The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts


Derek Barrows RRT-NPS, AE-C, TeneƩ Rowan RRT-NPS, AE-C, Children's Medical Center of Dallas

Introduction. The 2001 Evidence Report from the Agency for Healthcare Research and Quality identifies that a major arena for improving patient safety is competency evaluation and adherence to standards of care. Annual skill verifications are a common practice among respiratory care departments in order to satisfy credentialing requirements. These annual activities are often perceived as a necessary, but negative, aspect of clinical practice. Recognizing the limitations of annual skills verification, our department discontinued this process and implemented annual, age-specific bedside evaluations of competency. This process was labor intensive for staff and educators and did not allow for adequate teaching and discussion that would lead to an increasing level of staff knowledge and skills. With both of these models, we continued to experience unacceptable variability in the delivery of care to respiratory patients. This was especially true with therapists new to the profession. We recognized that in order to ensure appropriate, safe, consistent, quality respiratory care we would need to identify and implement a process that develops clinical expertise with staff members that are in their first year of practice and will also challenge and continue the development of very experienced staff members.

Methods. A focus group, comprised of educators, leaders and staff from both shifts utilized the Plan-Do-Check-Act methodology of process improvement in order to develop an effective process of competency verification. The outcome of this activity is a competency verification process that is pro-active, on-going, positively received by all stakeholders and effective in improving clinical practice and reducing adverse clinical practice events. The foundation of this process includes clinical practice observations by the educators. These observations ensure verification of skills, adherence to policies and guidelines and foster a supportive relationship between the bedside therapist and the educator. Results of these observations are entered into an Access database so aggregate data can then be used to concentrate educational resources and activities in identified areas of need. The activities include: in-services, monthly education days that include clinical simulations and skills stations, and quarterly skills fairs for low-volume, high-risk procedures.

Results. Performance observations facilitate clinical practice discussions between the educators and bedside staff as well as a means of gathering data for department educational activities, such as the next scheduled skill fair. Therapists in their first year of practice attend skills fairs quarterly. More experienced therapists attend two per year and the most experienced staff the skills stations. This has resulted in accelerated proficiency in understanding and administering low-volume/high-risk procedures. Data collected includes the skills fair scoring and the aggregate data from bedside observations. Quarterly skills fairs and the monthly multidisciplinary lecture series have given our therapists the opportunity to demonstrate their skills and discuss clinical knowledge and practice in a supportive, educational environment. After one year of implementation of this process, bedside observations have indicated a significant improvement in clinical practice and adherence to standards of care. There have also been fewer incident reports related to clinical practice, decreased levels of staff apprehension and improved practice with low volume procedures. It has also resulted in improved scores of therapist satisfaction surveys and Quality Resource Management reports.

Conclusion. On-going competency evaluations and educational plans tied to strategic initiatives, the experiential level of staff therapists and identified areas of clinical deficiencies are proactive in assuring the delivery of quality care. It is our experience that knowledge and skills should be measured and reinforced through multiple venues. Whatever the venue, effective training activities are supportive and professionally satisfying to all participants. A competency process that incorporates these qualities has increased the critical thinking skills of our staff, decreased errors in clinical practice and increased staff confidence with all respiratory care procedures. We have recently expanded our education days to include nurses and have invited nurses to utilize selected stations at our skills fairs to demonstrate their own clinical expertise.