PACU COMPETENCY BASED ORIENTATION

PACU COMPETENCY BASED ORIENTATIONWelcome to the Post Anesthesia Care Unit (PACU)Competency Based OrientationCompetency based orientation Defines skills and expectations required to perform the job safely andeffectively Provides a “blueprint” for performance excellence Evaluates performance and identifies skill and competency gaps Defines resources available to aid new staff in meeting expectations Provides a “map” for ongoing direction and support Describes expectations of preceptor for teaching and validation Outputs of the learning experienceWhat is Competence?Competence is ability of a nurse to integrate & apply the knowledge, skills, judgements,attitudes, values and beliefs required to practice safely and ethically in a designated roleor setting. (CNO 2008)Competencies can be defined as a set of statements about the knowledge, skills,attitudes and judgements required to perform safely within the scope of an individual’snursing practice or in a designated role or setting. (CNO 2008)Continuing competence is the ongoing ability to integrate & apply knowledge, skills &judgement required to practice safely and ethically. It involves a continual process oflinking the code of ethics, standards of practice & lifelong learning. Reflection andcontinued practice improvement is an ongoing process.

Scope of practice defines activities that nurses are educated and authorized toperform as set out in jurisdictional legislation. (CNO 2008)Self- Assessment is defined as learners taking initiative to assess their owneducation needs, set goals and objectives, plan and identify appropriateeducational activities, implement these activities and evaluate the outcomes.BENEFITS, BELIEFS AND GUIDING PRINCIPLES OF ACOMPETENCY BASED ORIENTATION PROGRAM1. Provides safe practice & identifies expectations ofcompetence per codes of ethics & standards of practice.2. Defines a required behaviour within a job role.3. Provides consistency in the orientation process.4. Links individual performance to goals of the organization.5. Individualizes the orientation process to meet individualneeds.6. Provides ongoing direction and support to staff.7. Encourages individuals to take responsibility for their owneducational needs.8. Monitors performance & identifies when an individualdoes not meet expectations.9. Provides justification for an extension of the orientationprocess & identifying goals to be met.2

SummaryThis section has identified the College's expectations of entry-level RNs and practice settingswith regard to practice decision-making. The framework and elements to support decisionmaking have been described. Practice experience will further contribute to the developmentof skills and confidence in making nursing practice decisions that promote quality client care.Decision Tree: A Guide to Practice Decision Making for the Entry-Level RegisteredNurseAssessmentGather the data.Analyze the dataDetermine if help needed to analyze data: Can I make sense of the data? Is the assessment te .Choose the care optionNO Am I satisfied that the option chosen is the best,most appropriate? *Consult/collaborate.YESIdentify options of care Can I identify:A range of care options?The indications and contraindications for each?The client's preferences?YESYES Do I have the authority to provide the care?NOCan I get it (physiciansorder)?YESYESNO Am I competent to perform the care? Can I manage the potential outcomes?YESNOPerform careSeek assistanceEvaluate care Has care achieved the desired outcome?YESReassess.NOEnd .The nurse's advocacy efforts m;r.; be required in situations where efforts to obtain a physician's order for the care option identified bythe nurse as "the best and most appropriate" have been unsuccessful.Adapted for College of Nurses of Ontario27

KEY POINTS ABOUT COMPETENCY – BASEDORIENTATION ANDEDUCATIONCLearning is a process that should continue along the continuum of novice to expert.Competency must be assessed at 3 levels:1. Technical2. Critical Thinking3. Interpersonal SkillsTraditionally, the technical component has been focused on during orientation;however, most performance issues arise due to critical thinking or relationalcomponents.Methods of assessing competence should be varied, & include Self – assessmentPreceptor assessmentWritten TestsReturn DemonstrationsMock scenariosObservation of care given / tasks performedMedworxxDay Surgery Competence Program Components1. Interprofessional Communication2. Teamwork3. Knowledge Based Practice3

PACU COMPETENCY BASED ORIENTATIONGREAT PLACETO WORKINTERPROFESSIONALCOMMUNICATIONPATIENTS FIRSTTEAMWORKGOALPerformance Excellence withinThe OrganizationUSING RESOURCESWISELYKNOWLEDGE BASEDPRACTICE

The Orientation ProcessInitial Meeting with the Manager/MentorOnce hired you will meet with the Manager for the unit you will be reporting to.You will receive the orientation folder. Manager explains the orientation program and answers questions Manager will provide you with an orientation of the unit and hospital wayfinding. You will be asked to complete the clinical experience rating of theCompetency based assessment tool.The new staff member and mentor will establish a plan for orientation based on theidentified learning needs.Mid-Orientation EvaluationThe Manager will meet with the new staff member to Review the competency based assessment to identify strategies to meetlearning needsEnd of OrientationThe Manager will meet with the new staff member to: Review the competency based assessment for incomplete items andestablish a learning plan for meeting learning needs. Evaluate the need for further orientation Suggest ongoing resources based on continuing learning needs

Benner’s Novice to Expert FrameworkPlease refer to the following definitions and examples to further assist you in the selfassessment processNoviceHas yet to receive the theoryComponent and hasnever performed the skill.AdvancedBeginnerHas received the theorycomponent and performedthe skill in a lab setting only.CompetentHas performed the skill inclinical practice but wouldprefer to have a clinicalmentor or peer nearby.The novice nurse has not been taughthow to insert a Foley catheter ordiscussed the expected care standardsin a classroom setting.This level practitioner has learned howto insert a Foley catheter and theexpected care standards, but has notpracticed these skills in a clinicalsetting.This practitioner can safely andcompetently insert a Foley catheter,but may request that a colleagueobserve the process and confirmstandard norms.ProficientHas achieved independencein performing the skill.Recognizes relevant clinicalchanges andorganizes/implements skilledresponses to these changes.Frequently assumes rolemodel/mentor role.This practitioner takes appropriateaction in response to the patient’schanging genitourinary status andinterpretation of the patient’ssigns/symptoms(Initiates emergency interventionPRN, collaborates with thephysician to revise the plan ofcare).ExpertConsistently demonstratescompetence in selected skills.Multiple experiences in theclinical setting. Has anintuitive grasp of terful in solvingproblems. Acts as a rolemodel/mentor.This practitioner enters the room andas a result of extensive experience withsimilar experiences, knows that apatient is compromised. This nursequickly and holistically assesses thesituation and identifies priorities.Anticipates revised plan of care.Complete the self-assessment on the following pages, and based on yourevaluation, assign yourself a level, from Novice to Expert. This will enable you tofocus on your present and future learning needs.

Brant Community Healthcare SystemPACU Competency ChecklistCriteria and CompetencyClinical ExperienceRating (CER):0 - no experience theory nitials. Date ofCompletionRe-evaluationof CER Planfor ContinuedLearningMentor/MenteeRe-evaluation1. Understands the Organization of the PACU:A. Locates emergency equipment Code Blue buttonCrash cartEmergency airway cartMalignant Hyperthermia cartVentilatorPortable O2 tank and suctionPanic buttons x2Glidescope, BougieHemoglobin Rainbow monitorCapnography monitorAmbu bagsOral airwaysNasal airwaysSuction equipment B. Locates Emergency exitsFire hoses and extinguishersFire alarm pull stations C. Locates unit resources Policieso Relevant PACU policieso Code policies Pharmacy IV Medication Monograph Halogen Email Risk Pro ParklaneD. Locates Stock Medications and request formsDirty utility/storage roomsWaiting roomHuddle boardDaily assignment sheetsSign-in log E. Demonstrates ability to enter orders andretrieve lab results from MeditechClinical Experience

Criteria and CompetencyRating (CER):0 - no experience theory only1-Limited2-acceptable3-CompetentF. Operates unit equipment Stretchers (adult, bariatric and pediatric)BedsMonitors:o Adult vs Paeds profileo Cardiac lead placemento Transport monitoringIV pumpsEpidural pumpsHypo/hyperthermia blanketBladder scannerCapnography monitorHbg Rainbow monitorGlucometerSuctionG. Tour of OR to locate Resuscitation cartMalignant hyperthermia cartDifficult Intubation EquipmentAdditional SuppliesMedicationsService Specific Rooms 2. Demonstrates Effective Communication SkillsAppropriate to PACUA. Requests and provides pertinent patient datawith interdisciplinary team, patient and family.B. Completes and accurately documents on PACU flow sheetAnesthesia Order SheetInput and OutputNarcotic Sign Out SheetTime log chit sheetC. Knowledge and correct use of SBARcommunication toolD. Recognizes and develops strategies for resolvinginterpersonal conflicts with family, patients andcoworkers. Discusses plan to cope with horizontal violencein work place3.Demonstrates Effective Action During anEmergency SituationA. Current CPR CertificationInitials. Date ofCompletionof CER Planfor ContinuedLearning

Criteria and CompetencyClinical ExperienceRating (CER):0- no experience theory only1-Limited2-acceptable3-CompetentB. Takes appropriate action when emergency planin effect (Call x5555, access Get Ready via VSNet) Code RedCode GreenCode WhiteCode PurpleCode BlackCode BrownCode GreyCode PinkCode OrangeCode AmberCode YellowCode SilverCode AquaCode NavyCode DECONCode BeigeCode Maroon C .Recognizes and takes appropriate action duringlife threatening conditions Respiratory arrestCardiac arrestLatex allergy- anaphylactic reactionMalignant hyperthermia crisisPaediatric tonsil hemorrhagePost-surgical hemorrhageLife threatening arrhythmiasBronchospasm, LarygospasmHypotension and Brady alt spinal4. Understands principals and responsibilities inrecovery processA. Describes phase 1, 2 and 3 of recovery processB. Describes flow of patient from OR to PACU, Zone2 and inpatient unitC. Knowledgeable of anaesthetic agents Indications Mechanisms Potential side effectsPACU managementPreceptor /PrecepteeInitials. Date ofCompletionRe-evaluationof CER Planfor ContinuedLearning