RN Competency Form: PACU

RN Competency Form: PACU

Competence Verification & Learning Guide: Facility

Name (learner) Date Initiated Unit

☐RN ⁯ ☐LPN ⁯ ☐Recent Graduate ⁯ ☐Experienced Nurse ⁯ ☐New to Specialty ⁯ ☐Traveling Nurse ⁯

Note: for LPN practice guidelines, see state nursing statutes & regulations

The preceptor will initial each competency when he/she, as preceptor and colleague, feels safe in allowing the learner to deliver this aspect of care without direct supervision.

Self-Assessment: 1 – Identified Limitation (little or no experience); 2 – Capable (familiar but may need assistance); 3 – Independent - can perform these tasks safely; 4 – Proficient - extensive experience *For further information, see instruction sheet at end of this form.

Learning Guide follows competency pages and contains items for each competency that need to be reviewed based on learner’s experience and unit need, they include reminders of important teaching points that may otherwise be missed.

Self-assessment / Required Competencies
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.) / Verification method
& facility specific requirements
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized / Date all met / Learner initials / Preceptor initials / References / Learning Guide #
IA. The learner will incorporate relevant assessment and intervention (A & I) skills in caring for the intra-operative patient::
Provide for intra-operative safety
check identity/correct site
follows universal protocol
complete accurate sponge, needle and instrument counts
track key times (tourniquet, birth, etc.)
check patient record for completeness and complicating factors
prevent OR complications
coordinate ID and handling of specimens
assist with intraoperative radiology / IA 1
Use PACU equipment per manuals and policy / IA 2
IB. The learner will incorporate relevant A & I skills in caring for the intra/post-operative patient:
Provide systematic & continuous patient assessment
identify changes in patient status promptly
take corrective action as needed / IB 1
Provide care for patient undergoing anesthesia
anticipate assessment findings
intervene for complications / IB 2
Integrate ABG results into care (RN only)
interpret results correctly
act to correct abnormalities / IB 3
Initiate care for patient in respiratory distress or failure
set up for emergency airway
implement relevant protocols consistent with patient status / IB 4
Provide care for intubated patient (RN only)
monitor tolerance (volume, pressure, synchronicity and oxygenation)
maintain patent airway by positioning, suctioning, checking and securing
check ventilator settings & that mode is appropriate for condition
troubleshot alarms to correctly intervene
extubate a patient safely / IB 5
Provide care for client with neurologic crisis per protocols / IB 6
Initiate care of patient with cardiac emergency per protocols / IB 7
Provide care for client with transvenous or transcutaneous pacemaker per policy (RN only)
demonstrate setting rate and sensitivity and stimulation thresholds
identify complications / IB 8
IC. The learner will incorporate relevant A & I skills in caring for the post-operative patient:
Administer IV drips (RN only)
calculate drip rate correctly
titrate drip per orders/need
wean drips per protocols / IC 1
Optimize patient comfort with sedation and pain control as indicated (IVP & PCA dose changes RN only)
evaluate patient using sedation & pain scales
evaluate effectiveness of paralytics
ensure adequate sedation & pain control with paralytic use
administer sedation per protocols
wean meds per pharmacy recommendations and patient tolerance / IC 2
Correlate clinical condition with drug indications, desired effects, dosage and contraindications for commonly given high risk medications / IC 3
Manage care of patient with malignant hyperthermia per protocol - extubate a patient safely / IC 4

Comments/alternative learning plans:

All preceptors are to sign & initial below. Ideally new graduates should have only one to two preceptors for the entire orientation.

Preceptor Signature / Initials / Preceptor Signature / Initials

Signatures at completion of preceptorship/orientation:

Preceptee/learner Date

Primary Preceptor Date

Manager Date

LEARNER GUIDE: Reference content in the right-hand column that needs to review.
IA. The learner will incorporate relevant assessment and intervention (A & I) skills in caring for the intra-operative patient:
IA 1 / Provide for intra-operative safety
- check identity/correct site
- follows universal protocol
- complete accurate sponge, needle and instrument counts
- track key times (tourniquet, birth, etc.)
- check patient record for completeness and complicating factors
- prevent OR complications
- coordinate ID and handling of specimens
- assist with intraoperative radiology / Review all intra-operative policies and procedures
Review OR complication prevention methods:
- dipersive electrocautery pad
- check limb CMS
- assess CV, respiratory, renal and nutritional status
- provide for privacy, warmth, etc.
- properly position, pad, restrain
- protect airway
- minimize distractions
IA 2 / Use PACU equipment per manuals and policy / Review cleaning, storage and troubleshooting of the following equipment: electrocautery, infant warmer and cart, suction curettage, beds/patient positioning devices, autoclave and other sterilizers, ECG, cardiac monitor, bedside and central monitors, cold therapy/elevation, laser, invasive lines including calibration, tubes and drains/expected function
IB. The learner will incorporate relevant A & I skills in caring for the intra-operative patient::
IB 1 / Provide systematic & continuous patient assessment
- identify changes in patient status promptly
- take corrective action as needed / Review assessment concerns for : level of consciousness, airway, cardiac rhythm and effectiveness, fluid balance including bladder distention, neuro assessment, vital signs, pain and nausea, circulation, mobility & sensation checks (extremity pain, pulse, paresthesia, paralysis), dressings and drains, bleeding, fundal checks & massage post C-section, sedation scale, coma scale, temperature control
IB 2 / Provide care for patient undergoing anesthesia
- anticipate assessment findings
- intervene for complications / Review expected effects, risks and reversal agents for all commonly used general, regional, epidural, spinal, local, nerve block & MAC anesthetic agents
Review teaching/communication techniques for children
Review age specific response for elders and pediatrics
IB 3 / Integrate ABG results into care (RN only)
- interpret results correctly
- act to correct abnormalities / Review ABG norms and interpretation of changes
Complete checklist for drawing ABGs if applicable
IB 4 / Initiate care for patient in respiratory distress or failure
- set up for emergency airway
- implement relevant protocols consistent with patient status / Review policies, procedures and equipment for emergency respiratory management
Review emergency airways: ETT, cricothyrotomy, tracheostomy
For peds, review equipment size differences, lung volumes, pediatric code management
IB 5 / Provide care for intubated patient (RN only)
- monitor tolerance (volume, pressure, synchronicity and oxygenation)
- maintain patent airway by positioning, suctioning, checking and securing
- check ventilator settings & that mode is appropriate for condition
- troubleshot alarms to correctly intervene
- extubate a patient safely / Review ventilator and intubation protocols, equipment, standing orders, and troubleshooting
Review initiation and indications for jet vent if applicable
Review SVO2 monitoring, set up and data analysis if done in unit
IB 6 / Provide care for client with neurologic crisis per protocols / Review measures to decrease intracranial pressure, seizure and stroke management
IB 7 / Initiate care of patient with cardiac emergency per protocols / Review the following unit protocols
- initial chest pain management
- dysrhythmias
- significant BP change
- CHF or pulmonary edema
- cardiogenic shock
- cardiac arrest
- code cart management
IB 8 / Provide care for client with transvenous or transcutaneous pacemaker per policy (RN only)
- demonstrate setting rate and sensitivity and stimulation thresholds
- identify complications / Review equipment, manufacturers recommendations, safety considerations, how to operate the pacer, pacing modes
Review complications: failure to pace, failure to sense, failure to capture, dysrhythmias, burns & pain (with transcutaneous)
IC. The learner will incorporate relevant A & I skills in caring for the post-op patient:
IC 1 / Administer IV drips (RN only)
- calculate drip rate correctly
- titrate drip per orders/need
- wean drips per protocols / Review all related policies, protocols and standing orders for commonly used IV drips.
IC 2 / Optimize patient comfort with sedation and pain control as indicated (IVP & PCA dose changes RN only)
- evaluate patient using sedation & pain scales
- evaluate effectiveness of paralytics
- ensure adequate sedation & pain control with paralytic use
- administer sedation per protocols
- wean meds per pharmacy recommendations and patient tolerance / Review sedation and pain scales and interventions including emergency equipment standby
Review use of and interpretation of results from peripheral nerve stimulator
Review policy for moderate sedation and complete any facility required training and/or checklists
IC 3 / Correlate clinical condition with drug indications, desired effects, dosage and contraindications for commonly given high risk medications / Review the following medications: dopamine, dobutamine, norepinephrine, epinephrine, nitroglycerine, nitroprusside, diltiazem, lidocaine, amiodarone, thrombolytics, procainamide, potassium, aminophylline, heparin, insulin, octreotide
IC 4 / Manage care of patient with malignant hyperthermia per protocol - extubate a patient safely / Review protocol
Other facility specific items to cover:

REQUIREMENTS: All nurses will complete these competencies upon hire. Some competencies may be reviewed annually. This form follows the Competency Outcomes and Performance Assessment (COPA) model.

PRECEPTEE/LEARNER INSTRUCTIONS:

Complete self-assessment: Rate your skill in each area to identify the areas where you need additional experience, access to teaching resources, and/or lab practice. Discuss your results with your preceptor to help establish a plan and goals for your learning experience and to aid in choosing patient assignments. Scoring per instructions at the top of page 1.

PRECEPTOR INSTRUCTIONS:

A. Review self-assessment with preceptee/learner to establish plan.

B. Required Competencies: The specialty area competency forms are required for independent practice on this unit. This column represents the Alaska Statewide required competencies per ACE-HC and should not be altered. The preceptor will sign each one off when he/she, as preceptor and colleague, feels safe in allowing the preceptee/learner to deliver this aspect of care without direct supervision.

C. Verification Method & Agency Specific. Document comments/check marks for the competency and any agency specific requirements. Verification methods include:

1. Demonstration – Preceptor watches learner perform task/procedure in safe, capable manner in a simulated lab or computer setting or as part of direct care performance. The expectation for new graduates is that they demonstrate as many of the competencies as possible.

2. Test – Learner passes a test provided by the facility to measure competence for this skill. (Minimum passing grade indicated. Initial only after test passed.)

3. Module –Learner has completed a training tool (computerized or written module, class, video, etc.) provided by the facility to measure competence for this skill.

4. Verbalization - Learner explains to the preceptor the process and/or planning that evidences safe, reliable knowledge base. This may include case scenarios, discussion, and/or description of plan.

NOTE: some competencies may have the verification method specified per facility guidelines (e.g. “test only”)

Record N/A and initials only for items that never apply to this learner’s role or performance.

D. Sign-off: Sign and date when all elements of the competency are met. If unable to sign off an area due to patient population issues or learner needs more time, document a plan in the comments section at the end of the form. Discuss alternative ways of meeting the requirement(s) as well as any additional time needed with the nurse manager and/or nurse educator. All preceptors assisting in orientation of a new staff member/intern must sign and initial in the signature chart at the end of this document.

E. References: Competencies should be met in accordance with these. Add your facility approved references here.

F. Learning Guide: These are memory ticklers. The amount of time spent on each of them depends on the learner’s experience. New graduates will likely need time on almost all of the areas listed.

REFERENCES COLUMN: List foundational documents to support the learning experience and to use as the official measure by which the competencies are assessed. The ACE-HC group recognizes the following as sources for evidence based practice that can be included in the reference list along with local policies, procedures and forms: Perry & Potter, Elsevier/Mosby, Lippincott, Kozier & Erb, ANA, nationally recognized hospital related regulatory organizations (CLIA, CDC, CMS, JC, etc.), and specialty nursing organizations’ scope, standards and core curricula. This column’s content may be changed to be facility specific.

NOTE: ACE-HC competency forms are intended to be used between facilities within Alaska.

Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.

Page 1