In-home comp observation alone won't cut it
In-home comp observation alone won't cut it
Many skills can be assessed in clinical labs
Some private duty agencies use a clinical nursing laboratory setting to assess competency of staff when in-home competency observation does not allow for all scenarios to be assessed and written tests don't allow for observation of skills.
"You can't hit every possible scenario in the home visits," says Donna Franks, RN, MS, CCM, home care consultant at HomeCare Resources Associates in Des Plaines, IL. "So the clinical nursing lab becomes an important part of the assessment process."
For example, she says, nurses can be evaluated on equipment that shows their venipuncture skills, which can't always be observed in the home. "Staff can certainly illustrate infection control procedures, catheter technique, IV therapy protocols, and drawing blood." She emphasizes that the lab should not take the place of observation in the home; it should be combined with home observation and any written or verbal tests to show comprehensive assessment of competency for staff.
Labs can be used to conduct an assessment and evaluation of the different competency levels of nurses, aides, and homemakers, allowing agencies to assess a range of skills, such as bathing, oral hygiene, or transfer of patients, right in the office. Usually, nurses' aides are paired to perform the skills on each other, or supervisors pose as patients.
Keep written exams short
If an agency uses written tests, they should be no more that 10 to 15 questions. Franks suggests that agencies first hold an inservice, distribute related information, and show a video on the topic covered. Staff then can be given a test that covers their knowledge of the topic presented. This test would go into the staff member's personnel file or education folder to serve as proof of competence. "The test does help to demonstrate a level of competency of knowledge and skills," Franks says.
"The Joint Commission accepts the assessment in clinical nursing labs as compliance with our standards," says Maryanne Popovich, RN, MPH, executive director of the home care program for the Joint Commission on Accredita-tion of Healthcare Organizations (JCAHO) in Oakbrook Terrace, IL. "The standards do not indicate that the competency must be performed by the agency itself, but that competency must be assessed by a qualified individual." (See related story, p. 51.)
Some skills can be evaluated through written tests; for example, a nurse must understand and be able to recognize the side effects of certain drugs. But Popovich says for other skills, observations are absolutely necessary, such as how to give a bath or draw blood. Interviews should also be utilized; for example, agencies may want to speak with a nurse to see how she will interview a patient.
Being consistent
Franks points out that in her experience, most private duty agencies do not assess the competency of staff on a consistent basis, and there is little or no regulation of private duty agencies. She suggests that agencies set up a consistent competency evaluation program that includes the following:
· annual in-home observation of staff skills while caring for patients;
· initial competency assessment in clinical nursing lab for new employees;
· annual competency evaluation of skills to be observed in the clinical nursing lab or home;
· aggregate and trend competency levels;
· regular inservice programs to teach staff competency results and provide written tests to document level of knowledge.
"We are consistent with our competency evaluations," says Lori Spoo, RN, director of nursing for Alpha Home Health Care in Aurora, IL. "Each aide or nurse must have an annual competency assessment with observation in the home and in the clinical nursing lab."
In the clinical nursing lab, she often gives cues on what to do; however, if more instruction is happening than observation, this may mean an unsatisfactory result for the employee.
Spoo explains that her agency's assessment process is twofold and includes a comprehensive - yet easy-to-use - assessment tool. (See assessment form, p. 52.) An initial assessment is performed during orientation to take a skills inventory of an individual. The competency evaluation is then done with the assessment tool.
"If we find that someone's skills are unsatisfactory in an area, we will work with them to improve," says Spoo. Aides who presented an unsatisfactory result are assigned work but not allowed to perform the skill until they are retested.
Alpha gives written tests as another method of detecting competency. The written test covers observations and reporting, infection control, body functioning, healthy environment, emergencies, privacy and property, and nutrition and fluids. Found at the bottom of the assessment tool, this section is the only area where employees are scored on their skills.
The assessment tool not only helps Spoo assess the competency skills of workers, it assists her in determining areas for inservice topics and educational programs. Each quarter, Alpha's different branches are required to submit total scores from the assessment tool on a tabulation form. Spoo then aggregates the information for the entire company and analyzes each branch's level of competency and education needs.
"This form allows me to see global areas where aides may be falling short, how different branches perform, and how geographical areas comply," she says. "Through our competency program, we are able to offer more quality staff to our patients, which creates a greater level of patient satisfaction."
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