competency training booklet
DESCRIPTION
TRANSCRIPT
P a g e | 1
Renal Training and Development Programme
COMPETENCY TRAINING BOOKLET
NEPHROLOGY NURSING
Name____________________________________________________________
Mentor___________________________________________________________
Backup mentor____________________________________________________
Date commenced__________________________________________________
P a g e | 2
Renal Training and Development Programme
Programme Aims
This training and development programme exists for staff who are new to the dialysis area. The aims of the programme are to introduce new members to the theoretical and practical skills required to competently participate in the delivery of renal replacement therapy in a safe and supported teaching environment. By programme completion, staff will participate in the assistance (HCA) or provision (RGN) of safe, effective; evidence based practice to patients within Wirral Renal Service. During the fast track training period all new staff will have considerable contact time, teaching and support from the Clinical Practice Development Nurse and will be placed with mentorship support from two members of our nursing team. The programme will take the learner through different stages of knowledge and skill until clinical and theoretical competence is achieved. Once the booklet is completed the learner will undertake an informal assessment of knowledge and practice. On successful completion, the learner is awarded a certificate of competency in this area. Wirral Renal Service is proactive in creating an educational learning environment for all of their staff. Staff will be guided and actively encouraged to continue through the different stages of their professional development. Registered Nurses are reminded that they are accountable for their own practice, and support staff must not undertake any activity outside of the Unit’s standards and guidelines and their competency training achievements. Welcome to the Renal Service and good luck with your training!
P a g e | 3
Renal Training and Development Programme
Wirral Renal Units comprise of a 19 bedded hospital based haemodialysis unit, a 7 bedded inpatient unit, 2 satellite units with 19 and 7 dialysis stations respectively and a home therapies unit. In addition, there are also an increasing numbers of patients receiving care within a community setting. The unit focuses upon the delivery of the highest standards of care to patients suffering from CKD 1‐5, or acute renal failure. Care of this patient group is multi faceted and requires specialist intervention from a team of healthcare professionals with expert knowledge acquired through in depth training and experience. Detailed below are some of the specialist services provided within different areas of the unit.
Haemodialysis.
This therapy is given via ward 31 out patient facilities. Patients will attend the ward up to thrice weekly for 4‐5 hours of therapy. The Advanced Nurse Practitioner (ANP) and Dialysis Access Coordinator provide specialist input for this group of patients, inserting new vascular access, preventing infection, completing vascular access surveillance programmes and ensuring that waiting times are kept to a minimum for new vascular access. Anaemia is managed by the Anaemia Coordinator, who will assess and implement anaemia treatments, ensure that protocols are maintained, lead audits and support staff and students with anaemia management.
Home Therapies.
Certain treatments such as peritoneal dialysis and home haemodialysis can be performed in the patients own home. The Home Therapies Specialist Nurses are responsible for the training and management of this patient group in a community setting. They are also responsible for the nurse led management of patients who choose not to receive any form of renal replacement therapy and are involved in informing pre‐dialysis patients of the treatment options available to them.
Specialist Clinics
There is a number of specialist renal out patients clinics, including Low Clearance, Iron/Anaemia and drop in. These clinics are nurse led by the CKD Specialist Nurses and ANP. The Renal Dieticians will also have input in these clinics and will continue to monitor patients after commencement of chosen renal replacement therapy.
In all areas patient care is overseen and monitored by 5 Consultant Nephrologists and a dedicated medical team. A Renal Pharmacist works closely with the medical and nursing teams to ensure that drugs are properly prescribed and administered. The ward area is managed by the Ward Manager and Deputy Ward Managers. Approximately 70 staff work within the unit, including Staff Nurses, Clinical Support Workers, Ward Clerks and Domestics. A Clinical Practice Development Nurse provides support and training to these staff. Nephrology is a diverse and continually developing area. The Clinical Practice Development Nurse is responsible for ensuring that staff are trained to the highest standards, protocols are developed using the latest evidence base and that practices are continually audited and updated.
P a g e | 4
Renal Training and Development Programme
Record of Formal Contact‐ with Mentor and CPDN
Week Content of education and discussion
1
Date__________________
2
Date__________________
3
Date__________________
P a g e | 5
Renal Training and Development Programme
4
Date__________________
5
Date__________________
6
Date_________________
P a g e | 6
Renal Training and Development Programme
Assessments
P a g e | 7
Renal Training and Development Programme
Induction
Staff new to the trust must complete induction programmes. All new staff will complete the renal unit induction programme during the first rostered week of duty. On your first day of duty you must cover the following:
Date Learner Mentor Layout of Ward / tour Emergency Procedures
Fire Procedure Health and Safety Issues Telephone / Bleep System Off duty / shifts Mandatory Training Documentation Computer Access Multi‐disciplinary team
P a g e | 8
Renal Training and Development Programme
Both learner and mentor have discussed the programme so far.
Learner Signature:________________________________Date:_____________________
Mentor Signature:________________________________Date:_____________________
P a g e | 9
Section A ‐ Preliminary Issues
Performance Criteria Supervised Assisted Competent Understands infection control policies and procedures with regard to the environment and equipment. Appropriate wearing of PPE Understands the need to maintain health and safety of self and others Demonstrates appropriate action to take with: i) Management of Waste ii) Blood Spillages iii) Ordering Stock iv) Maintenance of equipment v) Safe disposal of sharps
Completion of Section A Date: ______________ Mentor _______________________________________ Learner
_______________________________________
Renal Training and Development Programme
P a g e | 10
Renal Training and Development Programme
Section C ‐ Effective Preparation of the Machine and Extra Corporeal Circuit for Routine HD
Section B ‐ Basic Theory and Understanding Performance Criteria Supervised Assisted CompetentDemonstrate an understanding of the anatomy and physiology of the kidney Demonstrate an understanding of fluid and electrolyte balance Explains process of acid base balance Displays the knowledge of metabolic activity (calcium/phosphate/vit d) Explains the significance of BP control Demonstrates an understanding of chronic renal failure and 5 stages of CKD Demonstrates an understanding of acute renal failure Demonstrates an understanding of psychological and social impacts of disease to patient and family. Demonstrates an understanding of renal
fluid restrictions Demonstrates a knowledge & understanding of common renal medication Identifies treatment options for patients in renal failure Identifies an understanding of basic principles of haemodialysis
Completion of Section B Date: ______________ Mentor _____________________________________ Learner
P a g e | 11
Renal Training and Development Programme
Performance Criteria Supervised Assisted Competent Identifies all external components associated with blood pathway and states purpose of each. Identifies all external components associated with dialysate pathway and states the purpose of each. Demonstrate start up procedure, including power and water supply. Communicates to the machine which dialysate is being used. Identifies when to connect concentrate and change if required during treatment. Demonstrates correct and complete set up of dialyser, bloodlines and prime solution. Explains the importance of placing the venous line correctly within the prime detector. Explains the reason for priming solution and amounts used. Demonstrates how and when to set the air detector.
Demonstrates how and when to connect to the dialyser and establish dialysate flow. Demonstrate concentrate standby mode. Demonstrates the ability to prime following dialysers according to manufacturer instruction. 1. FX 2. Nephral Completion of Section C Date: _____________
Mentor _________________ Learner
_________________
P a g e | 12
Renal Training and Development Programme
Section D ‐ Setting Parameters According to Dialysis Prescription
Performance Criteria Supervised Assisted Competent Demonstrates appropriate correct machine programming. Demonstrates the ability to check or change the following 1. Sodium 2. Bicarbonate 3. Temperature 4. Time 5. UF Volume 6. Minimum UF Rate 7. Heparin hourly infusion/stop time Demonstrates understanding of function and action in: 1. Venous pressure 2. Arterial Pressure 3. Trans Membrane Pressure
Completion of Section D Date: ______________ Mentor __________________________________ Learner
__________________________________
P a g e | 13
Renal Training and Development Programme
Section E ‐ Associated Complications
Performance Criteria Supervised Assisted CompetentIdentifies and resolves the following dialysis associated complications to an optimum outcome. 1. Hypotension during HD treatment and intra dialytic. 2. Hypoglycaemia 3. Increased non diffusive time 4. Low/high venous pressure alarms 5. Low/high arterial pressure alarms 6. Low/high TMP pressure alarms 7. Air embolism 8. Clotting venous chamber 9. Air Detector alarm 10. Clotting venous chamber 11. Incorrect concentrate 12. Low conductivity
13. High temperature 14. Water/power failure 15. Clotting dialyser 16. Cardiac Arrest 17. Convulsions 18. Dialyser reaction 19. Disequilibrium syndrome 20. Chest pains 21. Cramp 22. Dialysis induced dyspnoea 23. Pyrexia/rigors 24. Raised / low potassium 25. Raised / low calcium Can demonstrate ability to assist in changing a kidney filter. Demonstrates ability to assist when converting from 2 needles to SNSS. Demonstrates an awareness of machine
communications regarding technical errors(i.e.spanner) Demonstrates restart with halt button Identifies who to contact and how if technical problem arises.
Recognises the value of recording the
incidence and type of error codes for effective communication and problem solving.
P a g e | 14
Renal Training and Development Programme
P a g e | 15
Section F ‐ Pt Assessment
Performance Criteria Supervised Assisted Competent
Demonstrates exceptional documentation standards and accurate record keeping Demonstrates how to assess patients pre/intra post dialysis
Demonstrates how to take BP, pulse rate using BPM on dialysis machine Demonstrates use of auto, manual and continuous modes Explains dry weight Explains clinical presentations and management of fluid overload(excessively over dry weight) Explains clinical presentations and management of dehydration(excessively under dry weight) Ensures patient is clinically stable for safe
discharge
Explains course of action should patient be unstable / unfit for discharge Demonstrates understanding and practicalities of straight swap technique Explains the reason behind the PPF prime
Demonstrates appropriate knowledge of reporting / referral priorities Demonstrates effective washback procedure and discontinuation of dialysis
Completion of Section F Date: ______________ Mentor _______________________________________ Learner _______________________________________
Renal Training and Development Programme
P a g e | 16
Renal Training and Development Programme
Section G ‐ Cleaning and disinfection
Performance Criteria Supervised Assisted Competent Demonstrates effective cleaning of external surfaces with appropriate cleaning agents Demonstrates procedure to initiate Bicart drain Demonstrates understanding and practice of: 1. Heat disinfection procedure 2. Decalcification 3. Rinse / drain Demonstrates the correct procedure for chemical disinfection and understands when to perform the process appropriately Demonstrates when and how the test procedure for residual bleach is performed Identifies the disinfection procedure that is required following a confirmed blood leak Understands the need for Auto Heat, how to activate and set times and dates to the machine Understands the process of integrated heat disinfection of WRO and demonstrates a rationale of practice
Completion of Section G Date: ______________ Mentor _______________________________________ Learner _______________________________________
P a g e | 17
Renal Training and Development Programme
Section H ‐ Vascular Access
Performance Criteria Supervised Assisted CompetentDemonstrates appropriate hand washing / decontamination using ayliffe techniques Demonstrate how to safely connect / assist with connection of patient using aseptic technique with central venous catheter Understands the difference between temporary and permanent lines and anatomy of where they can be placed Assists with neckline insertion Understands and follows the protocol for poor flow / blocked lines Understands and follows the protocol for infected lines Is aware of HII renal care bundle and how it impacts on management of care of the patient Demonstrates competency of line locks and flushes Demonstrates ability to safely complete, disconnect and discontinue dialysis aseptically via CVC Demonstrates and documents effective site care
and observation Has an understanding and knowledge of AVFs / Grafts Assists with connection/disconnection of patient using AVF/Graft Demonstrates ability of safe needling techniques and pre/intra/post dialysis assessment Explains the differences between needling fistula / Graft Explains rope ladder technique / button hole technique Demonstrates competency of needle removal and dressings Explains possible vascular access complications (pre/intra/post dialysis)
P a g e | 18
Renal Training and Development Programme
Completion of Section H Date:
_____________
Mentor _______________________________________ Learner _______________________________________
Section I ‐ Anaemia
Performance Criteria Supervised Assisted CompetentExplains the effects, symptoms and management ofanaemia Has an understanding of Eprex/Aransep and how/why certain doses are prescribed (As per unit protocol) Has an understanding of venofer and how/why certain doses are prescribed (As per unit protocol) Demonstrates a knowledge of unit blood transfusion protocol for dialysis Understands the reasons behind throwing dialysis pack
Completion of Section I Date: ______________ Mentor _______________________________________ Learner _______________________________________
P a g e | 19
Section J ‐ Single Needle Dialysis
Performance Criteria Supervised Assisted CompetentExplains the principles of SNSS Dialysis and double pump dialysis Demonstrates set‐up and priming appropriate with SNSS and double pump dialysis Explains how to set dialysis parameters and ensures accurate stroke volume Locates and explains the value of: 1. Stroke Volume 2. System Pressure Identifies the method by which the machine controls the phase shift during SNSS dialysis Describes the back up systems for the phase shifts Demonstrates safe and effective discontinuation of dialysis Identifies alarms and attention specific to SNSS dialysis
Completion of Section J Date: ______________ Mentor _______________________________________ Learner _______________________________________
Renal Training and Development Programme
P a g e | 20
Section K ‐ Profiling
Performance Criteria Supervised Assisted CompetentExplains the principles of sodium,UF and bicarbonate profiling Locates settings and data relevant to profiling Demonstrates how and when profiling can be activated
Completion of Section K Date: ______________ Mentor
_______________________________________ Learner _______________________________________
Renal Training and Development Programme
P a g e | 21
Section L ‐ BVS
Performance Criteria Supervised Assisted CompetentExplains the purpose of BVS Demonstrate how to confirm that BVS is turned "ON" to enable a self test during the function check Identify when the cuvette can be inserted into the BVS housing Identify the minimum Qb required BVS reading to register Identify the minimum and maximum haemoglobin values required for BVS readings to register Identifies when BVS cannot be used Demonstrate / describe the use of BVS alarm setting Explain what happens if BVS is turned "ON" after treatment has started Demonstrate how to dismount the BVS arterial bloodline with cuvette at the end of treatment
Completion of Section L Date: ______________
Mentor _______________________________________ Learner _______________________________________
Renal Training and Development Programme
P a g e | 22
Renal Training and Development Programme
Section M ‐ Diascan
Performance Criteria Supervised Assisted CompetentBriefly explains the purpose of Diascan Has an understanding of ionic clearan e c Provides a brief definition of the following: 1. K 2. Kt 3. V 4. Kt/V Uses Watsons calculation to calculate a "V" value for each patient in your unit Describe and explain: 1. 1st screen 2. 2nd screen 3. 3rd screen Briefly explains how the machine responds if any of the parameters are altered Discuss problem solving in the event of not achieving desired Kt/V in a single dialysis session/over a period of weeks
Completion of Section M Date: ______________ Mentor _______________________________________ Learner _______________________________________
Section N ‐ On‐line Convective therapies
Performance Criteria Supervised Assisted CompetentGives a clear definition of transport mechanisms involved in HDF/HF Explains the difference between HD/HDF/HF Can explain and give a rationale behind pre v post dilution Demonstrates correct and complete set up of concentrates, dialyser, bloodlines and steriset Demonstrates where to connect steriset on both pre and post dilution Demonstrates knowledge of when/how to connect dialysate fluid tubes and infusion
line to infusion port in HDF/HD Demonstrates how to put in HDF/HF mode Demonstrates correct priming procedure Demonstrates how to work out infusion volume using volume control Demonstrates how to set/use pressure control (ultra control) Demonstrates how to safely set parameters and start UF treatment Identifies and resolves the following problems: 1. Giving a bolus 2. Hypotension 3. System pressure alarm 4. TMP alarm 5. Clotting Dialyser 6. Loss of conductivity Can safely acknowledge end of treatment and prepare circuit for washback Can washback using on‐line fluid or if low conductivity, can washback using bag of saline Can safely disconnect patient and put machine into disinfection
Completion of Section N Date: ______________ Mentor _______________________________________ Learner
P a g e | 23
Renal Training and Development Programme
Section O ‐ Holidays
Performance Criteria Supervised Assisted Competent
Understands booking procedure and when bloods/swabs are to be sent for holiday patient and when to be sent
Completion of Section O Date: ______________ Mentor _______________________________________ Learner _______________________________________
Section P ‐ Transplantation
Performance Criteria Supervised Assisted CompetentKnows when to take appropriate bloods Understands when bloods are needed to be sent and where they are to be sent
Completion of Section P Date: ______________ Mentor _______________________________________
Learner _______________________________________
P a g e | 24
Renal Training and Development Programme
Record of Supervised Practice
Observation of CVC
Management
Date Signature of learner
Signature of observer
1
2
3
4
5
Observation of Exit site care
Date Signature of learner
Signature of observer
1
2
3
4
5
P a g e | 25
Renal Training and Development Programme
Observation of AVF Needling
Date Signature of learner
Signature of observer
1
2
3
4
5
Observation of Graft Needling
Date Signature of learner
Signature of observer
1
2
3
4
5
P a g e | 26
Renal Training and Development Programme
Summary Statement‐ Verification of Staff Competency
The learner identified has met the expected competencies set out in the Registered Nurse Dialysis Competency Level one training pack. The learner has been verified through training and formal assessment as competent in his/her practice and knowledge to undertake renal replacement therapy and the ongoing care of the chronic and acute renal patient.
Name of learner: ____________________________________
Date: ________________________
Signature: ____________________________ (Clinical Practice Development Nurse)
Signature: ____________________________ (Advanced Nurse Practitioner)
P a g e | 27
Renal Training and Development Programme
Acknowledgement
This training pack was devised in May 2008 and has been drawn together from a number of resources within the Wirral Renal Service. Successful training would not be possible without the support and experience of practitioners of all grades within the Haemodialysis Unit. Specific acknowledgement goes to the Practice Development link nurses who assisted in developing the programme and are an ongoing asset to the development and education within the service:
• Lauren Gould • Amanda Robinson • Kate Bonner • Jane Croxford
Further acknowledgement goes to the Gambro training booklet and Sarah Hodson’s initial training booklet from 2003 which provided guidance and an initial resource to compare and make additions to.
A continual focus on mentorship and preceptorship is vital for the development of
new staff and all mentors are thanked for their commitment to training and quality within the Wirral Renal Service.
Marie Bosworth
Clinical Practice Development Nurse
May 2008
P a g e | 28
Renal Training and Development Programme
Recommended Reading List and Sources for Information
You may find the following books and website addresses useful when reading around the subjects discussed in this booklet. Many can be sourced on the renal unit or in the hospital library.
Books
• Oxford Handbook of Dialysis by Jeremy Levy, Julie Morgan and Edwina Brown. (Oxford Handbooks)
• Renal Nursing by Nichola Thomas • Kidney Failure Explained (Third edition) by Dr Andy Stein and Janet Wild • Kidney Dialysis and Transplants‐ the ‘at your fingertips’ guide by Dr Andy
Stein and Janet Wild. • Vital Nephrology by Dr Andy Stein, Janet Wild and Dr P Cook
Websites
• • www.kidney.org.uk • http://www.kidneyschool.org/ • www.homedialysis.org • http://www.aakp.org • www.edren.org • www.cambridge‐transplant.org.uk/