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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT

EVALUATION OF CLINICAL PERFORMANCE


EMERGENCY DEPARTMENT TECHNICIAN
1 = Cannot Perform Skills Independently
2 = Requires Some Assistance to Perform Skills
3 = Can Perform Skill Independently
NA = Not Applicable

Supply Closet Stock:

NA

Order sheet

NA

To call ED physician extension __1001_____

NA

Use of Computer:

Clinical Lab orders (enter and receive)

NA

Electronic Health Record

NA

NA

Admission of Patient to Observation:

Emergency Telephone Use:

Checking and Restocking Supplies:

Charge sheet

Follow through on admission orders

Patient Transfers to Another Facility:

Copies all pertinent records

NA

Initiate transfer via DASH

NA

Initiate MOT form

NA

Calls appropriate transport vehicle

NA

Triage Assessment:

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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT


TECHNICIAN (continued)

Takes vital signs accurately

NA

Notifies ED physician or ED nurse of signs and symptoms that


require immediate intervention or changes in vital signs

NA

Trauma Care

Assesses/documents ABCs

NA

Undresses patient

NA

Alerts ancillary departments, if needed

NA

Brings appropriate equipment

NA

NA

Vital Signs

Monitor Application:

Use of Lifepak

NA

Use of EKG machine

NA

Pulse Oximetry Application

NA

Application of Oxygen

NA

Airway Management:

Nasal cannula

NA

Mask

NA

Humidification

NA

Oral airway

NA

Assist with intubation setup

NA

NA

Performance of CPR

Control of Bleeding:

Venous

NA

Arterial

NA

Wound Care:

Demonstrates proper wound cleaning

NA

Sets-up for suture

NA

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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT


TECHNICIAN (continued)

Maintains sterile technique

NA

Dressing application

NA

Documents description of wound

NA

OB/GYN:

Sets-up for pelvic exam and assists with exam

NA

Assists delivery with BOA kit

NA

Demonstrates knowledge in collection of specimens

NA

NA

Orthopedics:

Assesses neurovascular status

Palpates pulses:

Brachial

NA

Pedal

NA

Posterior tibia

NA

Popliteal

NA

Radial

NA

Assists with application of OCL splint

NA

Assists with C-spine immobilization

NA

Applies c-collar/Cervical Immobilization Device

NA

Applies sling

NA

Applies clavicle strap

NA

Applies shoulder immobilizer

NA

Measures for fit of crutches

NA

Educates patient on crutch walking

NA

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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT


TECHNICIAN (continued)

Application of cast shoe

NA

Application of finger splint

NA

Specimen Collection:

Clean catch urine

NA

Urine bags to pediatric patients

NA

Sputum

NA

Stool

NA

Suction:

Set up

NA

Oral

NA

Tracheal

NA

Canister change

NA

Miscellaneous Procedures:

Assists with chest tube insertion

NA

Assists with central line or cut down insertion

NA

Assists with emergency tracheostomy

NA

Assists with lumbar puncture

NA

Assists with thoracentesis

NA

Assists with paracentesis

NA

NA

Demonstrates knowledge of infection prevention and control policies and


procedures, i.e., Standard Precautions, Transmission-Based Precautions,
personal protective equipment, aseptic technique, hand hygiene.

List criteria for identification of abuse victims:

Infant/child

NA

Adolescent

NA

Elderly

NA

Domestic abuse

NA

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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT


TECHNICIAN (continued)

Fiduciary

NA

Neglect

NA

NA

Demonstrates competence in reporting victims of abuse according to


established hospital standards and state and local laws.

Locate the Following:

Adult crash cart

NA

Pediatric crash cart

NA

Laceration Carts/Trays

NA

Doppler

NA

Demonstrates competency in the knowledge of the delivery of patient


care in an environment that optimizes patient safety and reduces the
likelihood of medical/health care errors.

NA

Demonstrates the knowledge of proper identification and reporting of


medical/health care errors. Protects the patient in the event of a
medical/health care error and, as appropriate, assists in medical/health
care error resolution.

NA

Demonstrates knowledge of and follows organization policies regarding


the applicable National Patient Safety Goals. (See NPSGs and Universal
Protocol Competency Form)

NA

Demonstrates knowledge of the organizations Emergency Operations


Plan.

NA

Documentation:

Emergency Department Record

NA

Electronic Health Record System

NA

AMA/Elopement

NA

Animal bite reporting

NA

Transfer forms

NA

Stock order forms

NA

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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT


TECHNICIAN (continued)

Discharge instructions

NA

Patient education

NA

Incident report forms

NA

Charge sheets

NA

Unit Environment - Able to locate the following:

Directory:

Hospital telephone numbers

NA

Physicians

NA

Fire Equipment:

Alarms

NA

Extinguishers

NA

Exit doors

NA

Oxygen valves and shutoff

NA

Food refrigerator

NA

Isolation equipment

NA

Emergency (red) outlets

NA

Linen

NA

Stocking individual treatment areas.

NA

Other:

Unit Organization - Able to describe roles and functions of:

Emergency Department Nurse Manager

NA

Emergency Department Physician Director

NA

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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT


TECHNICIAN (continued)

Emergency Department Physicians

NA

Emergency Department Nurse Practitioners

NA

Emergency Department Physicians Assistants

NA

Emergency Department RNs

NA

Emergency Department LPNs/LVNs

NA

Support Services:

Imaging Services/Radiology

NA

Pharmacist

NA

Other departments

NA

Unit Resources - Able to locate and demonstrate the use of:

Emergency Department Policy and Procedure Manual

NA

Hospital Policy and Procedure Manual

NA

Fire/Emergency Management Manual

NA

Infection Prevention and Control Manual

NA

Material Safety Data Sheet (MSDS)- how to obtain

NA

PDR/Drug Reference- how to obtain

NA

Unit Specific Reference Materials

NA

Community Resources

NA

Patient Teaching Aids/Materials

NA

PI Documentation

NA

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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT


TECHNICIAN (continued)

Physician list

NA

Others

NA

Unit Routines - Able to describe, locate and/or demonstrate knowledge of:

Communication System:

Demonstrates understanding of the principles of


information management

NA

Bulletin boards

NA

Logbooks

NA

Meeting minutes

NA

Ordering supplies

NA

Cultural Factors:

Religion

NA

Food preferences

NA

Family/community relationships

NA

Healthcare attitudes/understanding

NA

Trust/privacy needs

NA

Socioeconomic environment

NA

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ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT


TECHNICIAN (continued)
SCORING:
80 to 100%
50 to 79%
0 to 49%

= Exceeds Performance
= Expected Performance
= Needs Improvement

(Note: Be sure to not calculate those skills which have been documented as NA)
Skills rated 3 X the number:
Skills rated 2 X the number:
Skills rated 1 X the number:
Add the above numbers to obtain the Employees Score:
(Employees Score Maximum Score = _____ X 100 = The Employees Score in a Percentage)
EXAMPLE:
77 skills are on the competency; two (2) of those skills are not applicable for this employee. Therefore, the employee
was evaluated on 75 skills for a maximum score of 75 X 3 = 225.
The employee received:
Skills rated 3 X the number: (40 Skills X 3)

120

Skills rated 2 X the number: (30 Skills X 2)

60

Skills rated 1 X the number: (5 Skills X 1)

Add the above numbers to obtain the Employees Score:

120 + 60 + 5 = 185

(185 225 = .82 X 100 = 82.2%. The employees score falls into the category of Exceeds Performance.)
Identified Areas that Require Improvement:

Comments:

Name:

Title:

Date:
Signature of Supervisor:
Signature of Staff Member:

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