How To Develop & Implement a Practical Staff Competency
Plan
Pat Comoss RN, BS, MAACVPR Nursing Enrichment Consultants, Inc. I
have no financial relationships to disclose
Financial Disclosure I have no financial relationships to disclose
Staff Competencies in Rehab
Upon completion of this activity, participants will be able to:
Discuss why an annual staff competency plan is important for rehab
personnel Identify criteria that are useful when choosing
competency topics List acceptable methods for evaluating a staff
members competency Match selected competencies to AACVPRs published
Core Competencies for CR & PR Staff Competencies in Rehab
Not New, Revisit WHAT WHY WHEN WHO HOW WHY Staff Competencies
Intrinsic Philosophy: desire for continuous learning to be the best
rehab practitioner you can be WHY Staff Competencies
Intrinsic Philosophy = desire for continuous learning to be the
best rehab practitioner you can be Extrinsic Expectation: Hospital
requirement Joint Commission standard AACVPR Program Certification
criteria WHY Staff Competencies
The Joint Commission Competence assessment lets the hospital know
whether its staff have the ability to use specific skills and to
employ the knowledge necessary to perform their jobs. Human
Resources chapter: 2015 Hospital Accreditation Standards TJC:
Standard HR 01.06.01 The hospital
Defines the competencies it requires of staff who provide patient
care/ treatment/services TJC: Standard HR Uses assessment methods
to determine competence in the skill being assessed Test taking
Return demonstration Simulation/role play Observation of actual
patient care TJC: Standard HR An individual with the educational
background, experience, or knowledge related to the skills being
reviewed assesses competence: Instructor Preceptor Coworker TJC:
Standard HR 01.06.01 The hospital can utilize:
An outside individual Such as: guestspeaker, consultant Competency
guidelines from an appropriate professional organization Such as:
AACVPR Core Competencies TJC: Standard HR 01.06.01 Staff competence
is assessed & documented
once every 3 years or more often per hospital policy WHY Staff
Competencies
AACVPR Program Certification CR & PR: Requirement #1 = Staff
Competencies Individuals should possess a common core of
professional & clinical competencies, regardless of academic
discipline WHY Staff Competencies
AACVPR Program Certification CR & PR: Requirement #1 = Staff
Competencies A program must provide evidence of annual assessment
of clinical/professional staff competency AACVPR Program
Certification
PULMONARY REHAB Program Certification: Four assessed competencies
MUST be specific to Clinical Competency Guidelines for Pulmonary
Rehabilitation Professionals 2014 Collins EG, Bauldoff G, Carlin B,
et al. JCRP 2014; 34: AACVPR Program Certification
CARDIAC REHAB Program Certification: Four assessed competencies
MUST be specific to Core Competencies for Cardiac Rehabilitation/
Secondary Prevention Professionals: 2010 Update Hamm L, Sanderson
B, Ades P, et al JCRP 2011; 31: 2-10 WHAT Staff Competencies
Similar Categories for Staff Competencies CR & PR: Patient
Assessment Exercise Training Psychosocial Management Tobacco
Cessation Emergency Planning WHAT Staff Competencies
Cardiac Rehab Blood pressuremanagement Lipid management Diabetes
management Weight management Pulmonary Rehab Dyspnea assessment
& management Oxygen assessment & management Collaborative
self-management WHAT NOT Staff Competencies
Discipline-specific hospital/department required competencies:
Cardiology RNs = conscious sedation Respiratory RTs = precautions
to prevent ventilator acquired pneumonia (VAP) WHAT NOT Staff
Competencies
Initial/Orientation checklist for new employees often emphasize
mechanical functions within dept vs. specific clinical patient care
Hospital-wide required competencies e.g. HIPAA rules,
safety/security color-codes, etc. HOW Staff Competencies
1. Choose skills that need to be learned, reviewed, or updated
because they are: NEW/CHANGED HIGH RISK LOW VOLUME PROBLEMATIC HOW
Staff Competencies
Categories Patient Assessment Exercise Training Psychosocial
Management Tobacco Cessation Emergency Planning Etc. Criteria
NEW/CHANGED HIGH RISK LOW VOLUME PROBLEMATIC HOW Staff
Competencies
2. Sources of choices: INSIDE - OUT Use Core Competency documents
for staff self-assessment = Identify strengths & weaknesses
HOW: Inside - Out Examples NEW = BODE Index calculation (PR),
MET-minutes calculation (CR) HIGH RISK = diabetic exercise
management (blood sugar testing, high & low cut-offs) LOW
VOLUME = tobacco cessation HOW Staff Competencies
Cross reference to Core = Smoking Cessation Core Competencies for
Cardiac Rehabilitation/Secondary Prevention Professionals: 2010
Update pg 7 Tobacco cessation; Knowledge 1-7, Skills 1-3. Pulmonary
Clinical Competency Guidelines: 2014 Update - pg. 299, Tobacco
cessation; Knowledge 1-7, Skills 1-2. HOW: Inside - Out Challenge:
find resources to teach the topic/skill to rehab staff in rehab
context Within facility or external expert? PROFESSIONAL
DEVELOPMENT OPPORTUNITY = elect a staff member to study/research
the topic & become the rehab expert HOW Staff
Competencies
2. Source of choices: OUTSIDE - IN Use authoritative external
information for competency ideas = Identify need to update/upgrade
program HOW: Outside - In Challenge: make sure chosen topic/skill
is within the scope of Core Competencies expectations Where does
the new interest match document? PROFESSIONAL DEVELOPMENT
OPPORTUNITY = elect a staff member to track connections between
chosen topics & competency bullets Pulmonary Rehab
Example
NEW/CHANGED: Need to update PR policy & practice to incorporate
latest evidence-based recommendations for this important outcome
measure Pulmonary Rehab Example
Changes to 6MWT Performance 2015: For initial assessment, do 2
walks & take best result as baseline measure Use patient's own
oxygen equipment & usual O2 flow = DO NOT TITRATE O2 Allow O2
sat to drop to low value cut-off of 80% saturation For exit
evaluation, look for change of at least 30 meters/100 feet to be
clinically significant Pulmonary Rehab Example
Exercise Testing p.298 Use of field testing (6MWT, shuttle walk) as
outcome measure Complete 6MWT using ATS criteria Appropriately
monitor responses Develop ExRx on basis of results as appropriate
Cardiac Rehab Example NEW/CHANGED: Need to update CR policy &
practice to incorporate latest evidence-based recommendations for
this important outcome measure Cardiac Rehab Example Changes to BP
Management 2015:
New target value for secondary prevention of cardiac events =
140/90mmHg Much lower is not necessarily better & may
contribute to side effects or complications Decreased coronary or
cerebral perfusion Orthostatic problems DBP less than 65mmHg should
be avoided in older patients Cardiac Rehab Example BP Management
p.6
Normal range of BP at rest & with exercise; Current BP targets
for secondary prevention Accurate determinations Recognition of
deviations from range Measurement of outcomes HOW Staff
Competencies
WHAT WHY WHEN HOW WHO WHEN Staff Competencies
Schedule an in-service presentation and/or practice session
Annually Quarterly Staff Competencies: SUMMARY
WHAT = documentation of staff knowledge, skill, & ability WHY =
improve quality of program; requirement for TJC & AACVPR WHEN =
4 each year for cert/recert HOW = learn, practice, demonstrate,
document WHO = staff member, outside expert Cardiac Rehab - SPECIAL
NOTE
Core Competency document is basis for new CCRP certification!
Professional certification exam to be given at this AACVPR National
Meeting: September 7, 2016 New Orleans, LA Pulmonary Rehab
PREVIEW
PR Core Competency document will be basis for new CPRP
certification! Now in development!! References Hamm LF et al. Core
Competencies for Cardiac Rehabilitation Professionals: 2010 Update.
JCRP 2011;31: Collins EG et al. Clinical Competency Guidelines for
Pulmonary Rehabilitation Professionals. JCRP 2014; 34: References
Holland AE et al. An official European Respiratory Society/
American Thoracic Society technical standard: field walking tests
in chronic respiratory disease. Eur Respir J 2014; 44: Rosendorff C
et al. Treatment of Hypertension in Patients with Coronary Artery
Disease. Circulation 2015; 131: e1 e36. Staff Competencies in
Rehab
Thank You! Good luck with planning & documenting your programs
staff competencies!! Staff Competencies in Rehab
Q & A ? ? ?
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