Evaluation Competency Tech

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:
Reference #3018 Emergency Department
1 of 9
MCN Healthcare (800) 538-6264
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
2 of 9

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
3 of 9

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
4 of 9

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
5 of 9

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
6 of 9

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
7 of 9

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
8 of 9

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:
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
60
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:
9 of 9

Evaluation Competency Tech

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Evaluation Competency Tech

Transféré par

Droits d'auteur :

Formats disponibles

ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT

EVALUATION OF CLINICAL PERFORMANCE

Supply Closet Stock:

To call ED physician extension __1001_____

Clinical Lab orders (enter and receive)

Electronic Health Record

Admission of Patient to Observation:

Emergency Telephone Use:

Checking and Restocking Supplies:

Follow through on admission orders

Patient Transfers to Another Facility:

Copies all pertinent records

Initiate transfer via DASH

Initiate MOT form

Calls appropriate transport vehicle

Reference #3018 Emergency Department

MCN Healthcare (800) 538-6264

ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT

Takes vital signs accurately

Notifies ED physician or ED nurse of signs and symptoms that

Alerts ancillary departments, if needed

Brings appropriate equipment

Use of EKG machine

Pulse Oximetry Application

Assist with intubation setup

Demonstrates proper wound cleaning

Sets-up for suture

Reference #3018 Emergency Department

MCN Healthcare (800) 538-6264

ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT

Maintains sterile technique

Documents description of wound

Sets-up for pelvic exam and assists with exam

Assists delivery with BOA kit

Demonstrates knowledge in collection of specimens

Assesses neurovascular status

Assists with application of OCL splint

Assists with C-spine immobilization

Applies c-collar/Cervical Immobilization Device

Applies clavicle strap

Applies shoulder immobilizer

Measures for fit of crutches

Educates patient on crutch walking

Reference #3018 Emergency Department

MCN Healthcare (800) 538-6264

ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT

Application of cast shoe

Application of finger splint

Clean catch urine

Urine bags to pediatric patients

Assists with chest tube insertion

Assists with central line or cut down insertion

Assists with emergency tracheostomy

Assists with lumbar puncture

Assists with thoracentesis

Assists with paracentesis

Demonstrates knowledge of infection prevention and control policies and

List criteria for identification of abuse victims:

Reference #3018 Emergency Department

MCN Healthcare (800) 538-6264

ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - EMERGENCY DEPARTMENT

Demonstrates competence in reporting victims of abuse according to

Locate the Following:

Adult crash cart

To call ED physician extension 1001___