- Email: [email protected]
Legally Speaking: The Impact of Competency, Training, and Quality Assessment
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Nancy Moureau, BSN,CRNI The Impact of Competency, Training, and Quality Assessment
Competency and Training he keys to the reduction in legal liability for peripherally inserted central catheter (PICC) and intravenous (IV) insertions are education and competency. Liability is reduced through documentation of training and validation of competencies on a yearly basis at least. Scatt reported in 1988 that over 55% of vascular access device (VAD )-re.ated complications were related to health care professionals not having sufficient education and training.' The Centers for Disease Cont rd and Prevention (CDC), in the most recent 2002 Guidelines jor the Prevention oj Intravascular CathetfY--Related Injections' recommended that facilities have designated trained personnel for the insertion and maintenance of intravascular catheters. In addition, the CDC stated that facilities should maintain personnel who have been trained and exhibit competency in the insertion of catheters to supervise trainees who perform catheter insertion, with both recommendations designated as Category lA. It is clear that education and training a re vital to adequate pelf 0 mRnce; this is also clear to those who review records for potential medical malpractice. Reviewers consistently look for p rcof of initial education, competency evaluation, and annual education certificates. Increased education and training result in better understanding of ways to prevent complications with intravascular devices. Better understanding tends to be re flected in the clinician's
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Correspondence concerning this article should be addressed to [email protected] 001: 10.2309/java.10-3-4
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overall documentation. Clinicians must be properly trained to effectively perform patient care duties within acceptable levels of competency; this would apply to both basic IV insertion and the advanced-level PICC insertion. Evaluation of competency can be assessed in multiple ways. One method of evaluation is to pull a competency assessment out of PICC or IV complication monitoring. By tracking complications for each patient, which can be correlated for each person inserting the device, the reviewer can verify good performance and, thus, competency in the insertion. The usual method of competency assessment is through direct observation with an annual supervised insertion. Observing the person inserting the device during a procedure can allow identification of specific areas that need impDvement or confirm a solid and competent procedure. Some facilities include both methods of competency assessment in their policies and practice. Policies and pocedurei are established in hospitals and other care facilities to protect the patient and the clinician. Adequate liability potection comes when policies are reviewed annually, with an eye to national guidelines and standards, and updated as needed. It is difficult for any facility to stay up to date on guidelines. Conferences, seminars, and education outside the facility can expose the clinician to research, tips, and practices that impact best practice policies. Something as simple as not updating policies on a yearly basis to keep up with changes in practice can result in patient harm and failure to follow the standard of care . Changes within policies pomote retraining and education of the staff. Overall liability is reduced when nursing staff has frequent training and
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instruction on the current standard of care. Organizational policies and proced u rei should detail the requirements for clinical competency, ongoing training and education, and monitoring.
Quality Assessment Every IV provider should have an established quality assessment process to ensure patient safety, the appopriateness of patient selection, and the competency of the clinicians who are treating patients. According to the Infusion Nurses Society, "A quality assessment program is a systematic pocess to improve organizational petforrnance and ensure desired patient outcomes. Such programs should objectively identify, evaluate, and solve problems associated with infusion patient treatment modalities."3 The Institute of Medicine defines quality oj care as, "... the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.'" By monitoring clinical outcomes, a facility can evaluate its strengths and weaknesses, identify problem areas, and work toward establishing a program with the highest quality. Benchmarking outcomes with other high-quality facilities or through established research can also prove safe practice and provide evidence that the facility is conscientiously striving toward best practice. Outcomes data should be collected for each device in specific patient populations. Facilities can then establish and revise policies and procedures based on trends in the data. Documented results of quality assessment and monitoring that demonstrate competence by staff are also factors that provide proof of adherence to a high standard of care.
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Conclusion Vascular access management is a dynamic field, requiring frequent policy and procedural changes, highly skilled staff, and constant education. Only those who are able to keep up with the regulations, standards, guidelines,
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and recommendations will provide patients with the highest standard of care. Maintaining up-to-date knowledge of vascular access devices and related issues requires constant vigilance, review of preventative measures, and current research. Facilities that pro-
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vide ongoing education and monitoring of outcomes will have the highest quality of care. Reduce your liability through education, competency assessment, and outcome monitoring.
REFERENCES 1. Scott WL. Complications associated
with central venous catheters. A sUIvey. Chest. 1988;94:1221-1224.
2. O'Grady NP, Alexander M, Patchen Dellinger E, et al. Guidelines for the prevention of intravascular catheter-
related infections. MMWR Morb Mortal Wkly Rep. 2002;51:RR-1O. 3. Intravenous Nurses Society. Infusion nursing standards of practice. ] Infusion Nurs. 2000;23(suppl):6S. 4. Institute of Medicine. (2004). Focus on
Crossing the Quality Chasm: The IOM Health Care Quality Initiative. Retrieved
May 1, 2004. Available at http://www.iom.edulfocuson.asp?id=8089
OTHER SUGGESTED READING 1.
Hall MA, Green MD. Malpractice litigation reform: empirical approaches to establishing the legal standard of care. ] Med Pract Manage. 2004;19:279-282.
2. Hyde L. Legal and professional aspects of intravenous therapy [Review]. Nurs Stand. 2002;16(26):39-42.
3. Monarch K. Legal aspects of infusion practice: trends and issues. ] In/us Nurs. 2002; 25(suppl 6):521-530.
Probe Cover Kits inclUde: probe cover, sterile gel, instructions, and elastics
• 70 additional sizes &packaging available • Materials Optimal for Ultrasound Imaging • Latex Free • Si·Directional Rolled • True Form Fitting • Wrinkle Free • Abrasion and Puncture Resistance • Comfortable Feel • Higher Microbial Resistance • Lowest Competative Price
We have your (jfj§j~waiting! Just e-mail or call www.sheathes.com 408·782·2720· tax 408·782·2740 Toll Free 800-873·3n6· tax 877·244·5048
e-mail [email protected] Cop~©2OOI1I'eathi"oJTeclrdogies,
200 5
n:. 11"e IHEATHE'i l"Io'" tI'e Il'eat~ TecIrd"lle5 """" ar. a trademark oIlheathi"oJ Teclrdogies , n:.
Vo I
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0
3
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107
E
G
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L
s
L y
p
E A
K
N
G
Nancy Moureau, BSN,CRNI The Impact of Competency, Training, and Quality Assessment
Competency and Training he keys to the reduction in legal liability for peripherally inserted central catheter (PICC) and intravenous (IV) insertions are education and competency. Liability is reduced through documentation of training and validation of competencies on a yearly basis at least. Scatt reported in 1988 that over 55% of vascular access device (VAD )-re.ated complications were related to health care professionals not having sufficient education and training.' The Centers for Disease Cont rd and Prevention (CDC), in the most recent 2002 Guidelines jor the Prevention oj Intravascular CathetfY--Related Injections' recommended that facilities have designated trained personnel for the insertion and maintenance of intravascular catheters. In addition, the CDC stated that facilities should maintain personnel who have been trained and exhibit competency in the insertion of catheters to supervise trainees who perform catheter insertion, with both recommendations designated as Category lA. It is clear that education and training a re vital to adequate pelf 0 mRnce; this is also clear to those who review records for potential medical malpractice. Reviewers consistently look for p rcof of initial education, competency evaluation, and annual education certificates. Increased education and training result in better understanding of ways to prevent complications with intravascular devices. Better understanding tends to be re flected in the clinician's
T
Correspondence concerning this article should be addressed to [email protected] 001: 10.2309/java.10-3-4
106
.JAVA
Vc I
overall documentation. Clinicians must be properly trained to effectively perform patient care duties within acceptable levels of competency; this would apply to both basic IV insertion and the advanced-level PICC insertion. Evaluation of competency can be assessed in multiple ways. One method of evaluation is to pull a competency assessment out of PICC or IV complication monitoring. By tracking complications for each patient, which can be correlated for each person inserting the device, the reviewer can verify good performance and, thus, competency in the insertion. The usual method of competency assessment is through direct observation with an annual supervised insertion. Observing the person inserting the device during a procedure can allow identification of specific areas that need impDvement or confirm a solid and competent procedure. Some facilities include both methods of competency assessment in their policies and practice. Policies and pocedurei are established in hospitals and other care facilities to protect the patient and the clinician. Adequate liability potection comes when policies are reviewed annually, with an eye to national guidelines and standards, and updated as needed. It is difficult for any facility to stay up to date on guidelines. Conferences, seminars, and education outside the facility can expose the clinician to research, tips, and practices that impact best practice policies. Something as simple as not updating policies on a yearly basis to keep up with changes in practice can result in patient harm and failure to follow the standard of care . Changes within policies pomote retraining and education of the staff. Overall liability is reduced when nursing staff has frequent training and
ION c
3
200 5
instruction on the current standard of care. Organizational policies and proced u rei should detail the requirements for clinical competency, ongoing training and education, and monitoring.
Quality Assessment Every IV provider should have an established quality assessment process to ensure patient safety, the appopriateness of patient selection, and the competency of the clinicians who are treating patients. According to the Infusion Nurses Society, "A quality assessment program is a systematic pocess to improve organizational petforrnance and ensure desired patient outcomes. Such programs should objectively identify, evaluate, and solve problems associated with infusion patient treatment modalities."3 The Institute of Medicine defines quality oj care as, "... the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.'" By monitoring clinical outcomes, a facility can evaluate its strengths and weaknesses, identify problem areas, and work toward establishing a program with the highest quality. Benchmarking outcomes with other high-quality facilities or through established research can also prove safe practice and provide evidence that the facility is conscientiously striving toward best practice. Outcomes data should be collected for each device in specific patient populations. Facilities can then establish and revise policies and procedures based on trends in the data. Documented results of quality assessment and monitoring that demonstrate competence by staff are also factors that provide proof of adherence to a high standard of care.
L E
G
A
L
L
Conclusion Vascular access management is a dynamic field, requiring frequent policy and procedural changes, highly skilled staff, and constant education. Only those who are able to keep up with the regulations, standards, guidelines,
s
y
p
A
E
and recommendations will provide patients with the highest standard of care. Maintaining up-to-date knowledge of vascular access devices and related issues requires constant vigilance, review of preventative measures, and current research. Facilities that pro-
K
N
G
vide ongoing education and monitoring of outcomes will have the highest quality of care. Reduce your liability through education, competency assessment, and outcome monitoring.
REFERENCES 1. Scott WL. Complications associated
with central venous catheters. A sUIvey. Chest. 1988;94:1221-1224.
2. O'Grady NP, Alexander M, Patchen Dellinger E, et al. Guidelines for the prevention of intravascular catheter-
related infections. MMWR Morb Mortal Wkly Rep. 2002;51:RR-1O. 3. Intravenous Nurses Society. Infusion nursing standards of practice. ] Infusion Nurs. 2000;23(suppl):6S. 4. Institute of Medicine. (2004). Focus on
Crossing the Quality Chasm: The IOM Health Care Quality Initiative. Retrieved
May 1, 2004. Available at http://www.iom.edulfocuson.asp?id=8089
OTHER SUGGESTED READING 1.
Hall MA, Green MD. Malpractice litigation reform: empirical approaches to establishing the legal standard of care. ] Med Pract Manage. 2004;19:279-282.
2. Hyde L. Legal and professional aspects of intravenous therapy [Review]. Nurs Stand. 2002;16(26):39-42.
3. Monarch K. Legal aspects of infusion practice: trends and issues. ] In/us Nurs. 2002; 25(suppl 6):521-530.
Probe Cover Kits inclUde: probe cover, sterile gel, instructions, and elastics
• 70 additional sizes &packaging available • Materials Optimal for Ultrasound Imaging • Latex Free • Si·Directional Rolled • True Form Fitting • Wrinkle Free • Abrasion and Puncture Resistance • Comfortable Feel • Higher Microbial Resistance • Lowest Competative Price
We have your (jfj§j~waiting! Just e-mail or call www.sheathes.com 408·782·2720· tax 408·782·2740 Toll Free 800-873·3n6· tax 877·244·5048
e-mail [email protected] Cop~©2OOI1I'eathi"oJTeclrdogies,
200 5
n:. 11"e IHEATHE'i l"Io'" tI'e Il'eat~ TecIrd"lle5 """" ar. a trademark oIlheathi"oJ Teclrdogies , n:.
Vo I
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0
3
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