harry basdeo clinical consultant rn rm rpn rt rchn btech imm wcc
Post on 27-Dec-2015
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CLINICAL SKILLS COMPETENCY IN
A LITIGIOUS ENVIRONMENT
Harry BasdeoClinical Consultant
RN RM RPN RT RCHN BTech IMM WCC
WHY THE NEED ??? Clinical practice management is a area
of increasing medico legal risks. The patient profile is changing to
incorporate the new age techno savvy patient who is constantly web surfing his or her condition and treatment
The emergence of a multi million dollar medico – legal industry is enforcing the implementation of core clinical skills competency at practice level.
Rapid migration of nurses back to public sector due to more attractive packages
CRITICAL QUESTIONS What went wrong???? How did this happen?? Who is responsible?? Doctor/nurse Are the personnel adequately trained?? Blame game Million dollar claims What is the core clinical skills
competency of staff at ground level? Agency vs permanent staff ongoing
dilemma who is accountable.
CLINICAL SKILLS COMPETENCY DOMAINS
Scientific foundation
s
Leadership attributes
Quality manageme
nt
Clinical practice
Ethical attributes
Independent
practitioner
Technology competenc
e
Policy competenc
y
Financial integration
SAFE CLINICAL PRACTICE Core Clinical governance dictates that
risk management reduces the chances of patients being harmed.
This will also reduce the risk of complaints or litigation against the nurse /organization
Audit is a key tool in effective clinical governance.
An ongoing core clinical skills competency programme is imperative to prevent such adverse incidents.
WHERE ARE WE NOW? Current iv practices fall to a large extent
into the nurses domain including the act of vein cannulation.
Currently this process is not well defined by the SANC Scope of Practice R2598
This is placing an increasing burden of litigation on the nurses performing cannulation.
Clinical skills competency then become imperative for infusion management
THE PLAN Identify the key personnel who will head
up the clinical skills competency programme.
The lead role could be rotated between team members.
Could be any member of the MDT The leader must have access to all
relevant resources to implement a core clinical skills competency programme.
Resource allocation to roll out an effective clinical skills competency programme.
CLINICAL SKILLS COMPETENCY IN INFUSION MANAGEMENT The job description• A plan for clinical skills competency in
infusion management.• In house training on infusion
management• Infusion nursing standards• Training needs assessment• Local support database• Linking with academic and clinical
expertise
FINDINGS IN IV SEPSIS Current cannulation procedures Instutional policy guidelines Internationally recognized guidelines The clinicians vascular practice Nursing /medical personnel cannulation
practice Other categories of staff performing
vascular access Devices/ accessories /trays
METHODS OF DATA COLLECTION Internal wards stats Infection control officers data Inpatient records Laboratory data Ward meetings / handover rounds Patient surveys Significant event audit
PERCENTAGE OF BACTERAEMIA RELATED TO CVCS AND PERIPHERAL IV BY SPECIALITY
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
CVC
PIV
Surveillance of hospital acquired
bacteraemia
PRACTICAL ISSUES IN IMPLEMENTING CCSC IN INFUSION MANAGEMENT
Once problems have been identified Swot analysis on IV practices Team meetings Past practice analysis Future planning Implementing research findings Shared best practices
CLINICAL SKILLS COMPETENCY IN INFUSION MANAGEMENT Improvement process must be integrated
– Must be part of daily practice. Lessons learned from failure – Implement
the “Best Practices” learned from these lessons
I.V Clinical Policies must be evidence based – Research must be on going
Spread good practice – Forum i.e. ICU and Neonatal/conferences. Implementation across the spectrum in the Hospital
IMPLEMENTATION OF BEST PRACTICE IN INFUSION MANAGEMENT
Identifying areas where increase number of problems in iv management occurs may occur
Implementing strategies /mechanisms to prevent or reduce the extent of damages
Implementing best and safest products/policies
Risk prevention by review, maintenance and training
Risk acceptance to identify financial consequences
RECOMMENDATIONS
Increase in core clinical skills competency of staff performing vascular access.
The team using the Clinical governance approach are monitored and the results published
The results showed an increase in clinical skills expertise.
Lower IV infection rates Patient and staff satisfaction. Budget allocation for Implementation of a clinical
skills programme. Ongoing process for the successful implementation of
Core clinical skills competency programme.
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