UCHC Competency Checklist

UCHC Competency Checklist: ANNUALPosition Title: Registered Nurse, JDH Employee Name: Unit: ONC 6Cluster Area: Med-Surg: Med 4, Med-Surg 5, Onc 6, Surg 7, Med-Surg Float PoolMethod of Validation Key:ORDTV====Observation (in clinical setting)Return Demonstration/simulatedWritten TestVerbal TestA. EQUIPMENTLEVEL 2: CLUSTER SPECIFIC COMPETENCIESAlaris Pump-use of guardrails, secondary infusion tubingChest Drainage SystemLEVEL 3: UNIT SPECIFIC COMPETENCIESAlaris Pump – use of new chemotherapy administration tubing (Infusion RN)Safe Handling of Hazardous Drugs – Proper PPE and Double GlovingCapnographyExchange TransfusionsBlood WarmerB. DOCUMENTATION/COMMUNICATIONLEVEL 1: ROLE COMPETENCIESIdentifies reportable conditions via Patient Safety NetLEVEL 2: CLUSTER SPECIFIC COMPETENCIESWrites a timely, appropriate progress notes when needed, in DAR format,nursing notes should be titled according to problemSafety huddle/hourly rounding/white boardsInitiates and review/revises patient care plan per patient diagnosis/problemsDocuments education in PCDCompleted PCD Review for Pain, CIWA, and Restraints Live/via Saba.LEVEL 3: UNIT SPECIFIC COMPETENCIESCalculates AUC dosing for Carboplatin prior to administering (See AttachedCompleted Case Study)C. PROVISION OF CAREHOSPITAL ADMINISTRATIVE MANUALProvides care according to the following protocols/procedures:Chemotherapy OrdersReport/ Handoff/ Safety Huddle/Hourly RoundingVaccinations: Adult Pneumococcal and Influenza VaccinationNURSING PRACTICE MANUALProvides care according to the following protocols/procedures:AnticoagulationChart ReviewCentral Lines: Patient CareIV Push MedicationsMedications: Double CheckValidationMethod(Use evaluationKey on Left)VVV, RDVVVVVVVTVVVVV,OVVVValidation of CompetencyValidator’sInitialsDateInitials Signature Initials SignatureRevised 5/1/2007, 1/29/2008, 3/27/2009, 3/5/2010, 2/28/2011, 3/26/2012 Page 1 of 2

UCHC Competency Checklist: ANNUALPosition Title: Registered Nurse, JDH Employee Name: Unit: ONC 6Cluster Area: Med-Surg: Med 4, Med-Surg 5, Onc 6, Surg 7, Med-Surg Float PoolMethod of Validation Key:ORDTV====Observation (in clinical setting)Return Demonstration/simulatedWritten TestVerbal TestValidationMethod(Use evaluationKey on Left)1:1 Observation / Constant Observation VPatient BelongingsVPressure Ulcer Management and Treatment/AdultsVSkin Care: Pressure Ulcer Prevention and ManagementVUNIT PRACTICE MANUALProvides care according to the following protocols/procedures:Structure Standards – medications/drips allowed, frequency of vital signsVIV Push and IV Medication GuidelinesV IV Push Narcotics, IV BenadrylChemotherapy Administration (Onc 6)VExtravasation: Assessment and Management of Chemotherapy-RelatedVIntraperitoneal Chemotherapy (Onc 6)VBio-Chemotherapy/IL2 (Onc 6)VD. PERFORMANCE MEASUREMENT INITIATIVES(Core Measures)Surgical Care Improvement Project (SCIP)Heart Failure – provides CHF education / teaching sheet to patients withprimary or secondary diagnosis of CHFPneumonia – provides Smoking Cessation education / teaching sheet toappropriate patientsVVVValidation of CompetencyValidator’sInitialsDateInitials Signature Initials SignatureRevised 5/1/2007, 1/29/2008, 3/27/2009, 3/5/2010, 2/28/2011, 3/26/2012 Page 2 of 2