Competency vs. Training
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Hello All!
We were recently inspected by Joint Commission and they informed us that we need to have an initial training form as well as a competency form. I am finding it hard to have 2 separate forms with pretty much the same information on it and I know I will get push back from the nurses. Does anyone have any ideas or suggestions on how to meet this standard but also not make it impossible for the nurses to follow through? This question is in reference to POC testing. We already have a Competency checklist that covers all 6 elements.
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To go back to the presentation by Jean Ball, initial training is just that--it is training and not competency. Once cannot be competent or prove competency after just being trained, and there is no expectation that the person is competent. The expectation is that the trainee has mastered the test and whatever goes along with it (QC, for example) and is now prepared to begin testing. The regulations all state that person's doing testing have to be adequately trained. Hence, the training assessment--did the trainee learn the steps to test and retain the information to be able to do testing.
Competency is a different animal. The operator has been performing the test and getting experience with it, and now we can assess their competency. That will be at 6 months (or at least once in the first year, depending on your accreditation), then annually for non-waived, and annually for waived.
I don't see a problem with using the same materials for initial training, then again for competency assessment, as long as you designate which it is on the form.
I think the "when do I have to have a competency performed" falls directly to what your policy states. Does it say, no testing will be performed until competency has been assessed? I did have to call CAP on this a while back. It was understood that the person was initially trained and then did not have a competency until 6 months later. Testing was performed on patients during that 6 month period. The 6 month competency is designed to reflect that the user has retained the training. It sounds weird to us that we would allow a person to test patients and not have a competed "competency assessment". Our waived testing isn't CAP. It would fall under JC (hospital) or CLIA (Practices).
I use two different forms because the training form is describing training elements of the procedure while the competency addresses assessment of testing. I can share what I use and it would be great to see what others are using too.
Soo much truth in what you said there Peggy!
I found this specific guideline for competency assessment below. Having a separate form is outdated and not a very efficient process. It would seem like a spot on your current form to assess competency as "competent" or "needs additional training" could satisfy the standard and based on running QC, direct observation, or running a patient. Initial competency is evaluated with a quiz and maybe running two levels of controls. I have a form in which the trainee has to acknowledge running two levels of QC that passed which serves as their competency assessment after training.
Six month and annual competency assessment is satisfied with most of our routine evaluations of critical results and reviewing patient results any outliers and the operator is emailed.
The department leader ensures the completion of competency assessments in one of four ways.
He or she does one of the following:
at the time of orientation and on an ongoing basis thereafter
and direct observation
Lori, thanks for this information. different take on this
Do you mind sharing the source?
Hello-
I found a resource "Standards BoosterPak for Waived testing" on TJC site. (We are TJC accredited for POC).
There is a section "Implementation Expectations" regarding this topic. The last bullet states:
"For LAB only, newly hired employees are oriented and assessed for competency by a qualified individual. ....This assessment is documented prior to any unsupervised patient contact."
If you are TJC, check it out. I found it helpful.
Randi
I use the same form for Competency but have boxes for Orientation, 6 months or Annual.
I designed a Training form separate from the Competency.
I color coded them. Initial Training in white, 6 months in yellow, Annual in pink.
It is a little confusing what Joint Commission wanted.
But the inspector like the color coded documents.
The training is more of learning parts of the instrument and how they work ;
and reagents of non-waived tests.
Competency is divided in the 6 elements required of Competency.
Joint Commission is stricter with the non-waived documents.
Attached is a response by TJC on their interpretation of the number of times competency is assessed.
I cannot remember who asked this question to TJC but someone did and I got this copy.
It must have been posted by a listserv POC.
Pet Maniquis, MPA, MT(ASCP) POCS (AACC)
Laboratory Point-of Care Coordinator
Providence Medical Center/ Saint John Hospital
8929 Parallel Parkway, Kansas City, KS 66112
Ph: 913-596-4727; Fax: 913-596-4728
PManiquis@primehealthcare.com
From: Amanda Miller via POCT Listserv (Groupsite)
Sent: Monday, August 19, 2019 12:59 PM
To: Perpetua Maniquis (PMC)
Subject: [POCT Listserv] Re: Competency vs. Training
WARNING: This email originated outside the Prime Healthcare email system! Do Not Click links if this user is unknown.
Glucose meter is a waived test. It need only 2 elements of competency.
It also need initial training and annual competency.
Per TJC, non-waived tests operator is required to have training/orientation, initial competency, 6 months and annual.
The time between the initial l training and initial competency – to me - is a gray area. No time frame is specified.
For our moderately-complex tests (inspected by CAP) we have
Initial Training and Initial Competency checklists. The initial training checklist covers all the things a new employee needs to learn in order to perform a test/use an analyzer. The initial competency checklist only covers observation of a patient
test. Combined, these “initial” checklists cover the same six elements which are on the “annual”
Competency Assessment Checklist.
After we receive documentation of “Initial Training”, we give a new operator provisional access for one month. During that time they are observed performing an actual patient test. If their skills are satisfactory, then the trainer documents
“Initial Competency”.
Amanda,
My Joint inspector required separate forms. I did explain to him that I believe they are competent when I turn them loose at the POC. It might take longer to
train a person who has never touched an I-Stat for example. I do monitor their Quality Check Codes and results, but they are in a different environment than main lab. During orientation on a unit, they are observed by the person training them.
He didn’t like that the forms were dated the same and I reminded him that POC devices have a lot of safeguards for use by “non-lab” staff. There is a lot more
involved with becoming competent on a chemistry analyzer vs a POC device. And, we have to send them to the unit prepared to test!
Dawn
We have separate forms for Training and Competency.
Attached are the samples.
Pet Maniquis, MPA, MT(ASCP) POCS (AACC)
Laboratory Point-of Care Coordinator
Providence Medical Center/ Saint John Hospital
8929 Parallel Parkway, Kansas City, KS 66112
Ph: 913-596-4727; Fax: 913-596-4728
PManiquis@primehealthcare.com
From: Erika Deaton-Mohney BS, MT(ASCP), CPP via POCT Listserv (Groupsite)
Sent: Tuesday, August 20, 2019 8:32 AM
To: Perpetua Maniquis (PMC)
Subject: [POCT Listserv] Re: Competency vs. Training
WARNING: This email originated outside the Prime Healthcare email system! Do Not Click links if this user is unknown.
Probably most of you got this. If not, here is an E-alert from TJC.
https://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFAQChapterId=99&StandardsFAQId=2017