Establishing and Maintaining Nurse Competency Lou Anne Epperson, MSN, RN Coram Specialty Infusion Services, Denver, CO Debra Moll, RN, BSN Community Surgical Infusion, Toms River, NJ Top 5 Things to Know for CE: Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. Carry the Evaluation Packet you received on registration with you to EVERY session. If you re not applying for CE, we still want to hear from you! Your opinions about our conference are very valuable. Pharmacists, Pharmacist Technicians i and Nurses need to track their hours on the Statement of Continuing Education Certificate form as they go. FOR CE: At your last session, total the hours and sign your Statement of Continuing Education Certificate form. Keep the PINK copy for your records. Place the YELLOW and WHITE copies in your Evaluation packet Make sure an evaluation form from each session you attended is completed and in your Evaluation packet Put your name and unique member ID number (six digit number on the bottom of your badge) on the outside of the packet, seal it, and drop it in the drop boxes in the NHIA registration area at the convention center Disclosures Lou Anne Epperson and Debra Moll declare no conflicts of interest or financial interest in any service or product mentioned in this program. Clinical trials and off-label uses will not be discussed during this presentation. 1
Objectives Define competency Determine a process for establishing and updating validated competencies for home infusion nurses and home health nurses Delineate options for assisting patients/caregivers to achieve maximal independence with their home infusion therapy List valuable tools and references that facilitate delivery of home infusion nursing education Fiscal Challenges in Home Infusion Rising Per Diem Costs Salaries and benefits Pump and supply costs Cost of delivery Additional staff for insurance and admissions functions Fiscal Challenges in Home Infusion Rising Ancillary Costs Mileage and travel Training Home health agency Infusion staff RNs Certification and recertification 2
Other Challenges in Home Infusion Pharmacist Shortage Nursing Shortage Smaller pool of infusion specialists/home care Increased number of Rural referrals Specialty Drugs Aging Population Increase in Medicare Referrals Effective Resource Management Where can we leverage efficiencies? Must be based on strategic tactical plan Crucial to fiscal, quality and operational success Nursing Resource Management Human resource management Fiscal resource management Outcomes management 3
Human Resource Management Decreased pool of experienced nurses Compete with HHAs for same staff Salary competition Future competition CRNI Managing evolving infusion skills and knowledge bases Fiscal Resource Management Nursing is a cost center Cost per visit Cost per patient per month Cost as a % of net revenue Hospital pre-discharge Future pricing challenges Outcomes Management Quality as well as cost-effectiveness Competency required Changes in products Who offers the best outcomes: Home infusion nurses Trained home health nurses Both? Future: New therapies in the pipeline 4
HHA Strategic Relationships Strategic tactical plan derived from resource challenges Can benefit both the home infusion providers and agencies Infusion RNs Subcontracted RNs CHHA RNs Agency Assessment Geography Accreditation Competency How do they measure competency? Skill and experience of staff Knowledge of infusion devices/supplies and lines RN vs. LPN/LVN What is Competency? Validation of skills and knowledge Based on learning modules Demonstration and practice live or model f Performance-related Measurement of patient outcomes True measure of competency Determines organizational quality Objective data for patients and payors 5
Core Competency Hiring criteria must be aligned changes Infusion specialty evolved from patient needs Autonomy and accountability Knowledge of anatomy and physiology Specific knowledge of vascular system Attainment of skills needed for administration of infusion therapies CRNI Core Competencies Technology and clinical application Fluid and electrolyte balance Pharmacology Infection control Pediatrics Transfusion therapy Antineoplastic therapy Parenteral nutrition Performance improvement Develop Core Competencies From Novice to Expert Competent vs. Proficient IV skills not enough Application in various scenarios needed Higher level of problem-solving and knowledge Autonomy in home care Patient education requires knowledge of adult learning principles 6
Competence vs. Confidence Confidence plays a role with patient education and satisfaction impacts outcomes impacts nurse retention Adult Learning Principles for both patients and RNs Cognitive Domain Affective Domain Psychomotor Domain Establishing Competencies for HHA Staff Rely upon the adult learning principles Determine competencies for specific patient populations Disease state information Vascular access principles Equipment management Case scenario discussions/problem-solving Emergency back up plans 7
How Do We Establish Competencies for Agencies? 1:1 Education Training by manager or preceptor Return demonstration Case scenario discussion Patient education protocols Written SOPs Equipment operation and troubleshooting Strategic plan for ongoing education of staff Mentoring Obstacles with 1:1 Education Time involvement Proximity to infusion branch Number of branch agencies New staff competency New product utilization New patient type/therapies Ongoing competency assessment How Do We Establish Competencies for Agencies? Other Modalities Learning management systems Secured web and social network media Professional organizations specific to home infusion, infusion nursing and disease states Ongoing mentoring programs 8
Learning Management Systems Multiple modalities Discussion forums FAQs Captivate capabilities Learner modulated skills testing Conducive to adult learner Post testing opportunities Multiple opportunities to review Verbal and visual Secure Web and Social Media Sites Easily accessible Utilization capabilities Download information i World wide data base Time efficient Access to Target Audience Professional Organizations Networking access for educational opportunities Industry standards Core competency standards 9
Ongoing Mentoring Teacher and guide Problem-solving opportunities Specific timeframe for follow up Guide through complicated cases Patient/Caregiver Education Assist patients/caregivers to achieve maximal independence with their home infusion therapy Adult learning principles i again Learning readiness and education level Patient/Caregiver Education Active listening Working from patient s agenda Identifying patient beliefs and values 10
Validation of Competencies Skills Checklists Case scenario discussions Demonstration of knowledge/skill *Patient Outcomes* Online programs with testing On site supervisory visits Teleconferences Tools Available Manufacturer websites Patient/staff teaching tools E- or online learning & blended education Weekly conferences Skills testing realistic simulations Pump teaching programs (Healthstream) SOPs Models Computerized mannequins Infusion models INS competency tapes Specific developed learning modules 11
Resources Available Handout In Summary Discussion of meeting objectives Define competency CRNI competencies Adult learning both for patient and RN Challenges Obstacles Importance of patient outcomes 12