It's not that easy to assess staff competency
System meets JCAHO standards
Many home care agencies find meeting the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) competency assessment standards easier said than done, sources say. JCAHO standard HR.6 requires that organizations assess, maintain, and improve the competency of all care and service staff members.
Agencies' difficulty with this standard usually arises from an incomplete competency evaluation system or inappropriately qualified competency observers, says Mary Friedman, MS, RN, CRNI, principal for Home Health Systems Inc. in Marietta, GA.
Hospital-based agencies also sometimes stumble by not separately assessing the home care-specific competencies of staff who work in both home care and the hospital, she adds.
Sources offered these tips to combat these issues:
· Identify staff whose competency must be assessed. Providers must assess the competency of all employees, contractors and volunteers who directly provide patient care or whose work directly impacts patient care. This includes all professional staff (RNs, LPNs, physical, occupational and speech therapists, and social workers) and any managers who may make visits or perform core competency functions such as education from the office, says Friedman. Agencies with infusion or DME services must also assess competencies of positions such as pharmacy technicians and delivery drivers. (Home health aide competency assessment is nothing new to Medicare-certified agencies; it is a long-standing condition of participation.)
Home care agencies are responsible for their contractors' competency - both independent individuals and those employed by other companies. Your organization can conduct these assessments itself, hire an outside firm to do so, or rely on the contractor. If you utilize the contractor's evaluation system, make sure it assesses the same skills you defined in your competency set, warns Friedman. And maintain separate files on all individuals providing care under contract to your organization.
· Establish position competencies. The Joint Commission does not dictate qualifications; each organization must determine its own required knowledge and skill set. Core competencies should include frequently performed procedures and know-how needed to care for an agency's general patient population, says Friedman.
Providers must also develop separate competencies for specialty populations and equipment, such as pediatrics, ventilators, or infusion therapies. Only staff who will service specialty patients must undergo specialty competency assessment, adds Friedman.
· Identify assessors. Professional staff with the same or higher licensure status may assess peers' competency. Providers' interpretation of this requirement is sometimes problematic, says Friedman. A common mistake is crossing disciplines. For example, an RN can assess a physical therapist's infection control knowledge and documentation skills but is not qualified to evaluate his or her practice-specific proficiency.
Some organizations also incorrectly assume that only supervisory or training staff can evaluate competencies. But appropriately qualified peers may also participate, says Friedman. The size of your operations may dictate whom you engage as assessors.
For example, with only managers involved, organizations which offer shift care and have a large per diem staff may have great difficulty maintaining current assessments. Sizable agencies may consider offering a skills day where certain core competencies can be observed in the office, Friedman suggests.
St. Joseph Hospital Home Health Care Services in Augusta, GA, utilizes skill labs and inservice programs for its ongoing staff competency assessment.
Recent inservices include new pumps and new dressing change and wound care techniques, says Tony Zizzamia, administrator.
The perinatal service of Northside Hospital Home Care in Acworth, GA, incorporates equipment inservices and competency assessments into its routine staff meetings. The program's small size (less than 10 employees) facilitates round table demonstrations and reviews, says Diana Christy, RN, C, patient care coordinator.
· Determine when competency assessments must be performed. Competency assessments must be performed upon hiring; after orientation; with new services, skills, technologies and products; and periodically at organization-established intervals.
· Outline the evaluation process. The Joint Commission does not define how agencies must determine an individual's competency. Common methods include personal interviews, letters of reference, licensure and certifications, education and prior work experience, knowledge testing, and self-reporting. Both St. Joseph's and Northside use these elements. Both organizations tailor orientation to meet new hires' self-reported areas of deficiency, coupled with a skills lab for direct observation and return demonstration of key skills.
Observation waived under certain conditions
Home care departments often share staff with other hospital services.
Each program is not required to separately assess all its respective competencies; only those unique to its services, says Friedman.
For example, a home care agency that employs a pediatric RN part-time whom a hospital department also employs full-time, may waive demonstration for all but the home care-specific skills, says Friedman. Each department's competency reviews should be attached and placed in the employee's human resource file. Friedman reports many of her hospital-based clients, skeptical that both forms will remain together in the employee's master file, choose to maintain their own file, but this is not a JCAHO requirement.
Skills not observed during orientation in the office must be evaluated in the field before the staff member can perform them in practice. Both St. Joseph's and Northside have extensive orientation programs that pair new employees with veteran nurses. Each program lasts about a month. The nurses observe and demonstrate all required competencies before handling their own case load.
After orientation, most companies observe competencies at least annually to coincide with staff performance evaluation, Friedman notes. Christy conducts supervisory visits for each perinatal staff member periodically throughout the year.
· Report activities to your governing body. Inform the hospital board and executive management about your competency assessment process at least annually. You may report on information such as the number and results of orientation and ongoing assessments, and your staff's overall learning needs and education plans instituted as a result, says Friedman.
Ongoing home care competency assessment is logistically challenging, providers concede. "It takes extra time and effort and requires day-to-day time and energy," says Friedman.
Says Zizzamia, "It is challenging and costly to implement, but it shows we have a quality service because our staff must maintain minimum standards." However, he cautions "against going overboard. You don't have to recertify someone's license. You just focus on the high risk, frequently performed skills. If you worry about everything under the sun, you'll never see a patient."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content