**INDUCTION FOR For transfer to CRITICAL CARE Intensive Care STAFF

Education Team March 2020

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 (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 : Science and Practice 3rd Ed. Oxford University Press; Oxford.

Hodge, T (2015) Fast Facts for the Cardiac Nurse: Caring for Cardiac Surgery Patients in a Nutshell 2nd Ed. NY Springer Publishing Company; New York.

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

Olson, K (2014) Oxford Handbook of 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/

Senior Nurse Team – Critical Care

Deputy Director of Nursing John Logan

Head of Nursing Donna Cummings

Matrons General Critical Care Cardiac Critical Care Tom Withers Sherly Udeshi Rowena Murray

Education & Development

Practitioner’s Angela Giddins (Critical Care)

Sheba John (CICU)

HDU Manager Senior Sisters/Charge Senior Sisters/Charge Melissa Rowlatt Nurses Nurses (CICU) Khanyi Gwitsha ICU Dawn Saad-Saoud Gerry Maclean Zee Harwood Sandy Stannard Jackie Newman Raj Kandasamy Sujita Mathew Andy O’Malley Teresa Tinker Danielle Benjamin Minimole Antony Paul Conway Ali Austin Kenneth Smith Anna Johnstone Sarah Dutton Induction Programme Day 1 Welcome to Critical Care

Time Topic Speaker Venue

Introduction to critical care- unit information including policies, Education Seminar room 3 8am – 8:15am competency booklets, shifts, off duty, ID Team Critical Care badges etc.

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

Moving and Handling Theory & Practical Education 9am-10:30am Clinical Area Skills including Proning Team

Break 10.30-10:45am Bedside Safety Checks and competency Initial Patient Head to Toe Assessment (A- E assessment) and Monitoring 10:45am- Education care including medical Skills Room 12pm Team devices and assessment:-Nasofix, Anchorfast, Flowtron, Care Bowel Management System ANTT/ Hand Hygiene Donning & Doffing & FIT Testing Isolation Rooms Education Seminar room 3 12pm-1pm Damp dusting Team Critical Care COSHH Waste management Specimen collection/acceptance Lunch 1– 1.30pm

Medication Management Education Seminar room 3 1:30pm-4pm Including Oral, NG, PEG, JEJ, SC, IV Team Critical Care piggybacking

Induction Programme Day 2

Time Topic Speaker Venue

Invasive/Non Invasive Ventilation PB- Competencies/Etco2 Education Seminar room 3 8am - 10am ARDS/ARDS net Protocol Team Skills Room Airvo Carina Break 10am - 10:15am

10:15am – Sedation Management Education Skills Room 11:15am Nurse led weaning Team

Ventilator Associated Bundle 11:15am- Education Chest Drains Skills Room 12:15pm Team Management and Removal of Chest Drains

12:15pm- Education Seminar room 3 Documentation 1pm Team Skills Room

Lunch 1pm – 1.30pm

Seminar room 3 1.30pm - Education Critical Care/ Tracheostomy Care/ Emergency Algorithm 2pm Team Simulation Room

Education Seminar room 3 2pm -4pm Care of the deceased Team Skills Room

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

Not Competency Achieved 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 . 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

Individual 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 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 Signed by candidate: Policy and will abide by this policy in my practice.

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

Not Competency Competent 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 Competency Training 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 Individual Signature Print

Critical Care Airvo 2 Competency

Name Date Competency Initial Competency Training Completed Theory Discussion Able to Explain Indications for High Flow Therapy Able to Explain Goals of High Flow Therapy Able to Explain Causes of 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  Assemble all components of circuit correctly 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

Initial Competency Competency Training Completed Theory Discussion Able to Explain Indications for  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  Assemble all components of circuit correctly  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 Not Competencies Achieved 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 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 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.

Print Assessors Signature

Print Individuals Signature

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

Competence Assessors initials

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 Any residual can interfere with the and dry adhesive Remove the paper from the adhesive Position the device so the This will protect the end of the nose clamps extend below the tip of against pressure from the plastic the nose by 0.5 inch. clamp Hold the device in place for 60 To ensure the adhesive has time to seconds warm and adhere to the skin Secure the NG Tube in place by The clamp has serrated teeth and closing the clamp. this should be firmly closed to secure the NG Tube

The Device should be To assess pressure area. Noting monitored every two hours changes to skin & changing position if necessary Documentation – on To identify changes and when they application and two hrly have occurred checks The patient may need to be The Tube may be difficult to re-pass referred to the Dietician for if dislodged or Patient may the insertion of a Bridle frequently remove NG Tube

Removing the Device Stop any feed In case of NG Tube displacement Release the NG Tube from the Maintain the NG Tubes position if clamps keeping in place. Gently remove the device from Report any skin damage in the the patients nose checking for repositioning chart any abnormalities Documentation – removal and To identify changes and when they changing of the device have occurred

Inotrope “Piggybacking” Competency

Name Date

Not Competency Achieved 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 Decontaminate hands as per the Trusts hand hygiene policy Collect all equipment Inform patient and/or relatives of procedure Decontaminate hands as per the Trusts hand hygiene policy 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 A. Demonstrates correct hand hygiene procedure as per of appropriate use of hand hygiene Trust Hand Hygiene Policy and Personal protective B. Demonstrates appropriate use of PPE equipment(PPE)

2. Demonstrates an understanding A. Maintain patient privacy and dignity of the importance of catheter care B. Discuss the procedure for consent to reduce infection 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 A. Identify when the bag requires changing of appropriate use of urine B. Identify when the bag requires emptying. collection bags

Nasogastric Tube - Confirming Position Competency

Name Date

Competency statements for confirming the position of a Staff Assessor Date nasogastric tube (NG) Initials Initials 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 Competence Assessors initials

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.

Initials Signature Name Date

Assessor