1. How To Develop & Implement a Practical Staff Competency Plan
Pat Comoss RN, BS, MAACVPR
Nursing Enrichment Consultants, Inc.

2. I have no financial relationships to disclose
Financial Disclosure
I have no financial relationships to disclose

3. Staff Competencies in Rehab
Upon completion of this activity, participants will be able to:
Discuss why an annual staff competency plan is important for rehab personnel
Identify criteria that are useful when choosing competency topics
List acceptable methods for evaluating a staff member’s competency
Match selected competencies to AACVPR’s published Core Competencies for CR & PR

4. Staff Competencies in Rehab
Not New, Revisit WHAT WHY WHEN WHO HOW

5. WHY Staff Competencies
Intrinsic Philosophy: desire for continuous learning to be the best rehab practitioner you can be

6. WHY Staff Competencies
Intrinsic Philosophy = desire for continuous learning to be the best rehab practitioner you can be
Extrinsic Expectation:
Hospital requirement
Joint Commission standard
AACVPR Program Certification criteria

7. WHY Staff Competencies
The Joint Commission
“Competence assessment lets the hospital know whether its staff have the ability to use specific skills and to employ the knowledge necessary to perform their jobs.”
Human Resources chapter:
2015 Hospital Accreditation Standards

8. TJC: Standard HR 01.06.01 The hospital
Defines the competencies it requires of staff who provide patient care/ treatment/services

9. TJC: Standard HR
Uses assessment methods to determine competence in the skill being assessed
Test taking
Return demonstration
Simulation/role play
Observation of actual patient care

10. TJC: Standard HR
An individual with the educational background, experience, or knowledge related to the skills being reviewed assesses competence:
Instructor
Preceptor
Coworker

11. TJC: Standard HR 01.06.01 The hospital can utilize:
An outside individual
Such as: guest speaker, consultant
Competency guidelines from an appropriate professional organization
Such as: AACVPR Core Competencies

12. TJC: Standard HR 01.06.01 Staff competence is assessed & documented
once every 3 years
or more often per hospital policy

13. WHY Staff Competencies
AACVPR Program Certification CR & PR:
Requirement #1 = Staff Competencies
Individuals should possess a common core of professional & clinical competencies, regardless of academic discipline

14. WHY Staff Competencies
AACVPR Program Certification CR & PR:
Requirement #1 = Staff Competencies
A program must provide evidence of annual assessment of clinical/professional staff competency

15. AACVPR Program Certification
PULMONARY REHAB Program Certification:
Four assessed competencies MUST be specific to Clinical Competency Guidelines for Pulmonary Rehabilitation Professionals 2014
Collins EG, Bauldoff G, Carlin B, et al.
JCRP 2014; 34:

17. AACVPR Program Certification
CARDIAC REHAB Program Certification:
Four assessed competencies MUST be specific to Core Competencies for Cardiac Rehabilitation/ Secondary Prevention Professionals: 2010 Update
Hamm L, Sanderson B, Ades P, et al
JCRP 2011; 31: 2-10

19. WHAT Staff Competencies
Similar Categories for Staff Competencies CR & PR:
Patient Assessment
Exercise Training
Psychosocial Management
Tobacco Cessation
Emergency Planning

20. WHAT Staff Competencies
Cardiac Rehab
Blood pressure management
Lipid management
Diabetes management
Weight management
Pulmonary Rehab
Dyspnea assessment & management
Oxygen assessment & management
Collaborative self-management

21. WHAT NOT Staff Competencies
Discipline-specific hospital/department required competencies:
Cardiology RNs = conscious sedation
Respiratory RTs = precautions to prevent ventilator acquired pneumonia (VAP)

22. WHAT NOT Staff Competencies
Initial/Orientation checklist for new employees
often emphasize mechanical functions within dept vs. specific clinical patient care
Hospital-wide required competencies
e.g. HIPAA rules, safety/security color-codes, etc.

23. HOW Staff Competencies
1. Choose skills that need to be learned, reviewed, or updated because they are:
NEW/CHANGED
HIGH RISK
LOW VOLUME
PROBLEMATIC

24. HOW Staff Competencies
Categories 
Patient Assessment
Exercise Training
Psychosocial Management
Tobacco Cessation
Emergency Planning
Etc.
 Criteria
NEW/CHANGED
HIGH RISK
LOW VOLUME
PROBLEMATIC

25. HOW Staff Competencies
2. Sources of choices: INSIDE - OUT Use Core Competency documents for staff self-assessment = Identify strengths & weaknesses

26. HOW: Inside - Out Examples NEW = BODE Index calculation (PR),
MET-minutes calculation (CR)
HIGH RISK = diabetic exercise management
(blood sugar testing, high & low cut-offs)
LOW VOLUME = tobacco cessation

27. HOW Staff Competencies
Cross reference to Core = Smoking Cessation
Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals: 2010 Update – pg 7 Tobacco cessation; Knowledge 1-7, Skills 1-3.
Pulmonary Clinical Competency Guidelines: 2014 Update - pg. 299, Tobacco cessation; Knowledge 1-7, Skills 1-2.

28. HOW: Inside - Out
Challenge: find resources to teach the topic/skill to rehab staff in rehab context
Within facility or external expert?
PROFESSIONAL DEVELOPMENT OPPORTUNITY = elect a staff member to study/research the topic & become the rehab expert

30. HOW Staff Competencies
2. Source of choices: OUTSIDE - IN Use authoritative external information for competency ideas = Identify need to update/upgrade program

31. HOW: Outside - In
Challenge: make sure chosen topic/skill is within the scope of Core Competencies expectations
Where does the new interest match document?
PROFESSIONAL DEVELOPMENT OPPORTUNITY = elect a staff member to track connections between chosen topics & competency bullets

32. Pulmonary Rehab Example
NEW/CHANGED: Need to update PR policy & practice to incorporate latest evidence-based recommendations for this important outcome measure

33. Pulmonary Rehab Example
Changes to 6MWT Performance 2015:
For initial assessment, do 2 walks & take best result as baseline measure
Use patient's own oxygen equipment & usual O2 flow = DO NOT TITRATE O2
Allow O2 sat to drop to low value cut-off of 80% saturation
For exit evaluation, look for change of at least 30 meters/100 feet to be clinically significant

34. Pulmonary Rehab Example
Exercise Testing p.298
Use of field testing (6MWT, shuttle walk) as outcome measure
Complete 6MWT using ATS criteria
Appropriately monitor responses
Develop ExRx on basis of results as appropriate

39. Cardiac Rehab Example
NEW/CHANGED: Need to update CR policy & practice to incorporate latest evidence-based recommendations for this important outcome measure

40. Cardiac Rehab Example Changes to BP Management 2015:
New target value for secondary prevention of cardiac events = 140/90mmHg
Much lower is not necessarily better & may contribute to side effects or complications
Decreased coronary or cerebral perfusion
Orthostatic problems
DBP less than 65mmHg should be avoided in older patients

41. Cardiac Rehab Example BP Management p.6
Normal range of BP at rest & with exercise;
Current BP targets for secondary prevention
Accurate determinations
Recognition of deviations from range
Measurement of outcomes

45. HOW Staff Competencies
WHAT WHY WHEN HOW WHO

46. WHEN Staff Competencies
Schedule an in-service presentation and/or practice session
Annually
Quarterly

48. Staff Competencies: SUMMARY
WHAT = documentation of staff knowledge, skill, & ability
WHY = improve quality of program; requirement for TJC & AACVPR
WHEN = 4 each year for cert/recert
HOW = learn, practice, demonstrate, document
WHO = staff member, outside expert

49. Cardiac Rehab - SPECIAL NOTE
Core Competency document
is basis for new CCRP certification!
Professional certification exam to be given at this AACVPR National Meeting:
September 7, 2016
New Orleans, LA

50. Pulmonary Rehab – PREVIEW
PR Core Competency document will be basis for new CPRP certification! Now in development!!

51. References
Hamm LF et al. Core Competencies for Cardiac Rehabilitation Professionals: 2010 Update. JCRP 2011;31: Collins EG et al. Clinical Competency Guidelines for Pulmonary Rehabilitation Professionals. JCRP 2014; 34:

52. References
Holland AE et al. An official European Respiratory Society/ American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014; 44: Rosendorff C et al. Treatment of Hypertension in Patients with Coronary Artery Disease. Circulation 2015; 131: e1 – e36.

53. Staff Competencies in Rehab
Thank You!
Good luck with planning & documenting your
program’s staff competencies!!

54. Staff Competencies in Rehab
Q & A ? ? ?