Can You Prove Competency ???

[crotchitymedic1986]

Combining alot of topics I have read on here in the past month, I have a question regarding Training at your department. One of the things that impressed me about hospital-based EMS, was that they fell under JCAHO (in the US). One of the things that JCAHO aggressively looked at a few years ago was "proving that all employees were competent to do their job". You had to have some proof that every employee (even part-timers) was trained on every piece of equipment in their department (or ambulance) and that they had some training regarding issues that were infrequent but were high risk or problem prone (like needle crich or IO), on a yearly basis at a minimum.

So if JCAHO walked into your service tomorrow (or whatevery governing body that you choose) and asked you to provide proof that every employee (including that parttimer who just picks up a weekend shift once per month --- or the guy who usually rides the engine, but sometimes rides the bus, or the brand new medic that you hired 30 days ago) in your service was "competent" in all aspects of their duties, could you prove it ? And if I added the caveat that the inspectors could speak with any employee of their choosing and quiz them on their knowledge, would you still say yes ?

If your answer is yes, what process does your service have that makes this possible ?

[Kaisu]

hahahahahahah.... stop it - you are killing me... hahahahhahahhahahhahhahhahahah

[crotchitymedic1986]

I guess I should be honest and also state that many of the checklists or training records were pencil-whipped or manufactured right before JCAHO arrived, so this process didnt actually "prove competency" but atleast the service had to take some effort.

But then again, this was back when you knew JCAHO was coming, I think at some point in the last 3 years they have gone to truly surprise visits.

[spenac]

Just passed one this week. My current service provides little training and even less education. I passed because I refuse to be sub par. I find those that know or I get a book I refuse to have anything on my ambulance that I could not use if needed.

[crotchitymedic1986]

Just passed what spenac, what do you or your service do ?

[spenac]

Just passed what spenac, what do you or your service do ?

Lot of details I can not release sorry, all I can say is I proved I was competent and knowledgable of all equipment and drugs, how and when to use. I can also say I still have my certification. Sorry no more legally able to discuss.

[crotchitymedic1986]

Thats cool, enough said.

[CBEMT]

I work for a JCHAO-covered entity. During every winter inservice, the RNs and MAs have a specific "clinical competency" that they all review together and then demonstrate, documenting same for JC. Last year it was using their glucometer. We ran an intubation competency station for the MDs (not that they'll ever do one, and most haven't even attempted one since their residency).

[EMS Solutions]

I have worked for several agencies that tracked advanced skills the employee did. IV, cardioversion, IO, Needle Cric, Pacing, ETI etc.

We would have to either fill out a short form or record book and document the skill along with noting dates, chart # and any issues we had in peforming the task - 2 attempts at ETI , 2 IV attempts, unsucessful IV attempts. Then sign the form or book.

In addition two agencies spent a lot of cash to get the equipment to cover skills not done all that much such as IO or Needle Decompression.

The medical director would have a requirement of maintaining skills by perfroming "X" amount of skills each year during patient contact.

If you did not fulfill those requirements then you would have to do them in a skill station type of scenario with the Medical Director or his appointed designee - usually a paramedic preceptor or training officer.

For those who worked only PT, they would either have to provide documentation from a FT job that they maintained the required # of ETI etc for the year or do a bunch of the skill station scenarios mentioned.

They also required that all employees do a clinical assessment annually, which includes a patient assess, mega code, trauma and medical scenarios as well as go over any recent changes in local protocols and new treatments. This was done annually along with a short exam.

I am not sure if they did it for JCHAO. It may have been for CAAS requirements though. I know that one reason it was done was also to try and protect the agency from legal questions. Such as if a patient or family complained you didnt do something right, management could always provide some type of documentation that you did the skill "x" amount of times succesfully.

As far as JCHAO, I believe that most of what they did was a rush every three years to cover things like RACE, right to know, PASS, hospital operations, HIPPA and employee documenation and not so much the skills and ops of the EMS department.