**INDUCTION FOR

**INDUCTION FOR CRITICAL CARE

STAFF

Education Team March 2020

For transfer to

Intensive Care

Welcome to Critical Care at MFT

Name

Contact Phone Number

Starting Department

Line Manager

Firstly, Critical Care would like to take this opportunity to thank you for your support in assisting in the Covid-19 escalation plan. The following document and competencies are to support your temporary return to Critical Care. The competencies and study day/s will help you deliver safe care while looking after critical care patients. If you require further information that is not included within this document please do not hesitate to ask either the Education Team or any member of the Critical Care Team.

General Information

Telephone Numbers Switchboard (0161) 2761234

Contact for Sickness – Absence Manager 03308080260

Cardiac Critical Care (0161)2764544

Intensive Care Unit (0161) 2764712/3

High Dependency Unit (0161) 2764166

Trafford High Care Unit (0161) 7462196

Critical Care refers to patients who require a higher level of care than the normal ward patient, level 2 and 3 patients.

The NHS has four levels of patients; Level 0 Ward patients who require minimal assistance and only require

Observations once per day. Level 1 Ward patients who require some assistance and Observations 4

hourly. Level 2 Patients who require close monitoring and assistance and hourly/2

hourly Observations. Level 3 Patients who require organ support usually ventilation and

continuous invasive monitoring.

Critical Care at MFT comprises of;

General Critical Care - Intensive Care Unit (ICU) MRI (20 Beds) High Dependency Unit (HDU) MRI (20 Beds) Trafford High Care Unit (THCU) TGH (4 Beds) Central Delivery Unit (CDU) St Marys Hospital

Cardiac Intensive Care Unit (CICU) MRI (16 Beds)

Reading List

Books

Adam, S. Osborne, S & Welch, J (2017) Critical Care Nursing: Science and Practice 3rd Ed.

Oxford University Press; Oxford.

Hodge, T (2015) Fast Facts for the Cardiac Surgery Nurse: Caring for Cardiac Surgery Patients

in a Nutshell 2nd Ed. NY Springer Publishing Company; New York.

Leach, R (2013) Critical Care Medicine at a Glance 3rd Ed. Wiley-Blackwell; London.

Olson, K (2014) Oxford Handbook of Cardiac Nursing 2nd Ed. Oxford University Press; Oxford.

Websites

http://gmccsi.org.uk

http://cc3n.org.uk/competency-framework/4577977310

www.bhf.org.uk/healthcare-professionals

www.heartelearning.org/

http://gmccsi.org.uk/

http://cc3n.org.uk/competency-framework/4577977310

http://www.bhf.org.uk/healthcare-professionals

http://www.heartelearning.org/

Senior Nurse Team – Critical Care

Deputy Director of Nursing John Logan

Matrons General Critical Care

Tom Withers Rowena Murray

HDU Manager Melissa Rowlatt Khanyi Gwitsha

Education & Development Practitioner’s

Angela Giddins (Critical Care) Sheba John (CICU)

Senior Sisters/Charge Nurses

ICU Gerry Maclean Jackie Newman Raj Kandasamy Andy O’Malley

Danielle Benjamin Paul Conway

Kenneth Smith Sarah Dutton

Head of Nursing Donna Cummings

Senior Sisters/Charge Nurses (CICU)

Dawn Saad-Saoud Zee Harwood

Sandy Stannard Sujita Mathew Teresa Tinker

Minimole Antony Ali Austin

Anna Johnstone

Matron Cardiac Critical Care

Sherly Udeshi

Induction Programme Day 1

Welcome to Critical Care

Time Topic Speaker Venue

8am – 8:15am

Introduction to critical care- unit information including policies,

competency booklets, shifts, off duty, ID badges etc.

Education Team

Seminar room 3 Critical Care

8:15am-9am Unit Orientation and Fire Safety Education

Team Clinical Area

9am-10:30am Moving and Handling Theory & Practical

Skills including Proning Education

Team Clinical Area

Break 10.30-10:45am

10:45am-12pm

Bedside Safety Checks and competency Initial Patient Head to Toe Assessment (A-E assessment) and Monitoring Pressure Ulcer care including medical devices and assessment:-Nasofix, Anchorfast, Flowtron, Catheter Care Bowel Management System

Education Team

Skills Room

12pm-1pm

ANTT/ Hand Hygiene Donning & Doffing & FIT Testing Isolation Rooms Damp dusting COSHH Waste management Specimen collection/acceptance

Education Team


Lunch 1– 1.30pm

1:30pm-4pm Medication Management Including Oral, NG, PEG, JEJ, SC, IV Inotrope piggybacking

Education Team


Induction Programme Day 2

Time Topic Speaker Venue

8am - 10am

Invasive/Non Invasive Ventilation

PB-Ventilator Competencies/Etco2 ARDS/ARDS net Protocol

Airvo Carina

Education Team

Seminar room 3 Skills Room

Break 10am - 10:15am

10:15am – 11:15am

Sedation Management Nurse led weaning

Education Team

Skills Room

11:15am-12:15pm

Ventilator Associated Bundle Chest Drains Management and Removal of Chest Drains

Education Team

Skills Room

12:15pm-1pm

Documentation Education Team


Lunch 1pm – 1.30pm

1.30pm - 2pm

Tracheostomy Care/ Emergency Algorithm Education Team

Seminar room 3 Critical Care/ Simulation Room

2pm -4pm Care of the deceased Education Team


Competency Date completed Signed

ANTT Blood sampling

ANTT IV Medication Administration

HDU/ICU Bedside Checks

Oral Medication Competencies

Enteral Medication Competencies

Inhalation Medication Competencies

IM and SC Medication Competencies

Drager Carina Competency

Airvo 2 Competency

Puritan Bennet 980 Ventilator

Invasive Line Competencies

Removal of central Line

Hollister Feeding Tube Attachment Device

Inotrope ‘Piggybacking’

Urinary Catheter Care Competencies

Nasogastric Tube—Confirming Position Competency

Removal of Chest Drains

Documentation

Donning and Doffing including FIT Testing

Damp dusting

Care of the deceased patient

Waste management

Sampling and Specimen collection/sending

Proning and Proning team

Critical Care

ANTT Blood Sampling

Name Date

Competency Achieved Not

Achieved

1. Patient Identification Inform patient about the procedure Wash/gel hands wear apron Check forename and surname Date of Birth Hospital/District number

2. Preparation Check patient against the ordered analysis Request analysis to be completed with a valid ICE Login Print labels at the bedside Gather appropriate sample containers

3. Prepare ANTT tray Clean using detergent and water/Azo wipes Clean using Sani-cloth 70% wipes Place all equipment into tray Wash/Gel hands Put on gloves and other PPE if required

4. Taking blood sample Wipe the Bio-connector with Sani-cloth CHG 2% for 30 seconds leave to dry for 30 seconds Keep all key parts protected/clean at all times Withdraw 3-5ml blood into 10ml syringe Attach connector to the Bio-connector Withdraw blood into the tubes brown/orange, red then green. Remove the connector and take ABG if required Attach clean 10ml syringe and flush port and line Remove syringe and clean bio-connector with Sani-cloth CHG 2% Discard waste appropriately Remove gloves and decontaminate hands

5. Labelling Attach labels at the bedside Second independent check of patient details against request and blood bottles Document what samples have been sent for analysis

6. Sending to the laboratory Place in appropriate sample bags at bedside, seal while independent checker present Both staff to initial bags before placing in POD system and send to 101

ANTT Blood Sampling Knowledge Assessment

Yes/No

What is the difference between Closed and Open Ended Questions?

Why is it necessary to ask Open Ended Questions?

What would you do if the Patient Identity Band was missing?

What is the risk associated with pre-labelled blood bottles?

The correct action to take if the information identifying a patient is missing?

The correct action to take if a discrepancy is found?

Assessor signature Print

Individual Signature Print

Critical Care

ANTT IV Medication Administration

Name Date

Competency Achieved Not Achieved

1. Pre-Administration Did the member of staff:

Check the validity of prescription?- 6 Rs’ Ensure the patient has patent IV access? Ensure the patient has wristband? Gain consent Gather the prescribed IV medication and necessary equipment? Able to describe the indications, contraindications and usual dosage range for the prescribed medication. Able to describe the role of the ‘Second Checker’

Able to identify resources if further information is required

2. Patient Identification Did the member of staff:

Whenever possible ask the patient or carer to state surname, forename and date of birth? Independent of the second checker, ensure that the details stated match the patient’s wrist band?

Able to describe the action to be taken if discrepancies in details exist.

3. Checking the Medication Did the member of staff and Second Checker:

Individually check the drug against the prescription (6 R’s) at the bedside. Individually complete drug calculation (if required)

4. Preparation & Administration Did the member of staff: (Whilst the Second checker observing the following steps)

Wash hands with soap and water at commencement of procedure and able to explain the purpose of hand washing. Use appropriate personal protective equipment (PPE) and change appropriately. Select and prepare appropriate aseptic field. Able to explain what key parts are and how these should be protected during the procedure. Prepare the medication (including flushes) while protecting the key parts. Complete labelling (if required) Clean the key parts for 30 seconds and allow to air dry.

Safely administer the prescribed medication including appropriate rate of administration.

5. Post Administration Disposal of all waste undertaken in accordance with Waste Management Policy. Remove PPEs and wash hands with soap and water. The member of staff and the Second Checker sign the prescription chart. The member of staff is able to discuss the signs and symptoms of possible side effects including anaphylaxis.

Complete appropriate documentation.

ANTT IV Medication Administration Knowledge Assessment

Yes/No

What are the 6 Rights of medication administration?

What would you do in the event of the medication being wrongly prescribed?

What is the importance of individual checks when delivering IV medication?

What checks would you make when assessing line patency?

Assessor signature Print


Competency Document for Bedside Safety Checks

Competence Assessors initials

Carries out systematic safety checks at the start of every shift, when taking over another patient, and following a significant event at the bed space i.e. cardiac arrest, percutaneous tracheostomy.

Checks ambu-bag and Mapleson-C circuit is ready for use and plugged into wall oxygen.

Checks emergency airway equipment present and correct (to include facemasks, yankeur sucker etc.)

Checks portable oxygen is available at the bed space.

If tracheostomy in situ, emergency tracheostomy box is checked and present.

Ensures low suction and high suction are in working order, are set appropriately if in use, and can achieve appropriate pressures for use in an emergency.

Checks chest drains are patent, positioned at the correct level, on suction as medically instructed, and clamps are available in an emergency.

Sets alarm limits appropriately, taking into account individual patients.

Checks all infusions against prescription, ensuring they are running at the correct rate.

Zero’s transducer’s and ensures correct fluid in use.

Checks all lines and infusions, ensuring appropriate route and compatibility

Checks additional equipment has appropriate alarm limits set, and is running in accordance with prescription and/or medical notes

- CVVH - IABP - Pacing

Name Initials Signature Date

Assessor

Oral, Enteral, Inhalation, IM & SC Medication Competencies

Name Date

Prior to undertaking the procedure the candidate is able to:

Yes No

State the location of the Trust Medicines Policy

List sources of reference for help and guidance

List the equipment required

State the potential complications of the procedures

I have read and fully understand the Trust Medicines Policy and will abide by this policy in my practice.

Signed by candidate:

Assessors Comments Please comment where exceptional competency is evidenced, where any difficulty is encountered and if any different method of administration requires a change in information or practice

Candidates Comments

Competency Competent Not

Competent

Identify the location of the Trust policies in relation to the administration of medicines.

Undertakes appropriate hand washing and infection control precautions when administering medicines

Describe how they would ensure patient identification and evidence this in practice

Discuss the principles related to the safe administration of medicines

Demonstrate and awareness for obtaining and storing medications on the ward.

Demonstrate safe practice in the checking and administration of oral medication.

Discuss the 6 R’s relating to medication administration

Describe the guidelines for the safe administration of medicines via enteral feeding tubes

Demonstrate the safe administration of medicines via an enteral feeding tube

Follows Trust policy on NG Tube placement checks & documentation on CIS

Discuss “Never Events” and how to ensure patient safety

Demonstrate safe practice in the administration of IM / SC injections.

Demonstrates safe practice in administering inhaled medications.

Discuss the role of the ward pharmacist.

Discuss the use / disposal of patients own medication.

Understand the procedure for obtaining drugs out of hours. Discuss the location of the emergency drug cupboard.

Discuss the procedure to follow if the drug prescribed is not available.

Discuss the appropriate action to be taken in the event of a drug error.

Discuss the appropriate action to be taken in the event of an adverse drug reaction.

The practitioner must be assessed administering medication on a minimum of 10 occasions 5 of which MUST be NG Medication

Date and time Drugs administered Route Signature of assessor

NG

NG

NG

NG

NG

Date of completion

Assessor Sign & Print

Individual Sign & Print

Critical Care Drager Carina (CPAP) Competency

Name

Competency Initial Training

Competency Completed

Theory Discussion Able to Explain Indications for CPAP Therapy Able to Explain Aims of CPAP Therapy Able to Explain Contraindications Able to Explain Complications Able to Explain Importance of Humidification:

Face Mask/Tracheostomy/Hood Able to Explain to the patient the need for CPAP:

Explain how face mask and hood is connected Gain Consent How will the nurse provide Psychological Support to Patient and the Family

Pre-use Safety Checks Demonstrate Pre-use safety checks Clean machine Identify service sticker Identify Carina parts Identify equipment needed:

Carina circuit

HME filter

Exhalation valve

Humidifier

Heated wire

ETCO2 cable for tracheostomy

Battery duration

Can Demonstrate setup and Describe Elements of the Carina

Circuit life span

Exhalation port & correct placement in the circuit

Difference between Face mask & Tracheostomy circuits(closed circuit suction use)

Identify MDI port, Saline flush, Subglottic port

Capnography use in Tracheostomy patients

Strategies to conserve battery

Assemble all components of circuit correctly

Perform initial test as per the setup Guide

Can Demonstrate Knowledge of Ventilation parameters and Modes

Continuous Positive Airway Pressure (CPAP)

Pressure support/Spontaneous Ventilation (SPN-PS)

Synchronized Intermediate mandatory ventilation (SIMV)

Biphasic Intermittent Positive Airway Pressure (BIPAP)

Assist Control (AC)

Demonstrate Correct Positioning for each of the Following: Face Mask

Use Correct fitting mask

Correct positioning

Identify Pressure Points

Use of Resmed

Correct positioning of Expiratory valve Hood

Why choose a hood?

Use of Correct Size hood

Correct positioning/Demonstrate 2 person placement

Correct positioning of Expiratory valve

Protection of axilla from straps Tracheostomy

Use of Capnography

Attach Suction

Able to Explain why Cuff need to be inflated prior to CPAP

Safe positioning of tubing & use of ventilator arm

Alarms Setup & Appropriate Actions to be followed

Apnoea

High & Low Minute Volume

High Peak Airway Pressure(Paw)

Low Pressure/Disconnection

High Pressure

Low Oxygen/Flow

HPO supply insufficient

Leakage valve blocked

Nursing Care/Responsibility Able to Discuss the following patient care:

Able to give Psychological Support

Able to perform Head to Toe patient assessment

Able to determine whether to use mask or hood based on patient history/compliance

Discuss how and when to give oral care and Drinks

Discuss the need to put patient on High flow O2 via Nasal specs while giving breaks and during eating & drinking

Pressure Area Care

Patient positioning

Chest Physiotherapy/Deep breathing & Coughing/regular expectoration

Eye Care

Regular NG aspiration to prevent vomiting and gastric distension

Change circuit if becomes contaminated

Use Tracheostomy Inner tube/ Clean each shift

Patient Observation whilst on CPAP Therapy

Able to discuss what observations and vital signs need to be recorded & how often

Able to report any concerns/changes to medical staff

Able to discuss what Investigations need to be done

Able to discuss the need for regular monitoring of GCS

Cleaning and Disposal of Equipment Able to discuss how to clean and store the equipment

Action to take if Carina becomes inoperable Able to describe required actions to be taken if machine stops working

Learning Resources Able to Identify resources for support and training, including RICON website

Assessor Signature Print


Critical Care Airvo 2 Competency

Name Date

Competency Initial Training

Competency Completed

Theory Discussion Able to Explain Indications for High Flow Therapy Able to Explain Goals of High Flow Therapy Able to Explain Causes of Respiratory Failure Able to Explain Potential Complications of High Flow Therapy Able to Explain importance of Humidification Able to Explain to the Patient and/or Family the need for Ventilation Gain Consent How will the nurse provide Psychological Support to patient & the Family

Pre-use Safety Checks Demonstrate Pre-use safety checks Identify Service Sticker Identify Airvo 2 Parts Identify equipment needed:

Airvo Circuit

Water for Humidifier

Trach care for Tracheostomy/Closed suction/Face Mask/Nasal Cannula

Capnography for Tracheostomy patients

Green Tubings for O2

White O2 tubing

Can Demonstrate setup & Describe Elements of Airvo 2

Circuit life span

Capnography Monitoring for Tracheostomy patients


Can Demonstrate the Setting of Airvo 2

Switching on and self-test

Setting Flow

Setting O2

Able to change Flow and O2 according to patient needs

Able to safely connect patient to the High Flow Able to record High Flow Observations on the CIS Able to report any concerns/changes to medical staff

Cleaning and Disposal of Equipment Able to describe how to clean and store the equipment

Learning Resources Able to identify resources for support and training

Assessor Signature

Individual Signature

Puritan Bennet 980 Ventilator

Name

Competency Initial

Training Competency Completed

Theory Discussion Able to Explain Indications for Mechanical Ventilation

Primary Indicators

Clinical Indicators Able to Explain Goals of Mechanical Ventilation Able to Explain Causes of Respiratory Failure Able to Explain Potential Complications of Mechanical Ventilation Able to Explain importance & Types of Humidification Able to Explain Humidification Protocol Able to Explain to the Patient &/or Family the need for Ventilation Gain Consent How will the nurse provide Psychological Support to patient & the Family

Pre-Use Safety Checks Demonstrate Pre-Use safety checks Identify service sticker Identify Ventilator Parts Identify Equipment needed:

Ventilator Circuit: Dry & Wet

HME Filter

Fisher Paykel Humidifier

Trach-care for ET tube & Tracheostomy/Closed suction Demonstrate the correct use of arm to secure ventilator tubing

Can Demonstrate Setup & Describe Elements of the Ventilator

Circuit Lifespan

Correct placement of HME filter & Bacterial filter

Identify MDI port, Saline flush, Subglottic port, Use of 100% O2 flush

Capnography Monitoring


Perform SST & do the initial setup as per the guide

Can Demonstrate Setting & Explain Ventilation Parameters & Modes

SIMV VC & VC+

SIMV PC

PSV

CPAP

Bilevel

Tube Compensation

Able to Explain Ventilator Terminology & Settings

Tidal Volume

Minute Volume

Pressure Trigger/Flow Trigger

FIO2

Inspiratory Pressure (IP)

Peak Airway Pressure (PAP)

I: E ratio Recognize breath Types on the screen S – Spontaneous/ C- Controlled/ A – Assist

Alarm Setup & Appropriate Action to be followed

High Pressure

Low Tidal/Minute Volume

Low Pressure/Disconnection

Apnoea

Able to Safely Connect patient to the Ventilator Able to record ventilation observations on the flow chart Able to report any concerns/changes to medical staff

Cleaning and Disposal of Equipment Able to describe how to clean & store the equipment

Learning Resources Able to Identify resources for support & training

Assessor Signature

Individual Signature

Invasive Line Competency

Name Date

Competencies Achieved Not

achieved

**Can explain the advantages of Invasive Monitoring: Gives examples of the advantages and disadvantages to the patient and clinicians caring for them. Sign off in Step 1 competencies

**Can discuss possible sites which can be used for Arterial and Central Line monitoring and the associated complications. Sign off in Step 1 competencies

Can explain the rationale for Storage of transducer Fluid away from the Intravenous fluid.

Ensure that transducer fluid is prescribed in the correct place in the prescription chart and that it is a two person check.

Able to correctly identify the transducer fluid following the 6 R’S and document.

Can prepare equipment for and assist in Arterial Line Insertion

Can Correctly Prime transducer set and attach it to the arterial line

Can zero transducer line set alarm limits as and adjusts scales on monitor as appropriate for patient.

ANTT to be used at all times

Understands reason for and can undertake the following Invasive line checks at the start of every shift: (Equipment Checklist) and signed at handed over

Transducer board is in correct position - mid axillary line (Phlebostatic axis) and re-zeroed. Is the pressure bag set to 300mmHg

Check transducer set/giving set is labelled with the date due to be changed.

Check Invasive lines are appropriately labelled (near to the sampling port.)

Ensures that the caps have been replaced with bionectors – Red for arterial lines and blue for central lines. Can demonstrate knowledge of when bionector needs changing.

Check dressings are in-date and intact and re-dress appropriately. Document in the MR VICTOR tool

Checks arterial line insertion site for signs of infection. Complete MR VICTOR tool daily.

Can explain signs of distal ischemia in Arterial Lines? (Pain, white, cold limb beyond cannula, poor capillary refill).

Checks transducer fluid bag changed when ¾ empty and pressure bag maintained to 300mmHg

Checks the line is clear of blood whilst flushing use pulsating movement

Able to set alarm limits appropriate for the patient

Assessors Signature Print

Individuals Signature Print

Demonstrates understanding of a damped trace, and can discuss implications of transducer not set at the appropriate level.

Is aware of who and how to access help if unable to correct fault.

Understands potential problems of air in line: damped trace, risk of introducing air into patient’s intravascular system

Demonstrates awareness of the use of Arterial lines for sampling and not for injecting drugs.

Is aware of the importance of timely removal of Invasive lines. Check Platelets and APTT.

Can remove sutures, line and disconnect from pressure bag and apply pressure. Routinely send CVP tips for Culture send Arterial line tips if line looks infected.

Can apply appropriate dressing and is aware of the need to monitor site for signs of bleeding.

Can dismantle transducer set and dispose of appropriately. Clean non-disposable equipment in line with Trust guidelines.

Able to correctly identify the transducer fluid in the transducer bag is correct and signed by the staff handing over.

Competency Document for the Removal of Central Venous Catheters (CVC’S)


Medical notes checked for written documentation from medics confirming CVC can be removed.

Recent clotting/FBC results checked to confirm within normal range.

Procedure explained to the patient and consent gained.

Appropriate equipment gathered, and area prepared.

Patient positioned supine.

Infection control guidelines adhered to throughout the procedure by maintaining strict hand hygiene and asepsis.

Dressing removed and site cleaned with 2% chlorhexidine and 70% alcohol. Site left to air dry.

Stitches removed.

Patient asked to perform the Valsalva manoeuvre (if unable to tolerate then patient asked to hold breath) and CVC removed, whilst pressing on swabs.

Occlusive Opsite dressing applied.

Tip checked to ensure intact. Tip sent if appropriate (indications for doing so should be discussed).

All equipment disposed of safely.

Patient made comfortable.

Procedure clearly documented on CIS.

Post procedural complications discussed and monitored.

Name Initial Signature Date

Assessor

Learner

Hollister - Feeding Tube Attachment Device

Action Rational √

Date & Sign

Applying the Device

Ensure patients nose is clean and dry

Any residual can interfere with the adhesive

Remove the paper from the adhesive

Position the device so the clamps extend below the tip of the nose by 0.5 inch.

This will protect the end of the nose against pressure from the plastic clamp

Hold the device in place for 60 seconds

To ensure the adhesive has time to warm and adhere to the skin

Secure the NG Tube in place by closing the clamp.

The clamp has serrated teeth and this should be firmly closed to secure the NG Tube

The Device should be monitored every two hours

To assess pressure area. Noting changes to skin & changing position if necessary

Documentation – on application and two hrly checks

To identify changes and when they have occurred

The patient may need to be referred to the Dietician for the insertion of a Bridle

The Tube may be difficult to re-pass if dislodged or Patient may frequently remove NG Tube

Removing the Device

Stop any feed In case of NG Tube displacement

Release the NG Tube from the clamps

Maintain the NG Tubes position if keeping in place.

Gently remove the device from the patients nose checking for any abnormalities

Report any skin damage in the repositioning chart

Documentation – removal and changing of the device

To identify changes and when they have occurred

Inotrope “Piggybacking” Competency

Name Date

Competency Achieved Not

Achieved

Achieved the Trust IV Module 1 & 2 and completed/completing the competency document

Assess the patients need for Inotropic support

Is the Inotrope prescribed correctly

Are there two free syringe drivers available at the bedside – clean, intact & within service date

Is there at least one senior nurse who has completed all IV competencies checking the Inotrope and procedure

Decontaminate hands as per the Trusts hand hygiene policy

Clean the ANTT trolley as per Trust ANTT policy


Collect all equipment

Inform patient and/or relatives of procedure


Wear gloves and aprons (other PPE if required)

Check the Inotrope with the second checker

Keeping key parts protected place syringe into syringe driver – new infusions (or change in concentration) need to attach the infusion line at this point.

Switch on the syringe driver and let it take up the slack

Using ANTT attach to the patient

Slow Piggyback Method 1. Start the new syringe at a low volume of infusion. 2. When this has run for 1 minute - reduce the original syringe

to maintain the original total volume infusing. 3. Keeping the total volume as the original gradually reduce

original syringe while increasing the new syringe until the new syringe is running at the volume required.

Quick Piggyback Method 1. Start the new syringe at the same volume as the original or

at the volume required. 2. When the MAP begins to rise with the increase in Inotropic

support reduce the original syringe by 50% 3. Continue to reduce the new rate by 50% each time until

there is 1ml left then discontinue.

Using ANTT disconnect the old original syringe and replace with a new syringe in preparation for the next “piggyback”

Safely dispose of equipment decontaminate hands & document procedure.

Urinary Catheter Care Competency

COMPETENCY STATEMENT

Demonstrates safe practice for patient requiring a urinary catheter

Key Skills Assessment Criteria

1. Demonstrates an understanding of appropriate use of hand hygiene and Personal protective equipment(PPE)

A. Demonstrates correct hand hygiene procedure as per Trust Hand Hygiene Policy

B. Demonstrates appropriate use of PPE

2. Demonstrates an understanding of the importance of catheter care to reduce infection

A. Maintain patient privacy and dignity B. Discuss the procedure for consent C. Prepare patient and explains procedure D. Identify the urethral meatus E. Using appropriate disposable cloth gently wash the

urethral meatus and catheter using soap and water, then dry.

F. Ensure the catheter fixation device is in place and the catheter is supported

G. Ensure the catheter bag is appropriately attached and supported on a catheter bag hanger or if a leg bag is in use, is attached to the leg using leg bag straps

H. Ensure the drainage bag is situated below the level of the bladder but off the floor.

3. Demonstrates an understanding of appropriate use of urine collection bags

A. Identify when the bag requires changing B. Identify when the bag requires emptying.

Nasogastric Tube - Confirming Position Competency

Name

Date

Competency statements for confirming the position of a nasogastric tube (NG)

Staff Initials

Assessor Initials

Date

Is able to identify and explain the rational for how the initial checking of the NG tube should be done

Is able to identify when the position of a NG tube should be checked

Is able to demonstrate how to obtain aspirate from an NG tube, check the pH and describe the rational for this

Is able to describe when it is ‘safe’ to use the NG tube based on pH measurement

Is able to describe what to do if the pH reading in outside the ‘safe’ range

Is able to describe what to do if they are unable to aspirate from the NG tube

Is able to demonstrate correct documentation of the NG tube position

Is able to explain the use of radiology in confirming the position of a NG tube

Is able to explain how to use the risk assessment tool

Is able to describe the care required by a patient with a NG tube

Is able to describe the care required by a patient who has a NG tube secured by a nasal bridle

Is able to describe the principles of securing a NG tube appropriately

Learner statement: I confirm that I have met the required standard and that I am both

confident to confirm the position of a nasogastric and the associated care unsupervised,

both safely and competently and fully understand and accept my responsibilities towards

the patient, myself and the Trust when undertaking this care. I agree to maintain my clinical

competence in the skill and keep myself updated.

Signed Print Date

Competency Document for Removal of Chest Drains

Competency Document for Removal of Chest Drains


Medical team documented that chest drains are for removal. Patient hits criteria for removal (no air leak present, drained <100mls in 5 hours, clotting in range) **in rare circumstances, it may be deemed in the patients best interests to remove the chest drains when criteria is not fulfilled- in these circumstances, a clear rationale for this should be documented in the notes by the medical team, and the nurse in charge should be made aware prior to removal.

Entonox prescribed (unless contraindicated- VSD/ ASD)

Ensure patient nursed in bed.

Gather dressing trolley and clean with Clinell wipes

Wash hands as per Trust Policy

Whilst trolley drying, gather equipment and ensure second nurse available (2 x visors, sterile pack, chroprep, stitch cutter, gauze x 3, IV 300 dressing, 2 x chest drain clamps, orange bags x 2 for disposal)

Explain procedure to patient, including delivery of Entonox. Ask patient to demonstrate ability to use following demonstration.

Alcogel hands

Set up trolley, maintaining aseptic field and protecting key parts.

Both nurses apply gloves, Nurse 1(sterile nurse), and Nurse 2 (non-sterile nurse). Patient instructed to use Entonox throughout procedure.

Nurse 2, remove old dressing and apply 2 x clamps (if 3 drains) to drains not yet for removal. 3rd drain remains unclamped and on low suction (to minimise blood splash and excess fluid being left in chest).

Nurse 1- cleanse skin with chlorprep

Nurse 1 separate purse string from suture. Hand purse string to Nurse 2.

Nurse 1 remove skin suture, and divide purse string into two to allow for Nurse 2 to tie on removal

Nurse 1 to ask patient to take three deep breaths and on the third breath hold. If patient ventilated you will need to time with peak inspiration.

When patient holding breath, remove chest drain, swiftly but steadily. Gauze held over removal site as Nurse 2 ties purse string.

Unclamp next chest drain, and remove as above until all drains have been removed.

Nurse 1 apply IV 3000 dressing.

Dispose of all equipment appropriately.

Remove gloves and aprons.

Document removal.

Ensure Chest X-ray ordered.

Name Initials Signature Date

Assessor

Documents

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