Professionalism and Professional Accountability in Clinical Skills Practice Guidance Notes for Assessors
Guidance Notes for Assessors Professionalism and Professional Accountability in Clinical Skills Practice The following guidance notes are not exhaustive, but are available to guide assessors to give appropriate feedback to the practitioner. They are not designed to pass or fail, however if assessors feel the practitioner has not covered key responses in their answers they should direct them to further revision and study. The references may assist further reading. Recommended actions for skills scenarios Scenario 1: Venepuncture a) The nurse should have responded to Mrs T s initial complaints with a thorough investigation and prompt action, including documentation of any investigations and treatments. The nurse should have offered her an explanation about her symptoms and provided reassurance, and should have checked to ensure the sampling had been carried out competently and as per policy, e.g. the sampler had washed hands and cleaned Mrs T skin as per policy, the correct equipment had been used, etc. b) Being busy is not a defense; it would have been good practice to carry out an initial assessment and then decide on appropriate action. Scenario 2: Peripheral IV cannulation a) You should remove the cannula, insert a new one, assess him for other symptoms, (e.g. is this a worsening of his cardiac condition or nerve damage), offer reassurance, and observe him and the insertion site, and document your actions and any treatments, e.g. he may require analgesia. b) You could justify practice through being able to provide evidence of your competence in cannulation practice (e.g. training/supervision process, evidence of your 2 year competence review, etc). Seek out colleagues to confirm your standards of practice, e.g. observations. Stipulate how you carried out assessment/procedure, e.g. correct gauge, angle of insertion, etc. Scenario 3: IV medicines administration a) Stop the medication and alert the medical staff and the nurse in charge. Ensure Miss X is monitored and observed, e.g. SEWS, and administer any prescribed antidote/treatment as necessary, e.g. antihistamine for itch. Document the incident. 1
b) You could justify actions by stating you are competent through regular practice and appropriate education/training initially. That you followed NHS policy, so you reconstituted as per guidance and that you had assessed the patient, e.g. drug history and any known allergies. Thus you are accountable for administering the medicine but you might not be accountable for the outcome, if an untoward or unknown allergic reaction. Scenario 4: Infusion Devices: Medical Device a) Alert the doctor and nurse in charge immediately, and carry out an immediate assessment of Mrs J and ensure ongoing monitoring, e.g. SEWS. Offer resuscitation measures as appropriate/prescribed, e.g. recovery position, oxygen. Await instructions re. infusion; if discontinued, retain so you can provide evidence such as rate, etc, later. Document the incident in her records and report via the NHS incident reporting system, e.g. Datix. b) Use a device specific line with anti siphon valve and if removing from an infusion device always clamp the line using line clamp; knowledge re. device alarms, which would inform the nurse if giving set/syringe was not inserted properly, and device specific training where all practitioners must be competent in the use of device/s. Check disposables to ensure they are not damaged and are appropriate for device. Consider the height of the device in relation to the cannula insertion site. Be aware of any Safety Bulletins and Hazard Notices re. faulty equipment. Participate in Safety Briefings and ward handovers, etc. Maintain device specific competence as per Code requirement (NMC 2008) and all clinical skills with competencies normally require formal review at 2years. Scenario 5: Immunisation a) Check Mrs P s records, has her capacity been assessed? Does the nephew have welfare guardian status or power of attorney? Speak with GP? Explain to John why you can t proceed if Mrs P is refusing. b) Consent here is the crucial aspect; just because Mrs P is there, you must not assume she is aware of the reason for her being there, and thus her presence does not necessarily mean she has consented, therefore it is not good practice to go ahead and give it to her. Also, you may need to consider that even if John has welfare guardian status or power of attorney, her refusal may lead her to become uncooperative, and this might lead to risks to you and her (e.g. needlestick injury). 2
If John does not have the legal authority to act for her, remember someone can t give consent on a competent adult s behalf (NMC 2008). Therefore, you might have to refuse the nephew s request and offer him full reasoning why. Scenario 6: Ear Irrigation a) Stop the procedure immediately and re assess Mr S s ear and tympanic membrane. If no evidence of rupture, ask him to fix his gaze on an object ahead for a few minutes and assess if the dizziness passes. If yes, recommence procedure, checking regularly Mr S feels OK. Document the procedure, his responses and your actions. If he still feels dizzy, stop the procedure and refer him to his GP. b) You could defend your practice through evidence that: the water was at the correct temperature (37 o C), the pro pulse machine was set at the correct pressure (3), and that you used the correct volume of water (500ml) and correct technique, e.g. gentle pressure. Furthermore, that dizziness is a known side effect and that you had had followed the policy and procedure correctly. Other actions and recommendations will be reviewed during the skill specific training and workshops, please ensure you bring this workbook with your answers to your session/s. 3