Chapter 3C Specialty Nursing Competencies Kookaburra Ward

Transcription

1 Chapter 3C pecialty Nursing Competencies ookaburra Ward Nursing Competency Workbook, 10 th Edition RCH Nursing Competency Workbook Chapter 3 Page 1

2 The Royal Children's Hospital (RCH) Nursing Competency Workbook is a dynamic document that will provide you with direction and assist you in your professional development as a nurse working at the RCH. The workbook also provides a record of your orientation and competency obtainment. Chapter 1 Includes resources for nurses and is complemented by the Royal Children s Hospital (RCH) New tarter Pack, Hospital Orientation and Nursing Orientation day, to provide an introduction to nursing at the RCH. Chapter 2 Generic Nursing Competency Assessment Forms Chapter 3 pecialty Nursing Competency Assessment Forms Appendix 1 Unit / Department Nursing Orientation All chapters and appendices are downloadable as pdfs from the Nursing Education Website. The RCH Nursing Competency Workbook developed by Nursing Education with input from specialist nurses at the RCH. For further information contact: Melody Trueman Director, Nursing Education T: (03) E: melody.trueman@rch.org.au Workbook Edition 10 January 2018 RCH Nursing Competency Workbook Chapter 3

3 Table of Contents Blood ampling from Central Venous Access Devices 1 Bone marrow aspirates and Lumbar Punctures (Oncology) 2 Chemotherapy (intramuscular administration) 3 Chemotherapy (intrathecal administration) 4 Chemotherapy (intravenous infusion) 5 Chemotherapy (intravenous push) 6 Chemotherapy (Management & upportive Care Theory) 7 Chemotherapy (oral administration) 8 Chemotherapy (afe handling) 9 Chemotherapy (subcutaneous administration) 10 Central Venous Access Device (Blocked) 11 Febrile Neutropenia 12 Hickman Catheter Removal 13 Infusion of Cryopreserved Haemopoietic Progenitor Cells (HPC) - Oncology 14 Infusion of Fresh Haemopoietic Progenitor Cells (HPC) - Oncology 15 Mucositis (Oncology) 16 Nutrition (Parenteral) 17 Pain (Analgesia Infusion) 18 Pain (Patient Controlled Analgesia) 19 Potassium Infusion (Oncology) 20 Procedural edation Nitrous Oxide competency skill 21 Procedural edation Nitrous Oxide competency theory 23 ubcutaneous Catheter devices management (Infusion and BD at-t-intima ) 25 Competency Feedback & Reflection 2526 RCH Nursing Competency Workbook Chapter 3

4 Blood ampling from Central Venous Access Devices ALERT: The Central Venous Access Device Management Competency should be completed prior to or in conjunction with this competency Competency tatement: The nurse can safely and effectively collect a blood sample from a central Venous Access Device (CVAD) 1. Describe the circumstances when bloods might need to be taken from a CVAD 2. Identify a. blood tests frequently taken from CVADs b. tubes required for tests identified above c. volumes required 3. Discuss when gloves would be worn for blood sampling from CVADs and why 4. Discuss safe handling procedures of blood specimens 5. Discuss the correct size syringe to take blood from a CVAD 6. Discuss, with regards to discarding blood: a. When a volume of blood should be discarded prior to the blood specimen being collected and why b. How much blood should be discarded c. In what circumstances a discard sample would be returned to the patient 1. Demonstrate education of the patient / family / carer regarding blood collection from a CVAD 2. Demonstrate correct completion of Pathology Collection from the EMR worklist 3. Assemble correct equipment for the collecting a blood specimen from a CVAD 4. Demonstrate the procedure for taking blood from a single lumen CVAD 5. Demonstrate the procedure for taking blood from a multi lumen CVAD 6. Demonstrate correct labelling of blood specimens 7. Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 1

5 Bone Marrow Aspirates and Lumbar Punctures (Oncology) Competency tatement: The nurse will safely and effectively care for a child with cancer requiring a bone marrow aspirate or lumbar puncture 1. Define: a. Bone Marrow Aspirate (BMA) b. Lumbar Puncture (LP) 2. Discuss the reasons for BMA and LP being performed on children with cancer 3. Discuss pre BMA and LP blood tests and range required in order for BMA or LP to proceed 4. tate potential complications and management of: a. BMA b. LP 5. Discuss required observations of patients post BMA or LP 6. Outline key considerations in the Intrathecal administration of drugs 1. Demonstrate location of most common site chosen for performing BMA and LP, including application of local anaesthetic cream 2. Demonstrate preparation of the patient for a a. BMA b. LP 3. Demonstrate education of the family regarding BMA and LP 4. Demonstrate the correct completion of the Theatre pecial request order set Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 2

6 Chemotherapy (intramuscular administration) ALERT: The nurse must have completed the medication administration, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer chemotherapy via intramuscular injection RCH References: RCH Intranet Clinical Management Guidelines: Cytotoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the cytotoxic agents to be administered 4. Outline the pre- chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of cytotoxic agent via intramuscular injection 8. Outline necessary monitoring of patient during / following administration of cytotoxic agents via intramuscular injection 1. Establish a safe work environment 2. Demonstrate the anatomical correct location for preforming an intramuscular injection 3. Demonstrate correct process to confirm accuracy of order on the Treatment Plan 4. Demonstrate the release of chemotherapy from the Treatment Plan, where applicable 5. Demonstrate application of principles of safe handling in administration of cytotoxic agent via intramuscular injection 6. Demonstrate safe disposal of equipment used in administration of a cytotoxic agent via intramuscular injection Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 3

7 Chemotherapy (intrathecal administration) ALERT: The nurse must have completed the medication administration, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse safely and effectively assists in the administration of intrathecal chemotherapy RCH References: RCH Intranet Clinical Management Guidelines: Cytotoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. List the drugs that are administered intrathecally in the treatment of cancer 4. Discuss the dose calculation for cytotoxic agents administered intrathecally 5. Identify the cytotoxic agents to be administered 6. Outline the pre-chemotherapy investigations required for the particular cytotoxic agents being administered 7. Recall potential side effects and management of the cytotoxic agents being administered 8. Discuss antiemetic coverage required for cytotoxic agent being administered 9. Discuss principles of administration of intrathecal cytotoxic agent 10. Outline necessary monitoring of patient during / following administration of intrathecal cytotoxic agents 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order on the Treatment Plan 3. Demonstrate application of principles of safe handling in assisting in the administration of intrathecal cytotoxic agent 4. Demonstrate safe disposal of equipment used in administration of an IT push of a cytotoxic agent Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 4

8 Chemotherapy (intravenous infusion) ALERT: The nurse must have completed the medication administration, intravenous cannula management (peripheral), CVAD management, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer chemotherapy via intravenous infusion RCH References: RCH Intranet Clinical Management Guidelines: Cytotoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the cytotoxic agents to be administered? 4. Outline the pre-chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of cytotoxic agents via IV infusion 8. Identify classification of cytotoxic agents being administered as non-irritants, irritants or vesicants 9. Discuss management of cytotoxic drug extravasation 10. Outline necessary monitoring of patient during / following administration of cytotoxic agents via IV infusion 11. Demonstrate the release of chemotherapy from the Treatment Plan, where applicable 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order from the Treatment plan 3. Demonstrate application of principles of safe handling in administration of cytotoxic agent via IV infusion 4. Demonstrate safe administration of an irritant or a vesicant agent as an IV infusion 5. Demonstrate safe disposal of equipment used in administration of an IV infusion of a cytotoxic agent Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 5

9 Chemotherapy (intravenous push) ALERT: The nurse must have completed the medication administration, intravenous cannula management (peripheral), CVAD management, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer chemotherapy via intravenous push RCH References: RCH Intranet Clinical Management Guidelines: Cytotoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the cytotoxic agents to be administered 4. Outline the pre chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of cytotoxic agent via IV push 8. Identify classification of cytotoxic agents being administered as non-irritant, irritant or vesicant 9. Discuss management of cytotoxic drug extravasation 10. Outline necessary monitoring of patient during / following administration of cytotoxic agents via IV push 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order from the Treatment Plan 3. Demonstrate the release of chemotherapy from the Treatment Plan, where applicable 4. Demonstrate application of principles of safe handling in administration of cytotoxic agent via IV push 5. Demonstrate safe administration of an irritant or a vesicant agent as an IV push 6. Demonstrate safe disposal of equipment used in administration of an IV push of a cytotoxic agent Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 6

10 Chemotherapy (Management & upportive Care Theory) ALERT: This competency is required for all nurses who care for a child receiving or who has received chemotherapy Competency tatement: The nurse has the requisite knowledge to provide supportive care to a patient receiving cytotoxic therapy. RCH References: RCH Intranet Clinical Management Guidelines: Cytotoxic drugs The management of 1. Locate and read the references related to this competency 2. Identify resources available to access for information regarding cytotoxic agents (drug information and supportive care) 3. Describe the key elements of the Treatment Plan Outline the pre chemotherapy investigations required 4. Discuss side effects of administered cytotoxic agents 5. Outline management for potential immediate side effects 6. Outline supportive care and management for potential long term side effects 7. ummarise antiemetic options for the patient receiving cytotoxic agents. 8. Discuss nursing precautions, care and monitoring for a patient receiving chemotherapy including a. monitoring of urine output b. pre and post hydration c. line set up d. observations e. other medications (e.g. mesna, folinic acid) 9. Identify relevant tests patient may require whilst receiving cytotoxic agents 10. Discuss the management of cytotoxic drug extravasation 11. ummarise family understanding of treatment being delivered and areas for education Not Applicable 12. Demonstrate the release of chemotherapy from the Treatment Plan, where applicable Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 7

11 Chemotherapy (oral administration) ALERT: The nurse must have completed the medication administration, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer oral chemotherapy RCH References: RCH Intranet Clinical Management Guidelines: Cytotoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the oral cytotoxic agents to be administered? 4. Outline the pre chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of oral cytotoxic agents 8. Outline the necessary monitoring of patient during / following administration of oral cytotoxic agents 9. Discuss the particular fasting/ dietary requirements when administering an oral cytotoxic agent (if applicable) 10. Establish a safe work environment 11. Demonstrate correct process to confirm accuracy of order 12. Demonstrate application of principles of safe handling in administration of oral cytotoxic agents 13. Demonstrate safe disposal of equipment used in administration of oral cytotoxic agents Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 8

12 Chemotherapy (afe handling) ALERT: This competency is required for all nurses who care for a child receiving or who has received chemotherapy Competency tatement: The nurse safely and effectively handles cytotoxic agents and disposes of cytotoxic waste. RCH References: RCH Intranet Clinical Management Guidelines: Cytotoxic drugs The management of 1. Locate and read the references related to this competency 2. Discuss safe transport and storage of cytotoxic agents from pharmacy to patient 3. Demonstrate set up of a safe working environment 4. Discuss correct use of personal protective equipment (PPE) required to a. administer cytotoxic agents b. dispose of cytotoxic waste i. equipment ii. excess cytotoxic agents iii. contaminated lined and clothing iv. patients personal waste (vomit, urine, faeces and blood) 5. tate action required if personal contamination with a cytotoxic agent occurs 6. Outline correct procedure to manage a cytotoxic spill 7. Discuss safe management/disposal of cytotoxic waste a. equipment b. excess cytotoxic agents c. contaminated linen and clothing d. patients personal waste (vomit, urine, faeces and blood) 8. ummarise information provided to children and families in regards to safe handling, including resources available Not Applicable Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 9

13 Chemotherapy (subcutaneous administration) ALERT: The nurse must have completed the medication administration, Chemotherapy (management supportive care theory) and Chemotherapy (safe handling) competencies prior to completion of this competency Competency tatement: The nurse will safely and effectively administer chemotherapy via subcutaneous injection RCH References: RCH Intranet Clinical Management Guidelines: Cytotoxic drugs The management of 1. Locate and read the references related to this competency 2. tate the child s diagnosis and treatment protocol 3. Identify the cytotoxic agents to be administered? 4. Outline the pre-chemotherapy investigations required for the particular cytotoxic agents being administered 5. Recall potential side effects and management of the cytotoxic agents being administered 6. Discuss antiemetic coverage required for cytotoxic agent being administered 7. Discuss principles of administration of cytotoxic agent via subcutaneous injection 8. Outline necessary monitoring of patient during / following administration of cytotoxic agents via subcutaneous injection 9. Discuss the use and management of Insuflons in the administration subcutaneous cytotoxic agents 1. Establish a safe work environment 2. Demonstrate correct process to confirm accuracy of order from the Treatment Plan 3. Demonstrate application of principles of safe handling in administration of cytotoxic agent via subcutaneous injection 4. Demonstrate safe disposal of equipment used in administration of a subcutaneous injection of a cytotoxic agent Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 10

14 Central Venous Access Device (Blocked) ALERT: The Central Venous Access Device Management Competency should be completed prior to this competency Competency tatement: The nurse can safely attempt to unblock a central venous access device (CVAD) RCH References: RCH Intranet Clinical Management Guidelines: Anticoagulation Therapy 1. Locate and read the references related to this competency 2. List possible causes of CVAD occlusion 3. Discuss CVAD management to minimise the risk of occlusion 4. Describe a Fibrin heath? 5. Discuss rationale for syringe size selection in flushing CVADs 6. Discuss the steps to be taken in attempting to unblock a CVAD that has a. A blood related blockage b. A chemical related blockage 7. tate the length of time TPA should be left in the line 8. tate the documentation / communication required to alert others that TPA is in the line 9. Describe the potential side effects of TPA and HCl 10. Discuss management of a blocked CVAD in which initial attempts to clear the blockage have failed 1. Demonstrate the procedure to unblock a CVAD with TPA or HCI. Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 11

15 Febrile Neutropenia Competency tatement: The nurse will safely and effectively care for a patient with Febrile Neutropenia RCH References: RCH Intranet Clinical Management Guidelines: Febrile Neutropenia; epsis Assessment & Management 1. Locate and read the references related to this competency 2. tate the normal values a. Haemoglobin b. Platelets c. White Blood count d. Neutrophils 3. Describe the function of neutrophils 4. Define the term febrile neutropenia 5. Discuss the observations required during an admission for neutropenia 6. Discuss the actions to be taken where observations are outside the normal range for the child s age 7. Discuss the use of paracetamol and Ibuprofen in the care of children who have febrile neutropenia 8. Explain the rationale for the following investigations a. Blood cultures b. wabs nose/ mouth / throat / CVAD c. Urine MC& d. tool pecimen e. Cross match 9. Explain which blood cultures need to be taken and how much blood you would take for a child weighing 20kg who has just presented with a fever. 10. Discuss CVAD line set up for administration of antibiotics for the child with febrile neutropenia 11. Discuss the management of suspected febrile neutropenia on presentation to emergency 12. Discuss the management provided in the first 72 hours of admission for febrile neutropenia 13. tate the antibiotics and dosages used as first line treatment for febrile neutropenia. 14. tate the expected timeframe that the first dose of antibiotics should be given, and why 15. Discuss treatment options for patients with unresolved fever after 72 hours 16. tate the signs and symptoms of septic shock 17. Identify potential sources/portals/causes of infection in patients with neutropenia and discuss ways to minimise the risk 18. List ways in which staff, parents and children can help prevent infection 1. Demonstrate collection of blood cultures from a Central Venous Access Device 2. Demonstrate education of children and families about neutropenia 3. Describe the key points that you would educate a family about febrile neutropenia. Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 12

16 Hickman Catheter Removal Competency tatement: The nurse safely and effectively removes a Hickman Catheter 1. Discuss reasons for Hickman Catheter removal 2. Discuss strategies to minimise pain and distress during Hickman Catheter removal 3. Describe the steps in removing a Hickman Catheter a. sterile field b. Location of cuff c. Removal of stitches (if applicable) d. Pulling on Hickman catheter e. Pressure to neck scar f. Dressing 4. Discuss the correct positioning of the patient during the removal of the Hickman Catheter 5. Describe observation and monitoring of patient post removal of Hickman Catheter 6. Discuss the education required by the family prior to discharge 1. Demonstrate preparation of the child and family for the removal of a Hickman Catheter a. Explanation of i. reason for removal ii. the process of removal iii. post removal care, b. Assemble required equipment c. Revise results of investigations to ascertain findings are within range for Hickman Catheter removal 2. Demonstrate removal of a Hickman Catheter Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 13

17 Infusion of Cryopreserved Haemopoietic Progenitor Cells (HPC) - Oncology ALERT: The nurse must have completed the CVAD Management competency prior to completion of this competency Competency tatement: The nurse will safely and effectively administer cryopreserved haemopoietic progenitor cells (HPC) via intravenous infusion. RCH References: RCH Intranet Children s Cancer Centre - Haematopoietic tem Cell Transplant (HCT) Program Documents: Infusion of Cryopreserved Haemopoietic Progenitor Cells Clinical Work Instruction CL-W-001; Transplantation of Cryopreserved Haemopoietic Progenitor Cells Clinical Procedure CL-P-001; Adverse Reactions Associated with Haemopoietic Progenitor Cell Infusion Clinical Work Instruction CL-W Locate and read references related to this competency 2. Discuss the actions required the day prior to and the morning of the cryopreserved HPC infusion including a. Communication with the Cell Therapy and Flow Cytometry laboratory b. Orders required for premedication, IV hydration and cryopreserved HPC product c. Recipient Cross Match 3. Identify premedications required prior to infusion of cryopreserved HPC and administer as prescribed 4. Identify hydration fluids required prior to and after infusion of a cryopreserved HPC product and administer as prescribed 5. Discuss the nursing care required post the HPC infusion 6. Outline a. urine testing requirements & output b.monitoring for delayed reactions 7. Discuss the adverse reactions associated with HPC infusion and identify the documentation and actions required for a a. mild reaction b. moderate to severe reaction c. late reaction 8. Outline the education required for the patient and family undergoing a cryopreserved HPC transplantation 1. Demonstrate correct set up of IV lines and outline a. line required for HPC infusion (do not prime with HPC product) b. additional Normal aline line 2. Demonstrate the patient monitoring required prior, during and post the cryopreserved HPC infusion (including presence of medical staff) 3. Demonstrate releasing the HPC product from the Blood flowsheet 4. Perform positive patient ID, donor ID and HPC product checks according to clinical procedure 5. Demonstrate the correct procedure for administrating a cryopreserved HPC product via a IV line 6. Outline a. which blood filter to be used b. fluids that may run with HPC infusion c. amount of HPC product to infuse initially d. wait time required before proceeding with rest of HPC infusion (restart IV fluids to prevent blockage) e. recommended infusion times of HPC 7. Demonstrate patient and family education regarding receiving a HPC product and expected nursing care Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 14

18 Infusion of Fresh Haemopoietic Progenitor Cells (HPC) - Oncology ALERT: The nurse must have completed the CVAD Management competency prior to completion of this competency Competency tatement: The nurse will safely and effectively administer fresh haematopoietic progenitor cells (HPC) via intravenous infusion RCH References: RCH Intranet Children s Cancer Centre - Haematopoietic tem Cell Transplant (HCT) Program Documents: Infusion of Fresh Haemopoietic Progenitor Cells Clinical Work Instruction CL-W-002; Transplantation of Fresh Haemopoietic Progenitor Cells Clinical Procedure CL-P-002; Adverse Reactions Associated with Haemopoietic Progenitor Cell Infusion Clinical Work Instruction CL-W Locate and read references related to this competency 2. Discuss the actions required the day prior to and the morning of the fresh HPC infusion including a. Communication with the Cell Therapy and Flow Cytometry laboratory b. Orders required for premedication, IV hydration and fresh HPC product c. Recipient Cross match 3. Identify premedications required prior to infusion of fresh HPC and administer as prescribed for a. ABO identical or group compatible HPC product b. Minor ABO mismatch HPC product c. Major ABO mismatch HPC product 4. Identify hydration fluids required prior to and after infusion of a fresh HPC product and administer as prescribed for a. ABO identical or group compatible HPC product b. Minor ABO mismatch HPC product c. Major ABO mismatch HPC product 5. Discuss the nursing care required post the fresh HPC infusion and outline a. urine testing & output b. monitoring for delayed reactions 6. Discuss the adverse reactions associated with fresh HPC infusion and identify the documentation and actions required for a a. mild reaction b. moderate to severe reaction c. late reaction 7. Outline the education required for the patient and family undergoing a fresh HPC transplantation 1. Demonstrate correct set up of IV lines and outline a. Line required for HPC infusion (do not prime with HPC product) b. Additional Normal aline line 2. Demonstrate the patient monitoring required prior, during and post the fresh HPC infusion (including presence of medical staff) for a. ABO identical or group compatible HPC product b. Minor ABO mismatch HPC product c. Major ABO mismatch HPC product 3. Demonstrate releasing the HPC product from the Blood flowsheet 4. Perform positive patient ID, donor ID and HPC product checks according to clinical procedure 5. Demonstrate the correct procedure and increasing of the infusion rate for administrating a fresh HPC product via an IV line and outline: a. Which blood filter to be used b. Which fluids that may run with HPC infusion c. infusion rate at commencement of HPC infusion d. recommended infusion times of HPC product & use of frusemide. Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 15

19 Mucositis (Oncology) Competency tatement: The nurse safely and effectively cares for a child with cancer at risk of or with mucositis RCH References: RCH Clinical Practice Guidelines: Mouth Care Oral Care of the paediatric oncology patient and haematopoietic stem cell transplant patient; Perianal care for the paediatric oncology patient 1. Locate and read the following clinical practice guidelines a. oral hygiene for haematology oncology children b. perianal care for the paediatric oncology patient 2. Define Mucositis 3. Discuss potential causes of Mucositis for children with cancer 4. Discuss the signs and symptoms the patient may present with when experiencing mucositis 5. Discuss the Oral Assessment Guide score 6. Discuss oral hygiene measures to reduce the risk of infection/ complications in a patient with oral mucositis 7. Discuss management to reduce the risk of infection/ complications in a patient with perianal mucositis 8. Discuss the nursing and medical management of a patient with mucositis a. Oral b. Gastrointestinal c. Perineal d. Pain relief 9. Discuss the link between recovering neutrophil count and resolution of mucositis 10. Discuss why children brush their teeth with fluoride toothpaste in the evening 1. Demonstrate assessment of a patient s mouth and accurate documentation of results in the notes 2. Demonstrate assessment of a patient s perineum and accurate documentation of results in the notes or under kin inspection in Focused Assessment 3. Demonstrate discussion with children / parents regarding mucositis and care including care at home Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 16

20 Nutrition (Parenteral) ALERT: The CVAD management competency should be completed in conjunction with this competency Competency tatement: The nurse safely and effectively administers Parenteral Nutrition RCH References: RCH Clinical Practice Guideline Nursing: Parenteral Nutrition Element Exemptions: oala and Cancer Care Unit (6a-b and 2b) 1. Locate and read the references related to this competency 2. tate the general indications for use of PN 3. Identify members of the multidisciplinary team involved in the care of this patient group, including each member s role 4. Identify at least five components which can be found in the PN solution 5. tate the ideal IV access for patients receiving a. Low dextrose nutrient solutions b. High dextrose nutrient solutions 6. Discuss the differences between hospital PN & Baxter PN for the following a. Fluid prescription and documentation b. Preparation & administration 7. Discuss the ongoing care requirements and management of patients receiving PN a. commencing b. ceasing c. weaning d. frequency of monitoring: i. Bloods ii. Urine iii. Weight iv. CVAD v. Documentation 8. Discuss how to administer non-compatible IV antibiotics to a patient receiving high dextrose PN solution 9. Discuss the correct action to be taken in the event that the nutrient solution finishes prior to the next bag being delivered from pharmacy 13.tate the maximum amount of potassium to be placed in a PN bag 1. Demonstrate checking of IV medication compatibility with PN prior to medication administration 2. Demonstrate IV line assembly & priming for the patient receiving a. Hospital PN olution b. Baxter PN olution 3. Demonstrate programming of IV pumps for all stages of weaning on & off PN 4. Demonstrate adjustment of rates in the fluid balance flowsheets Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 17

21 Pain (Analgesia Infusion) Competency tatement: The nurse will safely and effectively administer analgesia infusions RCH References: RCH Intranet Anaesthesia & Pain Management Pain Management Guidelines: Opioid Infusion; etamine Infusion 1. Locate and read the references related to this competency 2. Describe the pharmacokinetics of the analgesia infusion 3. Discuss the potential side effects of analgesia infusions 4. tate the minimal clinical observations required for a patient receiving an analgesia infusion 5. Discuss reportable parameters 6. Discuss nursing actions to take if pain escalates 7. Discuss when to give analgesia boluses and when to increase analgesia infusions 8. Discuss why we administer an initial bolus when analgesia infusions commence 9. tate when, why and how much naloxone should be given for opioid induced puritus, sedation and respiratory depression 10. Locate and complete the opioid primary competency quiz 1. Demonstrate pain assessment with an understanding of child development, language and appropriate pain assessment tools 2. Demonstrate accurate documentation of observations and assessment 3. Demonstrate correct set up of analgesia infusion pumps 4. Demonstrate explanation, answering questions and confirmation of understanding with family Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 18

22 Pain (Patient Controlled Analgesia) Competency tatement: The nurse will safely and effectively administer patient controlled analgesia (PCA) RCH References: RCH Intranet Anaesthesia & Pain Management Pain Management Guidelines: Patient Controlled Analgesia 1. Locate and read the RCH Patient Controlled Analgesia Guidelines 2. Describe the pharmacokinetics of the opioid analgesia used 3. Discuss the potential side effects of PCA 4. Discuss the appropriate patient group that would benefit from using a PCA 5. Describe the PCA pump program and demonstrates where the prescribed program is documented 6. tate the minimum observations for a patient receiving a PCA and recognizes reportable parameters 7. Discuss the nursing actions to take if pain escalates 8. Explain when, why and how much naloxone should be given for opioid induced puritus, sedation and respiratory depression 9. Discuss how to transition from a PCA to oral analgesia 10. Locate and complete the PCA primary competency quiz 1. Demonstrate a pain assessment 2. Demonstrate accurate documentation of PCA use on the PCA/ Epidural Flowsheet 3. Demonstrate explanation, answering of questions and confirmation of understanding with family Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 19

23 Potassium Infusion (oncology) Competency tatement: The nurse can safely and effectively administer a potassium infusion in children with cancer RCH References: RCH Intranet Children s Cancer Centre CCC Documents: Potassium Chloride Guideline for Infusions in the Children s Cancer Centre 1. Locate and read the references related to this competency 2. Describe the function of Potassium in the body 3. Identify risk factors for low or high potassium levels in children with cancer 4. Describe the signs and symptoms of hypo / hyperkalaemia 5. Explain why children with cancer sometimes require Potassium Chloride corrections 6. Explain the monitoring of potassium levels for acute corrections and continuous infusions 7. Discuss the management if a patient s potassium is too high / low 8. Discuss the monitoring requirements for a patient who has a potassium of 2.9 and receiving a potassium infusion 9. Discuss the monitoring requirements for a patient who has a potassium of 3.2 and receiving a potassium infusion 10. tate the only concentration of a potassium infusion administered in the Cancer Care Unit 11. Discuss precautions when patient is receiving 60mmol/l CL in their intravenous fluids 12. Discuss implications for a patient receiving TPN who also requires a Potassium Chloride infusion 13. Discuss how the administer a Potassium Chloride infusion and why 14. Identify what is the maximum rate/hour that can be administrated on the Children s Cancer Centre 1. Demonstrate preparation of a concentrated potassium infusion for acute corrections and ongoing infusions 2. Demonstrate correct double checking of the prescription and dose of a Potassium Chloride infusion 3. Demonstrate accurate documentation of a potassium infusion on the Fluid Balance Flowsheet Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 20

24 Procedural edation Nitrous Oxide competency skill ALERT: This competency should follow the procedural sedation nitrous oxide competency theory component. Nurses must attain the competency elements INDEPENDENTLY in order to be considered competent Competency statement: The nurse assesses and prepares a child and family for a procedure and safely and effectively administers nitrous oxide throughout the sedation period RCH references related to this competency: RCH Website - Comfort ids For Health Professionals nitrous oxide Accreditation Process RCH CPG edation-procedural edation-ward & Ambulatory areas and RCH CPG Procedural Pain Management. RCH Record of edation for procedure MR755/A 1. tate when the sedation period starts and ends 2. tate how to assess and maintain a patent airway for your patient 3. tate the function of the nitrous oxide delivery unit, include all components 4. tate the two built in safety features on the nitrous oxide delivery unit, include the rationale 5. Identify the appropriate time and support personnel to delivery nitrous oxide 6. Complete the Prior to the sedation section of the Record of sedation for procedure (MR755/A) to: a. Identify risk and to meet the criteria for nitrous oxide administration b. Obtain informed verbal consent and provide information (fact sheet) c. Obtain an order for nitrous oxide+/-additional analgesic+/- Topical LA 7. Demonstrate patient assessment, including correct sizing of the facemask 8. Demonstrate preparation of the child and parent, prior to the sedation event 9. Demonstrate the safety checks for the nitrous oxide delivery unit and assemble the disposable components of the unit, prior to the sedation event 10. Demonstrate preparation of treatment area and emergency equipment as per the Record of sedation for procedure MR755/A, prior to the sedation event 11. Demonstrate how to turn on the scavenging system for the nitrous oxide gas and ensure compliance with Occupation Health and afety standards 12. Demonstrate Time out or Positive Patient Identification 13. Demonstrate leadership as the edationist : a. Clarify the roles of staff and family, prior to the sedation event b. tate when the child is ready for the procedure to begin c. Direct staff and family, maintaining one leader and a calm environment 14. Demonstrate non-pharmacological strategies, as part of the sedation event 15. Maintain line of sight and verbal contact throughout the sedation period 16. Demonstrate continuous monitoring of vital signs and UM, documenting as per the Record of sedation for procedure MR755/A 17. Deliver nitrous oxide making adjustment to: a. the concentration of nitrous oxide based on anxiety, pain and sedation requirements b. the gas flows based on the patients age (child or adolescent), breathing pattern and volume of gas in the reservoir bag c. the facemask in order to maintain a seal over the nose and mouth 18. Demonstrate safe and timely management of side effects or adverse events 19. Monitor administration time and communicates timing with the Proceduralist 20. Demonstrate delivery of oxygen post procedure for 3-5 minutes 21. Perform the end of sedation period assessment, include level of alertness and return to baseline vital signs 22. Demonstrate recovery positioning and handover of patient when indicated 23. Complete all documentation for the sedation event per the Record of sedation for procedure (MR755/A) and medication chart (MR690A) 24. Demonstrate debrief of child and parent, include positive reinforcement 25. Discuss post sedation care with family and child, include falls prevention 26. Discuss travel arrangements and supervision (for outpatients) RCH Nursing Competency Workbook Chapter 3 Page 21

25 I have demonstrated the necessary knowledge, skills, abilities and attributes to be deemed competent in independently administering nitrous oxide. The minimum recommended number of supervised nitrous oxide events, achieving independent administration, was undertaken and documented below. I acknowledge that ongoing development and maintenance of competency is my responsibility and will Nurse Name: ignature: Date: Record of Nitrous Oxide Administration The recommended number of supervised nitrous oxide sedation events is based on prior experience of nitrous oxide administration. Refer to-comfort ids Website-For health professionals - nitrous oxide accreditation process Event Number & Date Feedback Prompts required Areas to improve Outcome for Event Assisted - Repeat Independent - Competent Assessor ignature & Designation RCH Nursing Competency Workbook Chapter 3 Page 22

26 Procedural edation Nitrous Oxide competency theory ALERT: This competency should precede the procedural sedation nitrous oxide competency skill component. Completion of this competency in isolation does not indicate the nurse s competency to administer nitrous oxide Competency statement: The nurse has the requisite knowledge to assess and prepare a child and family for nitrous oxide sedation and to safely and effectively administers nitrous oxide throughout the sedation period RCH references related to this competency: RCH Website - Comfort ids For Health Professionals nitrous oxide Accreditation Process RCH CPG edation-procedural edation-ward & Ambulatory areas and RCH CPG Procedural Pain Management. RCH Record of edation for procedure MR755/A 1. Locate and read a. CPG edation-procedural edation-ward & Ambulatory areas b. CPG Procedural Pain Management c. Procedural edation learning guide for healthcare professionals d. Orientation package for nitrous oxide e. Record of sedation for procedure MR755/A 2. Discuss the role and responsibility of the edationist 3. Describe the pharmacological effects of nitrous oxide 4. Outline the fasting guidelines for nitrous oxide and the consent process 5. tate the three RCH services available to provide procedural sedation advice/consultation and when this is required 6. Describe how to prepare a child/family for a nitrous oxide sedation event 7. tate any specific variation to nitrous oxide delivery or documentation that applies to your area ( DMU, PICU ) 8. Describe what considerations should be taken when administering nitrous oxide with another primary sedation agent or an opioid medication 9. tate the appropriate gas flow rate ( L/min ) and reservoir bag size (L) for a child and adolescent 10. tate what is required and the rationale for: a. Risk assessment b. Exclusion criteria c. Monitoring - Baseline and ongoing observation of vital signs d. Continual assessment of UM and maintaining verbal contact e. Line of sight clinical observation and appropriate staffing f. Maintaining a quiet environment g. Falls prevention h. Time out and positive identification i. Emergency equipment j. Occupational Health and afety k. nitrous oxide storage l. Post sedation discharge criteria m. Documentation and reporting of adverse events 11. tate the action required for: a. Equipment faults b. Loss of nitrous oxide or oxygen gas flow c. Failure to sedate or adequate analgesic effect 12. Describe the management and possible prevention of: a. Patient who is combative including loss of facemask seal b. Patient who complains of nausea or vomits c. Patient who desaturates, is apnoeic or respiratory depressed d. Patient who is distress from double vision or hallucinations e. Patient who is excessive drooling or excessively sweating f. Patient who progresses to an unintended deeper level of sedation g. Patient who is coughing or develops respiratory distress - include airway obstruction and laryngospasm h. Patient who has impaired coordination / balance 13. tate the maximum time of administration (minutes) recommended for a nitrous oxide procedural sedation event 14. tate the location of the emergency equipment in your area Not Applicable RCH Nursing Competency Workbook Chapter 3 Page 23

27 Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 24

28 ubcutaneous Catheter devices management (Infusion and BD at-t-intima ) ALERT: For palliative care patients please refer to the symptom management plan as documented by the Victorian Paediatric Palliative Care Program Competency tatement: The nurse safely and effectively cares for a patient who requires the use of a ubcutaneous Catheter device RCH References: RCH Intranet Palliative Care For Health Professionals: Parenteral infusions and syringe drivers; RCH Policies & Procedures: Medication Management; RCH Clinical Practice Guidelines: ubcutaneous Catheter devices management Infusion and BD at-t-intima ; ucrose (oral) for procedural pain management in infants 1. Locate and read the references related to this competency 2. Discuss the indications for medications to be given subcutaneously 3. Outline and discuss the different anatomical positions that an Insuflon and BD af-t- Intima TM can be placed subcutaneously. Include; a. Appropriate insertion sites b. Areas to avoid c. Other considerations 4. Outline the management of a ubcutaneous Catheter device. Include; a. Ongoing assessment of an Insuflon and BD af-t-intima insitu (or insertion site) b. Length of insertion time and indications for re-site c. Potential complications and management 5. Outline the documentation required for management of the ubcutaneous Catheter device 6. Demonstrate discussion and education with the child and parents/caregivers regarding the ubcutaneous Catheter device and care at home 1. Demonstrate the procedure for the subcutaneous insertion of an Insuflon 2. Demonstrate the procedure for the subcutaneous insertion of a BD af-t-intima TM 3. Demonstrate the procedure for the administration of medications via an Insuflon 4. Demonstrate the procedure for the administration of a bolus/breakthrough dose of medication via a subcutaneous BD af-t-intima TM 5. Demonstrate the procedure for the administration of a continuous infusion via a subcutaneous BD af-t-intima TM 6. Demonstrate the procedure for the removal of an Insuflon 7. Demonstrate the procedure for the removal of a subcutaneous BD af-t-intima TM Nurse Name: ignature: Date: RCH Nursing Competency Workbook Chapter 3 Page 25

29 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 26

30 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 27

31 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 28

32 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 29

33 Competency Feedback & Reflection This section is used to document constructive feedback relating to specific elements of any competency from assessors, and also provides space to document reflection on your own practice (either in direct relation to the feedback, or separately). Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] Competency Name: Element(s): Assessor Feedback: elf-reflection: Assessor [sign and date] Nurse [sign and date] RCH Nursing Competency Workbook Chapter 3 Page 30