Competency vs. Training

Hello Amanda,

Waived Testing only requires 2 elements of the 6 for TJC/CAP.

Your forms for initial competency should say just that initial competency.  This is training when they start work.

Annual competency should say just that 2019 Annual Competency Assessment. I have a template that I can just change the year.

Non-waived testing require 6 elements of competency:

Template for each test with a boxed check off- initial, 6 month and annual.

This helps me keep track of everyone and covers TJC and CAP.

There will always be some staff members that find competency assessments an issue but I send a list of staff who don't complete this requirement by years end to the Clinical Managers with a note saying "the following staff members are unable to perform point of care testing until they have completed comps."  This puts the onus on the Manager to chase staff.  Myself and professional development do the best we can to get all staff members but...some just don't!

Good Luck

Our form (we use the same one for all) has a check-box at the top that asks if it's Initial Competency, 6-month competency, or annual competency.

For competency, we do the same as Kathleen, one form for all with a checkbox for Initial, Six month, or annual.

Training documentation should be a separate form from the initial competency.

Hi Amanda,

I just had the TJC here for a survey and I have one form and check the top for either  1) initial, 2) 6 month or  3) Annual.  All elements are addressed as well. 

I would share it w/ you if you're interested please email me at  bpost@ghvhs.org and let me know what device you need it for.

Beth

Beth, we do that as well. The way I explain using the same 'form' is that our training 'assessment' matches the initial competency assessment (meaning we do the same online test and it's the same validation tool to document understanding of the key points and capture the observation if done, the results of the QC or patient performance).

What I question about our process (where I work, not picking on your, Beth) is that for TJC and CAP (even waived testing), competency assessment is to show the employee is performing the test correctly after training. That's by definition. To me then, what is lacking if we 'do the initial competency assessment' actually when the employee is training/at the end of training session is that we are not showing 'competency assessment' (even if we call it that). There is no time between the training assessment and the initial competency assessment. 

I find this to be a quandary. Has anyone asked their accreditation directly about this? Who out there figured this out successfully? 

In a talk given by Jean Ball of the CAP, she stated that initial training is not considered a competency assessment. So you would be doing an assessment of training success, since you wouldn't consider someone who is brand new competent in their job until a few months had passed. 

We also use the same assessment for competency as well as initial training: an electronic learning system PowerPoint, quiz, and direct observation checklist. Although initial training is not a competency assessment, we use the same program for both since it's really clunky to have more than one program, form, checklist, etc.

Kathleen and I are saying the same thing...so back to Kathleen 'to put her on the spot' (and anyone else who wants to jump in), I've confessed that I'm leery of our training assessment = initial comp assessment since it's clearly done 'at the same time', at the end of the training.

How long - days? weeks? - after the operator is 'trained' and goes through 'training assessment', do your POCCs or designated trainers, do the initial competency assessment with each trained operator?

Does this length of time between 'the training date' and 'the initial comp assessment date' depend if it's waived or moderately complex?

Hi there Peggy and Everyone,

Great question....  We use HEALTHSTREAM and I have a PPP along w/ the quiz on the link.  All staff is assigned.  The validation form signifies that the operator/end-user performed QC (all levels) and a patient successfully.  The initial training for NA/MA is over weeks (as long as it takes for them to complete the # of Glucose sticks and documented on the "Training Form") under supervision.  I can perform random checks in RALS for device compliance.

In 2020 my lab will start using CAP, can anyone send me info to help on these inspections for POCT and the Main Laboratory (all departments),  I am the compliance and Safety officer  (soon to be adding Regulatory too)  bpost@ghvhs.org I would really appreciate it.  

Thanks,

Beth

I am with you Peggy, I believe you stated my initial question more clearly than I. Up until recently we have used the same Checklist competency form as the Initial, 6 month and Annual Competency. However, that just doesn't sit right with me to cover initial training. When TJC was here they asked my fellow system supervisors to provide their lab personnel forms and they provided our annual competencies and so TJC responded saying, "ok, now where are the training forms". They specifically stated it is required to distinguish the two and to have both.

So with that, if we were to have "training" and then competency, how do you allow them to use the istat temporarily for their training before checking their competency and giving them full access? Within the lab, techs can use any instrumentation and do not need "access", its all just paperwork. How do we as POCC do that in this instance?

OR am I thinking too much into it? haha

FYI  I am referring to Glucometer

Look into the elements under the WT standard on 'competency'...

Amanda, I agree with you.

Using glucose as an example, and using tools that clearly are labeled 'training checklist' and 'training assessment quiz' and 'training validation tool (to capture observed QC or patient test performance by the operator), if the operator passes that, are they not 'competent to perform'?

I think that's the premise that we lean on if we have to send out operators once they 'pass' training... and don't do initial competency assessment until after they've performed in the workplace.   

My angst is how to determine (especially with an instrument install, let's say 2 - 3,000 operators trained on a new glucose meter) the timing of doing the initial comp assessment after the training classes are completed. Competency assessment is supposed to be 'individual competency'...does that mean we can't set up classes them to run 2,000 operators through the initial comp assessment since the # of tests each has performed will be different, folks gain competence/skills at different paces...this takes 'competency assessment' into a different view than most of us have had since we started our programs. Most have set up training classes to be the initial comp assessments so there is another year that can go by before we have to 'drag' all through annual comp assessments. 

I don't have experience using group-held or a skills fair kind of means for folks to demonstrate initial competency assessments after a high volume device install like a glucose meter. Anyone? 

For years I've been look at/for resources (eg 'Ready, Set, Test' is a nice guide from CDC/CLIA for waived testing), every webinar PPT on comp assessment for every accreditation. It was clear training and initial comp assessments were to be 'separate' but I haven't seen how to determine 'when'/at what point to conduct initial comp assessments. Anyone? 

It makes me think of putting a dozen eggs in a pot of water with the intent of creating the finish product of a dozen perfectly cooked hard boiled eggs. Do all the eggs turn from liquid to solid at precisely the same time? Are all eggs created equal? Is the heat even across the bottom of the pot or are there hot spots that prove problematic in outcome? etc. and so goes throwing medical assistants and RNs into training classes for POCT. Minus the hot water, I hope.

Another thing we always have to keep in mind with accreditation inspections and surveys:

outcome (deficiencies etc) and acceptance of one's policies and forms and tools used in POCT could depend on which credentialed surveyor or inspector visits. 

Example with TJC WT Chapter survey as part of the organization's hospital survey. My guess is that you have RNs or MDs surveying. That can make a difference in what the surveyor is looking for and feedback you receive.

I would prefer to have our waived surveyed by a lab-trained surveyor but that never happens in our health system.