vascular access infection prevention
Consistent Competency Assessment as a Reflection of Quality and Safety
Competency assessment through observational checklists , outcome monitoring , and to some degree , professional certification constitutes much-needed level of evaluation of adequate performance and facility quality that reflects a commitment to patient safety .
continue with the theme from last month
To that focused on the value of education for infection prevention , competency assessment to validate clinician performance is also a method to insure a high level of quality and patient safety with highly invasive procedures . In terms of nursing and medical staff performance competency or credentialling for procedures , the process for evaluation is often completed initially , and then not consistently reevaluated . In this era of electronic medical record implementation , many prior data collection reports with procedures for patient outcomes are still awaiting reinstitution . Outcome monitoring , through data collection reporting and analysis , functions to evaluate clinician performance or deficits . Competency assessment through observational checklists , outcome monitoring , and to some degree , professional certification constitutes much-needed level of evaluation of adequate performance and facility quality that reflects a commitment to patient safety .
As technologies and product complexities have increased more and more procedures require a prior demonstration of understanding and performance that reflect adequate competency with the steps , supplies and necessary equipment used in the procedure ( Hulse , 2013 ). As previously noted in the column on education , adequate education leads to better outcomes . But how do we evaluate adequate education and how can procedural competencies be measured consistently ? Equipment manufacturers used to take a more active role in the provision of education , prior to country wide concerns over the influence on purchasing and agreements ( McMahon , 2017 ). Hospitals are hesitant to allow sales representatives into hospitals to train or supervise , as a result some hospitals have seen a decline in clinician education . But who is evaluating and who is watching ?
With patient safety and liability concerns on the rise , it is imperative that standardized processes and tools be developed that will ensure the competency of practitioners performing invasive procedures ( Moureau , 2013 ). Defining a competent practitioner is a difficult task . Initial competence is often determined following a pre-determined number of procedures and subjective assessment by a supervisor who may or may not be qualified . An alternative method is a process that includes the completion of a written test that assesses the practitioner ’ s level of cognitive
• knowledge of the procedure , in conjunction with supervised practice to test the practitioner ’ s ability to perform the procedure to a satisfactory standard . Following successful completion and supervised competency assessment for patient insertions , the inserter should be responsible to seek out on-going competency assessment by a supervisor or peer at least every two years and registering the completion of the process in the employee documentation .
We know from the literature that an inverse relationship exists with healthcare professional experience and their rate of complications ( Moureau , et al ., 2013 ). Procedures performed less frequently and by less experienced physicians and nurses are more likely to have complications . Patient outcomes improve with education , hands-on training , and adequate procedural volume . Validation of understanding and performance through Global Rating Scales or checklists can provide some level of assurance of competency with the procedures . A more accurate level of assessment can be added to the competency assessment checklist in the form of outcome monitoring of procedures performed and associated complications .
Highly invasive procedures , such as central line insertions , should have automatic reporting of complications to the inserter and to the department head . Feedback to the inserter provides the opportunity for self-improvement . Feedback to the department head allows allocation of educational resources to correct any demonstrated deficits and address the problems to prevent reoccurrence . While central line-associated bloodstream infection ( CLABSI ) committees perform root or common cause analysis ( RCA / CCA ), they rarely involve the inserter or report back to the inserter . Improvement is most effective when the inserter is involved in the process of identifying potential sources of contamination .
Inserter responsibility and commitment to high quality may be reflected in professional certification . According to one report by Chopra and associates noted that certified inserters were more likely to apply evidence-based practices known to reduce complications ( Chopra , et al ., 2017 ). Certification and re-certification require the clinician to renew on a two- or three-year cycle of renewal , complete education , and in some cases , require insertion procedure documentation and competency assessment . Certification requirements that include
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