Evidence-Based Competency Assessment Redesign: Implications for the Residency Program Lisa Johnson, RN, MSN, OCN Kathrine Winnie, MSN, CNS, RN BC, CCRN Ridwana Fruitwala, RN, BSN Objectives To provide a brief overview of the current literature related to competency assessment. To highlight the anticipated benefits of competency redesign. To describe the process for this organization s redesign. To discuss the barriers and successes of the redesign process. To share the early findings subsequent to a competency assessment redesign. To articulate the possible implications for the future of this organization s residency program. Our Facility Keck Hospital of USC and USC Norris Comprehensive Cancer Center One of two university based hospital systems in the Los Angeles area Tertiary and Quaternary Care Acquired by the University of Southern California in April 2009 Part of a three hospital system 461 Bed Acute Care Facility Eight specialty ICUs Nine Telemetry/Medical Surgical One Stepdown unit One Rehab Over 40 outpatient facilities 1
Previous/Current Competency Process Annual house wide and unit specific competencies Largely focused on technical skills in a simulated setting Staff generally not involved in competency selection Verifications based on: Regulatory requirements High risk/low volume Traditional house wide and unit skills Minimally focusing on QI data Translational Data The Keck Hospital 2013 RN house wide IV pump skill station IV Pump Programming Errors Pass rate improved from 93% up to 97% Medication error data indicates no decrease in IV pump related errors This may suggest a lack of translational application of the skill Literature Competency assessment should not be limited to one aspect of practice (Harding et.al, 2013) Mastery of technical skills is not supported as the sole indicator of competency Three domains of skills Interpersonal Critical thinking Technical (Wright, 2013) 2
Literature 11 verification methods Wright, 2013, p.50 Competency Redesign Three pilot units Two Intensive Care Units 1 Telemetry 2 hybrid 1 comprehensive Hybrid Model Level I 5East Telemetry The process Assessment (Selection) Did not involve staff Planning Implementation Evaluation 3
Comprehensive Model 7West ICU The process Assessment (selection) Limited staff inclusion Planning/decision process Implementation Evaluation Hybrid Level 2 8West ICU The process Assessment (selection) Included post implementation debriefing of comprehensive model Staff inclusive Planning/decision process Implementation Evaluation Benefits Economic Staffing Annual housewide competencies Approximately 120 staff RNs are in class each day Unit specific competencies Approximately 20 RNs are in class each session Professional accountability Move from a passive learning environment to a self governing process Staff Engagement Quality Improvement 4
Current Residency (State of Keck) Voyager competencies = 3 domains (clinical reasoning, technical skills, interpersonal) Questions Are preceptors validating within the three domains? Would other verification methods be appropriate in the residency programs? Can certain nurses/units opt out of select competencies? Competency avoidance Less than dynamic preceptor engagement Residency Implications Subject Matter Expert (SME) competency needs assessment Alternate verification methods for competencies the resident may never experience Share needs assessment findings with Versant curriculum committee Residency Implications Engaged preceptors = Elevated clinical experiences for the residents Stronger RN Residency graduates 5
Contact information Lisa Johnson, RN, MSN, OCN Lisa.johnson@health.usc.edu Kathrine Winnie, MSN, CNS, RN BC, CCRN Kathrine.winnie@health.usc.edu Ridwana Fruitwala, RN, BSN Ridwanabanu.fruitwala@health.usc.edu 16 References Harding, A. D., Walker Cilio, G., Duke, A., Campos, G., & Stapleton, S. (2013). A framework for creating and evaluating competencies for emergency nurses. Journal of Emergency Nursing, 39(3). Retrieved from: http: //www.jeonline.org/article/s0099 1767(12)00222 X/fulltext Wright, D. (2013). The ultimate guide to competency assessment in healthcare. Minneapolis, MN: Creative Health Care Management. 17 6