Raising the bar: Olympic skills test challenges aides to go for the gold
Agency creates'skills olympics' competency testing
The education manager of a Maine home health agency looked far and wide for months, trying to find a skills olympics competency program for aides. Finally, she stopped looking and, with help, created her own. "We competency-tested aides on everything they had to do in the home, but we had no process to do it annually," says Mary Cahoon, RN, staff development and training coordinator for Community Health and Counseling Services in Bangor, ME, an agency with five area offices and two satellites covering northern and eastern Maine.
Cahoon created the skills olympics, or skills laboratories, with assistance from June Fiske, RN, MS, staff development and training assistant. They were motivated by two main factors, Fiske says. First, the Joint Commission on Accredi tation of Health care Organiza tions (JCAHO) in Oakbrook Terrace, IL, wanted evidence of staff competency. Second, super visors said they needed an annual test of certain aide skills not practiced regularly. (See guidelines for skills olympics, p. 148.)
The agency assessed the skills of 129 aides companywide and saw that 44% needed improvement, Cahoon says. Supervisors had some clear ideas of what they needed to do in terms of education and skills procedures, such as help with ambulation and personal care.
Cahoon and Fiske started developing the program in the spring of 1997 and finished in December 1997. Supervisors spent January 1998 reviewing the skills olympics process with aides. The agency held the skills olympics in February and March of 1998.
It worked: 100% of staff ultimately passed the skills labs and written test. Supervisors liked the new tools and have decided to use them during aides' assessments throughout the year. The new system is so airtight it even includes competency testing for supervisors. Cahoon included that to ensure supervisors follow a process that complies with the system she and Fiske developed. Here's how they created the skills olympics:
1. Met with aides' supervisors. Cahoon and Fiske met with supervisors and area managers to discuss what type of assessment would be relevant to the core competencies. Some supervisors felt strongly that aides were not performing all of their tasks as well as they could, Fiske says. "So we wanted some process to ensure us and the consumer that their level of skills was appropriate."
Also, some area managers reported a need for aides to learn some specialized skills because their patient populations had a higher number of certain diagnoses, she says. For example, one area office might have a lot of patients with stomas, an artificial opening in the gastrointestinal system or urinary tract. "So that manager might hope aides would be competent in caring for people with these openings."
Cahoon and Fiske decided to build flexibility into the skills olympics so these types of specialized competencies could be added when needed.
2. Created a criterion sheet for each competency.
They decided to create a tool, called a criterion sheet, that would allow supervisors to easily document aides' competency in any particular skill. The tool identifies the objective, provides space for scoring aides on skills testing, and has an area for identifying whether aides need to be retested. (See sample criterion sheets for measuring pulse oximetry and fingernail care, inserted in this issue.)
Community Health and Counseling Services uses 25 criterion sheets, which are divided into three major categories:
· Basic skills: such as hand washing, nail care, temperature, and vital signs.
· Ambulation: such as range of motion, use of mechanical lifts, use of safety belt, transfers, exercise, and positioning.
· Other: such as heat application, collection of urine specimens, ostomy care, catheter care, cleansing enema, suppository use, and simple dressings.
Cahoon and Fiske created the sheets, using a variety of resources. Those included:
· the agency's procedure manual;
· Tina Marrelli's Home Health Aide: Guidelines for Care, a home health aide manual published in 1996 by Marrelli and Associates Inc. in Kent Island, MD;
· basic nursing skills books;
· other references about aides;
· feedback from supervisors about which skills needed to be included.
Nurses used their creativity
They revised everything to make sure it fit the agency's needs and matched the agency's own procedure manual, Fiske says. Before the testing, aides were allowed to look at the sheets to see what the supervisors' expectations would be, Cahoon says.
The criterion sheets have proved very useful, Cahoon says. For example, if a number of aides demonstrated deficits in competency in one criterion sheet area, then she and Fiske knew they needed to create an inservice on that topic.
3. Set up skills testing stations in area offices.
Office managers were encouraged to set up stations however they liked. Some scheduled two to four aides to go through the stations every hour and held the olympics over a week's time. Other offices scheduled aides more frequently and therefore were a little crowded. Some used mannequins in stations that tested aides' skills in ambulation and positioning, and others used employees portraying patients, Cahoon says.
"Some were very creative," she adds. "For example, for rectal temperatures, one supervisor made a model out of pantyhose and stuffed it with batting. "The pantyhose model had an orifice for where the thermometer would be placed. It was made so that the aide would have to lift the pantyhose model's leg in order to insert the thermometer.
Other stations had aides demonstrate nail care, check blood pressure, and perform the other competencies. Supervisors also gave aides a written test. Some were given on a separate day than the day they went through the skills stations. Aides had to earn a 90% score to pass the written test. Those who missed the mark were able to review the information and then take a test on the areas they missed within a week, Cahoon says. The written tests incorporated critical thinking scenarios; aides were given a situation and asked to expound on it.
Aides received certificates and gold stickers in honor of their success in the skills olympics, Cahoon says. (See sample skills olympics certificate, p. 149.)
4. Obtained feedback.
They encouraged managers, supervisors, aides, and other staff to comment on the skills olympics. "We actually had a teleconference with all the supervisors involved and got feedback that way," Fiske says.
Some aides said they found it stressful to go through the hands-on stations, Cahoon says. "But they said when it was over, they felt happy they had done that, and many had comments about how it was good to remind them how things are done properly."
Other aides commented that the stations were too slow. But that's to be expected whenever there's a process where people might have to wait in line, Fiske says.
"All the supervisors agreed it was a huge undertaking," Cahoon says. And some staff made suggestions for minor changes to the criterion sheets. One physical therapist said it would be better if they changed the order on the competencies involving transfers and ambulation. "It might be something as simple as changing when aides put the patient's shoes on," she explains.
5. Revised skills olympics as necessary.
Some of the criterion sheets were revised based on staff comments. For example, supervisors want to change the process and incorporate criterion sheets into their supervisory visits. That way, they would be using criterion sheets throughout the year. Staff would become more comfortable with them, and supervisors would use them on a regular basis.
"After everyone completed the testing, we ran a report based on our staff development form to make sure everyone had finished it," Cahoon says. "We did another report based on their skills, what their issues were, and which skills needed to be beefed up." (See sample staff development chart, inserted in this issue.)
The competency report identified the total number of employees who were assessed and the number showing a need for improvement. "So we looked at that and tried to determine in what kind of areas there were some opportunities to improve what we were doing,"she explains.
For instance, one office's staff did well on positioning and body mechanics, but another satellite office did not do as well. A little detective work revealed the office that performed poorly on that section did not give aides hands-on training, unlike the other offices. That office since has changed its training method to include hands-on instruction.
It's on the calendar for next year
In addition, Cahoon and Fiske added a new line to each criterion sheet relating to transfer or ambulation exercises. The new line reads, "Demonstrate proper use of body mechanics throughout procedure." The statement was added to further reduce potential injuries, Cahoon says.
"We also modified the written test according to the response we received," she explains. They found that some of the critical thinking scenarios needed to state more clearly what it is they wanted in an answer.
For example, one of the test questions said something like this: You've been caring for Willy BeGood for two months. You ask him if he's OK because he seems a little wobbly. He replies,'I'm OK, but my leg is a little stiff now.' Then one day, he gets out of the bathtub and falls. What might you have done to prevent his fall?
The question asked for too broad, too vague an answer, notes Cahoon. "So we changed it to:'What three things might you have done to prevent this fall?' We hadn't defined the parameters of the answer in the first question."
The skills olympics worked so well the agency plans to use it each year, she says. "It was a big deal, and the staff performed beautifully. Even though this is a new process, they're going to feel really happy - and some already do - that we set the bar quite high, and they succeeded."
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