Competency Assessment in Oral Suction

Name:
Clinical Assessment Area (s) :
Name of Assessor:
Assessment Date:
Competency criteria / Competency level / Comments /
recommendations
1 / 2 / 3 / 4 / 5 / 6
1. Can locate and demonstrateawareness of their employers policies relevantto Oral suction
See appendix 1 Professionals Only
2. Can demonstrate an assessment of thechild’s respiratory system
See appendix 2
3. Can understand the reasons for oral suction completion
See appendix 3
4. Can demonstrate an understandingof the hazards of oral suction
See appendix4
6. Can demonstrate the correct procedurefor carrying out oral suction
Appendix 5OSCE assessment
7. Carer to understand and demonstrate actions to be taken aftersuction
See appendix 6
8. Can demonstrate an understanding of theneed to escalate care as appropriate
See appendix 7

Competence Level - Key

  • Competence Level 1 – Has observed this activity
  • Competence Level 2 – Has been involved in this activity with the support and assistance of experience professionals (Maximum level of competence for 3rd yr student nurse until assessed as competent)
  • Competence Level 3 - Can perform this activity satisfactorily without the need for supervision or assistance (Maximum level of competence for parents, carers and non-medical professionals)
  • Competence Level 4 –(Professionals only) can perform this activity satisfactorily in a timely manner
  • Competence Level 5 –(Professionals only)can perform this activity, safely, in a timely manner while showing initiative and flexibility in response to the child and families needs
  • Competence Level 6–(Professionals only) can perform this activity safely, in a timely manner, whilst responding to the needs of the child and family. Can lead and supervise others in performing this activity (Minimum level of competence for all assessors)

Declaration

  • This competency assessment tool is to be used in conjunction with the NMC and CSP Code of Conduct
  • Competency Level requirements are indicated for both qualified and unqualified staff
  • For the practitioner / learner to be deemed competent – the indicated level must have been consistently achieved
  • Once competence has been achieved a record of the training and assessment must be documented and logged
  • Competency assessment must be reviewed annually
  • Practitioners are reminded that they should not attempt to carry out tasks which they are not competent or confident to do

Carers/ Parents Only

This competency is for Child ______only

This competency certifies Parent/ Carer: ______

I the above named Carer / Parent certify that I am able to carry out the above procedure within the competencies detailed.

  • I understand the scope of these competencies
  • I will only use this training in respect of the child specifically named on the front of this form
  • I will not carry out procedures, which are contrary to or not covered by this training
  • I will seek further training if I have any concerns about my competency and in any event six weeks before the expiry date on the front of this form renew my training
  • Upon the date of expiry of this competency, if my training has not been renewed, or if I have concerns about my competency, I will discontinue undertaking the procedure detailed in this document and seek appropriate advice from a suitably qualified clinician and or my employer
  • I am aware that is my responsibility to ensure that I access appropriate training and updates as required by my employer or as agreed with my employer in order for me to continue to operate within these competencies

Verification of Competence

•I confirm that the individuals above have been assessed as competent at level 3 in carrying out oral suction on

Guidance notes

Appendix 1

For Professionals only with access to the Trust Intranet.

The Practitioner has an awareness of policies and guidance relevant to oral suction, including the infection prevention and control policy (C15), consent policy(C7), hand hygiene policy (C14), oxygen prescribing and administration in hospital guideline, Paediatric Early Warning Policy (C40) and resuscitation policy (C23).

Appendix 2

Assessment of the child and young person (CYP) includes

  • Colour
  • Respiratory rate and pattern
  • Signs of respiratory distress
  • Heart rate
  • Chest expansion
  • Palpation
  • SpO2
  • Effectiveness of cough
  • Pallor
  • Cyanosis
  • Irritability
  • Panic
  • Recession

(Carroll, (1994);Glass, C.A. & Grapp, M.J., (1995);Husband, S. & Trigg, E., (2005)).

Appendix 3

The Practitioner should discuss the following indications for suction:

  • Decreased SpO2 or change in colour due to oral secretions
  • Increased work of breathing due to secretions in mouth
  • Child continuously coughing
  • Inability to clear secretions from mouth
  • Vomiting without good swallow
  • Visible secretions in mouth causing distress

Appendix 4

Hazards associated with oral suction include

  • Loose teeth
  • Choking
  • Bleeding
  • Vomiting
  • Aspiration

Appendix 5 See OSCE below

Appendix 6

  • Assessment and reassessment of child or YP
  • Ensure CYP is comfortable
  • Restock equipment
  • Cleaning and charging of equipment
  • Disposing of waste appropriately

Appendix 7

Further interventions may be necessary and the practitioner should refer the child YP for medical review, or to A&E in an emergency.

Appendix 5

OSCE – Oral suction
Please greet the student and give him/her the following instructions:
“This patient requires oral Suctioning. Please go ahead and do so” / Performed adequately or completely / Attempted but incomplete or inadequate / Not
attempted
Introduces self and explains procedure to patient/parent / 1 / 0.5 / 0
Demonstrates a basic respiratory assessment / Colour, respiratory pattern and rate and saturations if appropriate / 1 / 0.5 / 0
Switches suction on and checks all connections are secure and suction pressure is correct / 150mmHg/ 20KPa / 1 / Fail / Fail
Position patient appropriate to age and condition of child YP / 1 / 0.5 / 0
Describes the procedure appropriate for the child YP’s age and level of comprehension. Awareness shown of psychological impact and encourages involvement if appropriate. / 1 / 0.5 / 0
States need to wash hands before the procedure / 1 / 0.5 / 0
Attaches the yankauer suction cathether and demonstrates how to apply the suction / N.B smaller yankauer have a hole which needs covering for suction pressure to be achieved / 1 / 0.5 / 0
Places the yankaeur catheter appropriately inside the oral cavity without touching the tongue or back of the mouth and applies suctioning on removal / N.B. only possible with smaller yankauer catheter / 1 / 0.5 / 0
Demonstrates the limitation of yankauer suctioning and when to consider nasal suctioning if competent to do so and when to ask for help / Will recognise limitations and when to seek help/advice (Husband, S. & Trigg, (2005) / 1 / 0.5 / 0
Monitor child’s condition for complications of suction throughout procedure, and acts appropriately / Will recognise limitations and when to seek help/advice / 1 / 0.5 / 0
At the end of the procedure flushes suction tubing with water and switches off suction equipment. / 1 / 0.5 / 0
States need to wash hands at the end of the procedure / 1 / 0.5 / 0

On completion, ask: Give one extra mark for each question

What are the indications for Yankauer suction? / Secretions in the buccal space after coughing. Poor oromotor control, difficulty removing secretions or vomit by mouth movement or swallowing. Mouthcare.
What are the complications Yankauer suction? / Trauma, vomiting, pain, gagging, loosen teeth and distress
Pass Mark / Needs further practice comments / Score and signature
15/20 / /20

References

Carroll, P. (1994). Safe Suctioning prn. Registered Nurse. 57 (5), 0033-7021.

Glass, C.A. and Grapp, M.J. (1995) Ten Tips for Safer Suctioning. AJN. 96 (5), 51-53.

Husband, S. & Trigg, E. (Eds). (2005). Practices in Children’s Nursing Guidelines for Hospital and Community. Churchill Livingstone.

Leanne Turner, Jennifer Bayliss Updated January 2016

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