cares for a child with cancer at risk of or with mucositis RCH References: RCH Clinical Practice Guidelines: Mouth Care Oral Care of the paediatric oncology patient and haematopoietic stem cell transplant patient; Perianal care for the paediatric oncology patient 1. Locate and read the following clinical practice guidelines a. oral hygiene for haematology oncology children b. perianal care for the paediatric oncology patient 2. Define Mucositis 3. Discuss potential causes of Mucositis for children with cancer 4. Discuss the signs and symptoms the patient may present with when experiencing mucositis 5. Discuss the Oral Assessment Guide score 6. Discuss oral hygiene measures to reduce the risk of oral mucositis 7. Discuss management to reduce the risk of perianal mucositis 8. Discuss the management of a patient with mucositis a. Oral b. Gastrointesitinal c. Perineal d. Pain relief 9. Discuss the link between recovering neutrophil count and resolution of mucositis 1. Demonstrate assessment of a patient s mouth and accurate documentation of results 2. Demonstrate assessment of a patient s perineum and accurate documentation of results 3. Demonstrate discussion with children / parents regarding mucositis and care including care at home RCH Nursing Competency Workbook Chapter 3 Page 17

21 Nutrition (Parenteral) ALERT: The CVAD management competency should be completed in conjunction with this competency Competency tatement: The nurse safely and effectively administers Parenteral Nutrition RCH References: RCH Clinical Practice Guideline Nursing: Parenteral Nutrition Element Exemptions: oala and Cancer Care Unit (6a-b and 2b) 1. Locate and read the references related to this competency 2. tate the general indications for use of PN 3. Identify members of the multidisciplinary team involved in the care of this patient group, including each member s role 4. Identify at least five components which can be found in the PN solution 5. tate the ideal IV access for patients receiving a. Low dextrose nutrient solutions b. High dextrose nutrient solutions 6. Discuss the differences between hospital PN & Baxter PN for the following a. Fluid prescription and documentation b. Preparation & administration 7. Discuss the ongoing care requirements and management of patients receiving PN a. commencing b. ceasing c. weaning d. frequency of monitoring: i. Bloods ii. Urine iii. Weight iv. CVAD v. Documentation 8. Discuss how to administer non-compatible IV antibiotics to a patient receiving high dextrose PN solution 9. Discuss the correct action to be taken in the event that the nutrient solution finishes prior to the next bag being delivered from pharmacy 13.tate the maximum amount of potassium to be placed in a PN bag 1. Demonstrate checking of IV medication compatibility with PN prior to medication administration 2. Demonstrate IV line assembly & priming for the patient receiving a. Hospital PN olution b. Baxter PN olution 3. Demonstrate programming of IV pumps for all stages of weaning on & off PN RCH Nursing Competency Workbook Chapter 3 Page 18

22 Pain (Analgesia Infusion) Competency tatement: The nurse will safely and effectively administer analgesia infusions RCH References: RCH Intranet Anaesthesia & Pain Management Pain Management Guidelines: Opioid Infusion; etamine Infusion 1. Locate and read the references related to this competency 2. Describe the pharmacokinetics of the analgesia infusion 3. Discuss the potential side effects of analgesia infusions 4. tate the minimal clinical observations required for a patient receiving an analgesia infusion 5. Discuss reportable parameters 6. Discuss nursing actions to take if pain escalates 7. Discuss when to give analgesia boluses and when to increase analgesia infusions 8. tate when, why and how much naloxone should be given for opioid induced puritus, sedation and respiratory depression 9. Locate and complete the opioid primary competency quiz 1. Demonstrate pain assessment with an understanding of child development, language and appropriate pain assessment tools 2. Demonstrate accurate documentation of observations and assessment 3. Demonstrate correct set up of analgesia infusion pumps 4. Demonstrate explanation, answering questions and confirmation of understanding with family RCH Nursing Competency Workbook Chapter 3 Page 19

23 Pain (Patient Controlled Analgesia) Competency tatement: The nurse will safely and effectively administer patient controlled analgesia (PCA) RCH References: RCH Intranet Anaesthesia & Pain Management Pain Management Guidelines: Patient Controlled Analgesia 1. Locate and read the RCH Patient Controlled Analgesia Guidelines 2. Describe the pharmacokinetics of the opioid analgesia used 3. Discuss the potential side effects of PCA 4. Describe the PCA pump program and demonstrates where the prescribed program is documented 5. tate the minimum observations for a patient receiving a PCA and recognizes reportable parameters 6. Discuss the nursing actions to take if pain escalates 7. Explain when, why and how much naloxone should be given for opioid induced puritus, sedation and respiratory depression 8. Discuss how to transition from a PCA to oral analgesia 9. Locate and complete the PCA primary competency quiz 1. Demonstrate a pain assessment 2. Demonstrate accurate documentation of PCA use 3. Demonstrate explanation, answering of questions and confirmation of understanding with family RCH Nursing Competency Workbook Chapter 3 Page 20

24 Potassium Infusion (oncology) Competency tatement: The nurse can safely and effectively administer a potassium infusion in children with cancer RCH References: RCH Intranet Pharmacy medicines information: potassium chloride infusions 1. Locate and read the references related to this competency 2. Describe the function of Potassium in the body 3. Identify risk factors for low or high potassium levels in children with cancer 4. Describe the signs and symptoms of hypo / hyperkalaemia 5. Explain why children with cancer require Potassium corrections 6. Explain monitoring of potassium levels for acute corrections and ongoing infusions 7. Discuss the management if a patient s potassium is too high / low 8. Discuss the monitoring requirements for a patient receiving a potassium infusion 9. tate the concentration of a potassium infusion administered in the Cancer Care Unit 10. Discuss precautions when patient is receiving 60mmol/l CL in their intravenous fluids 1. Demonstrate preparation of a concentrated potassium infusion for acute corrections and ongoing infusions 2. Demonstrate accurate documentation of a potassium infusion RCH Nursing Competency Workbook Chapter 3 Page 21

25 Procedural edation nitrous oxide accreditation skill ALERT: This competency should follow the procedural sedation nitrous oxide accreditation theory competency. Nurses must attain the competency elements INDEPENDENTLY in order to be considered competent Competency statement: The nurse assesses and prepares a child and family for a procedure and safely and effectively administers nitrous oxide throughout the procedure. 1. tate when a sedation period starts and ends 2. Describe the function of the Nitrous Oxide delivery unit components. 3. Assemble the disposable equipment required for nitrous oxide administration 4. tate the two built in safety features on the nitrous unit and rationale for these 5. ummarise and demonstrate delivery of oxygen post sedation 6. Demonstrate a safety check of the nitrous oxide and emergency equipment prior to the start of the procedure 7. Demonstrate preparation of the child and parent for the sedation event 8. Integrate non pharmacological strategies as part of sedation event 9. Maintain line of sight throughout the sedation episode 10. Deliver nitrous oxide including making adjustment to: a. the nitrous oxide concentration based on anxiety, pain and sedation requirements b. the gas flows based on patients needs. 11. cavenge nitrous oxide gas in accordance with Occupation Health and afety tandards 12. Perform end of sedation period assessment including assessment of level of alertness and return to baselines vital signs. 13. Correctly document (MR 56) the sedation event including all baseline observations, risk assessments, sedation summary and discharge criteria 14. Demonstrate discussion of post sedation care including falls prevention with family and child RCH Nursing Competency Workbook Chapter 3 Page 22

26 Procedural edation nitrous oxide theory ALERT: This competency should precede the procedural sedation nitrous oxide competency skill. Completion of this competency in isolation does not indicate the nurse s competency to administer nitrous oxide Competency statement: The nurse has the requisite knowledge to assess and prepare a child and family for, nitrous oxide sedation and the safe delivery of nitrous oxide during a procedure RCH references: RCH Clinical Guidelines: Procedural Pain, edation - Procedural edation Guideline - Ward and Ambulatory Areas 1. Locate and read the references related to this competency 2. Complete online learning package and pre test 3. Discuss the role and responsibility of the sedater for a nitrous oxide sedation event including reporting of adverse event. 4. Describe pharmacological effects of nitrous oxide 5. Outline the differences between anaesthetic and procedural fasting guidelines and consent. 6. tate the three RCH services available to provide procedural sedation advice/consultation. 7. Describe five ways to prepare a child/family for a nitrous oxide sedation event 8. tate any specific variation to nitrous oxide sedation guideline that applies to your area 9. Describe what considerations should be taken when administering nitrous oxide with another primary sedation agent. 10. tate the rationale for a. Risk assessment b. Baseline observations and ongoing observations c. edation scale d. Line of sight monitoring e. Post sedation discharge criteria for patients in your area f. Falls prevention g. Emergency equipment h. Occupational Health and afety i. Nitrous oxide storage j. Documentation responsibilities 11. tate the action required for a. Equipment faults b. Loss of nitrous or oxygen gas flow c. Failure to sedate 12. Describe the adverse events that might occur during administration of nitrous oxide and outline the actions required 13. Describe the actions required for the following side effects: a. Hallucinations b. Over sedation c. Vomiting 14. tate the location of the emergency equipment unit/ department box. Not Applicable RCH Nursing Competency Workbook Chapter 3 Page 23

27 ubcutaneous Catheter devices management (Infusion and BD at-t-intima ) ALERT: For palliative care patients please refer to the symptom management plan as documented by the Victorian Paediatric Palliative Care Program Competency tatement: The nurse safely and effectively cares for a patient who requires the use of a ubcutaneous Catheter device RCH References: RCH Intranet Palliative Care For Health Professionals: Parenteral infusions and syringe drivers; RCH Policies & Procedures: Medication Management; RCH Clinical Practice Guidelines: ubcutaneous Catheter devices management Infusion and BD at-t-intima ; ucrose (oral) for procedural pain management in infants 1. Locate and read the references related to this competency 2. Discuss the indications for medications to be given subcutaneously 3. Outline and discuss the different anatomical positions that an Insuflon and BD af-t- Intima TM can be placed subcutaneously. Include; a. Appropriate insertion sites b. Areas to avoid c. Other considerations 4. Outline the management of a ubcutaneous Catheter device. Include; a. Ongoing assessment of an Insuflon and BD af-t-intima insitu (or insertion site) b. Length of insertion time and indications for resiting c. Potential complications and management 5. Outline the documentation required for management of the ubcutaneous Catheter device 6. Demonstrate discussion and education with the child and parents/caregivers regarding the ubcutaneous Catheter device and care at home 1. Demonstrate the procedure for the subcutaneous insertion of an Insuflon 2. Demonstrate the procedure for the subcutaneous insertion of a BD af-t-intima TM 3. Demonstrate the procedure for the administration of medications via an Insuflon 4. Demonstrate the procedure for the administration of a bolus/breakthrough dose of medication via a subcutaneous BD af-t-intima TM 5. Demonstrate the procedure for the administration of a continuous infusion via a subcutaneous BD af-t-intima TM 6. Demonstrate the procedure for the removal of an Insuflon 7. Demonstrate the procedure for the removal of a subcutaneous BD af-t-intima TM RCH Nursing Competency Workbook Chapter 3 Page 24

28 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 25

29 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 26

30 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 27

31 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 28

32 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 29