Management of Medical Devices Policy - … · Policy Lead: Natalie Warman ... 14 12 References 15 ... Manual Handling, Health and Safety, Resuscitation, Incident policy,

Management of Medical Devices

Policy

Version: Version 5

Policy Lead: Natalie Warman Assistant Director of Nursing for Physical and Public health

Policy Category: Clinical

Date issued: January 2011

Review date: January 2013

Ratified by: Governance Executive

Date ratified:

Name of responsible committee: Medical Devices Committee

Target audience: Clinical and Non Clinical Staff

Approved by …Medical Devices Committee

Date: September 2010

Ratified by … Governance Executive.

Date:

Equalities Impact Assessment Assessor: Natalie Warman Date: 6.1.11

Child Safeguarding Assessment

Assessor Matt Beavis Date:

HRA Impact Assessment Assessor: Date:

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CONTENTS Page

1 Introduction 3

2 Purpose of Policy 3

3 Consultation and communication with stakeholders 3

4 Roles and Responsibilities 5

5 Ordering Equipment 9

6 Decontamination and cleaning 10

7 Incidents relating to medical devices 10

8 Training 11

9 Policy Standards 13

10 Implementation of Policy, including dissemination, and training. 14

11 Monitoring Compliance and the Effectiveness of Policy, including

audit and review. 14

12 References 15

Terms of Reference Medical Devices Committee 16

Appendices

Appendix A

Recommended medical devices equipment. 19

Appendix B

Reporting faulty medical devices for repair 20

Appendix C Decontamination and cleaning 21

Appendix D Declaration of decontamination Form 24

Appendix E

Mattress Guidance 25

Appendix F

Commode Guidance 28

Appendix G

Procurement of medical devices 29

Appendix H

Contact details

30

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CONTENTS Page

Appendix I Verification of Competencies and safe use of Medical Devices

31

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1. INTRODUCTION

Medical devices are essential in assessing service users’ overall physical health. The physical health needs of people with a mental illness are documented within both statutory and clinical literature. Medical devices are essential in the assessment and monitoring of our service users health either in detecting a baseline or identifying deterioration or improvements in patients. This policy will apply to any Medical Device including Medical Laboratory Equipment which is either owned by the Trust, or used in connection with patients who are being managed by the Trust; the policy will also apply to devices on loan or trial.

Definition of a medical device The Department of Health defines a medical device as ‘any instrument, apparatus, appliance, material or other article whether used alone or in combination, intended by the manufacturer to be used for human beings for the purpose of: control of conception; diagnosis, prevention, monitoring, treatment or alleviation of disease; diagnosis, monitoring, treatment, alleviation of or compensation for an injury or handicap; investigation, replacement or modification of the anatomy or physiological process. Surgical instruments are medical devices. Therefore medical devices include, for example, commode chairs, dressing trolleys, BP cuffs and bedpans”

2. PURPOSE OF POLICY

The purpose of this policy is to ensure that medical devices used by staff: • promote patient safety • are used by appropriately trained and competent staff • are clean and decontaminated • are properly procured • are suitable for its intended purpose • in a safe and serviceable condition • annually serviced and audited

This policy is to be used in conjunction with the Resuscitation Policy 2010, Physical

Health Care Policy 2010 and the ECT Policy and infection control policies. This policy also merges the existing infection control decontamination policy.

3. CONSULTATION AND COMMUNICATION WITH STAKEHOLDERS

This policy was developed by the Trusts’ Medical Devices Committee and consulted and communicated with all directorates across the organisation including the heads of professions and social care.

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4. ROLES AND RESPONSIBILITIES

4.1 THE TRUST

Recognises its roles and responsibilities in relation to:

• The procurement of medical devices • Will investigate all adverse incidents involving medical devices and report faulty

equipment to the Medical and Healthcare Products Regulatory Agency (MHRA) • Will ensure that all staff are competent in medical devices via the CEO Performance

Management Review framework • Will provide EBME services.

.

4.2 THE MEDICAL DEVICES COMMITTEE

• Monitor and tender for contracts in line with safety, quality of service, performance, cost effectiveness and financial instructions.

• Will make recommendations to clinical staff and directorates on the standardisation of medical equipment throughout the Trust and develop systems in which this can be implemented.

• Will monitor incidents relating to medical devices and produce an annual summary of adverse incidents occurring with Medical Devices to the Trust’s Risk Management Committee.

• Will disseminate any alerts from the MHRA in relation to medical devices. • Will standardise equipment across the Trust. • Will identify and develop systems to ensure that training is available to staff and

develop competency requirements for clinical and non clinical staff in the use of medical devices

• Will support the directorates to identify the medical devices requirements • The Medical Devices Committee will monitor the compliance and effectiveness of the

policy and report to the Risk Management Committee and the Clinical Effectiveness Committee

• Will monitor the contract for EBME • Will report to the MHRA any adverse incidents relating to equipment. • Will seek advice from the MHRA on any safety or quality aspects of medical devices

management. • Will monitor hire arrangements with companies that have been approved by the

medical devices committee to ensure they meet MHRA regulations.

4.3 SUPPLIES

• Will ensure that staff order the recommended items as specified via the Medical Devices Committee.

• Will ensure that staff receive all medical devices ordered • Will advise the medical devices committee regarding tendering arrangements • Will make recommendations to the medical devices committee in respect to

appropriate suppliers . 4.4 TRUST HEALTH AND SAFETY RISK MANAGER

• Will distribute Alert Notices through the Central Alert System (CAS) from the Medical and Healthcare Product Regulatory Agency (MHRA) and National Patient Safety Agency (NPSA) to staff

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• Will follow up the implementation of actions required by information received from Alert Notices from the NPSA and MHRA and report these to the medical Devices Committee.

4.5 PATIENT SAFETY OFFICER

• Will ensure that all staff have up to date information regarding the Trusts’ recommended medical devices equipment list

• Will annually audit the availability of resuscitation and other approved medical devices equipment within the clinical areas.

• Will provide or liaise with manufactures regarding a training programme on medical devices for all staff.

• Will provide support to staff regarding re-ordering of recommended equipment .4.6 ELECTRO-BIO MEDICAL EQUIPMENT DEPARTMENT (EBME)

EBME will keep an inventory of all Trust Medical Devices and will review this Bi annually with the Medical Devices Committee this will be provided by Key health Solutions Limited 08700 420 735.

Will register all equipment on the inventory and label with an allocated inventory number. Where labelling is impractical, the owner must keep a separate record cross referencing the item’s identification number with an alternative means of identification (e.g. serial number and description of item).

Will ensure that equipment in clinical use is safe and in serviceable condition so that it is capable of fulfilling the purpose for which it was designed.

This contract covers all medical equipment with the exception of: • equipment still under warranty • equipment in ECT suites – including anaesthetic machines • neuro-imaging and x-ray department equipment

If equipment can not be repaired on site EBME will take equipment for repair or disposal.

EBME will provide an annual audit of all equipment across all clinical sites. This will include:

• inspecting all devices in the clinical area or setting • conducting functional tests to manufacturers standards • identifying faults • safety [PAT] testing • repair and recalibration • disposal of obsolete equipment • updating equipment inventory, and bar coding all devices

All items repaired and returned to the Trust will be decontaminated beforehand and evidence from EBME must be provided that this has been done.

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EBME services will contact all clinical areas to arrange visits which are convenient to the service.

EBME will report any potential incidents regarding faulty equipment to the • Chair of the Medical Devices Committee • the Ward Manager/ Team Leader • the Patient Safety Officer • Head of Supplies

EBME will respond to calls within 24 hours with the exception of weekends.

4.7 CAG DIRECTORS

• Will ensure that both inpatient and community teams are able to procure medical devices to clinical teams to support the safe assessment and management of patients

• Will ensure that all appropriate clinical staff are trained and competent to use medical devices

• Are compliant with national standards in relation to medical devices. • will ensure that staff have knowledge of the medical devices policy • All directorates must have a rolling programme of equipment replacement. Planned

replacement of major items should be incorporated into CAG business plans 4.8 WARD MANAGERS AND TEAM LEADERS

• Will purchase the recommended equipment from the medical devices committee and from NHS supply chain.

• Ensure that all new equipment is reported to EBME department for inclusion onto the audit and medical devices register.

• Ensure devices that are purchased for multiple use are designed and manufactured for that purpose.

• Will ensure that there is a log book in each area that contains accurate records for each piece of equipment regarding the purchasing, warranty, servicing and disposal of all items of equipment.

• Ensure that contractual warrantees on specific items of equipment are maintained.

• Will ensure that all new equipment is installed correctly and all the appropriate documentation logged into a log book that is available to present as evidence for audits or inspection from both internal and external inspectors.

• The provision of alternative facilities in the event of equipment failure are provided

• Ensuring that all staff are made aware of the Medical Devices Policy requirements and responsibilities to them

• Ensure that staff know how to report faulty equipment to EBME services • Ensuring that changes to equipment are reported to the EBME department. • Will be competent to assess clinical and non clinical staff in the use of medical

devices equipment • Ensuring that users of equipment have completed there medical devices

competency every 2 years and will keep records of staffs training and verifications of competency.

• Ensure that resuscitation/ emergency equipment is checked weekly. that is available as evidence for audit or inspection from both internal and external inspectors see appendix

• Have systems in their environments to ensure that medical devices are clean.

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• Ensure that all medical devices have a cleaning schedule that is available as

evidence for audit or inspection from both internal and external inspectors. • Will ensure that equipment is replaced, when it is: • worn out beyond economic repair • damaged beyond economic repair • clinically or technically obsolete • requiring repair but spare parts no longer available • will report to the chair of the medical devices committee, the local Health and

Safety co-ordinators and the nurse advisors any equipment that appears to be faulty in design, that may pose a risk to other patients and other users across the Trust, so that this can be investigated Trust wide.

4.9 ALL CLINICAL STAFF

• Are responsible for being familiar with their responsibilities under this policy and complying with them. They are also required to be familiar with other associated relevant Trust policies such as those for Infection Control, Nutrition, Physical Health, Manual Handling, Health and Safety, Resuscitation, Incident policy, Mental Capacity Act Guidelines

• All staff will have their competency regarding medical devices checked as a minimum every 2 years,(staff should identify their continuing professional development needs via appraisal and supervision regarding competencies concerning medical devices)

• Clinical staff, who have a physical impairment that may affect their ability to use a medical device, must inform their ward manager or team leader so that adjustments can be made.

• Will contact the Trust’s patient safety advisor if they are unable to install a new piece if equipment.

• All staff will clean/decontaminate any medical device after use. • Ensure that all disposable items for single use are disposed of after single use in the

appropriate manner. NO ATTEMPT SHOULD BE MADE TO CLEAN, STERILISE OR DISINFECT SINGLE USE ITEMS AFTER THEY HAVE BEEN USED

• Ensure that any equipment that appears to not be working appropriately is taken out of the clinical areas cleaned and then labelled as faulty.

• Immediately report faulty equipment to EBME for investigation and assessment and ensure that arrangements have been made for collection /on site repair.( see appendix B )

• Ensure that any equipment that requires replacement is done so immediately, and that items are procured from either the Trusts recommended list of equipment or if not available via the NHS supply chain.

• Will report all adverse or potentially adverse incidents involving medical devices on an adverse incident reporting form and to their line manager.

4.10 NON CLINICAL STAFF

Non clinical staff may use equipment that does not require a professional qualification. If a non clinical member of staff is required to use a piece of equipment:

• This must be identified as a professional development needs and agreed via the appraisal and supervision system.

• Are responsible for being familiar with their responsibilities under this policy and

complying with them. They are also required to be familiar with other associated

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relevant Trust policies such as those for Infection Control, Nutrition, Physical Health, Manual Handling, Health and Safety, Resuscitation, Incident policy, Mental Capacity Act Guidelines.

• Receive the relevant training and complete the relevant competency verification documents before using the equipment.

• Report and document findings to a shift co-ordinator or in the community to a trained clinician.

4.11 STUDENTS

• all student nurses will report and document all findings to the shift co-ordinator • Will have their competencies verified throughout their placement

5.0 ORDERING EQUIPMENT

A list of standardised medical equipment can be found on the Trusts medical devices equipment page. These items must be ordered to ensure standardisation, ease of ordering and cost efficiency. http://sites.intranet.slam.nhs.uk/resus/Medical%20Devices/Forms/AllItems.aspx A number of medical devices can be found in the NHS Supplies catalogue. Any items which can be found in the catalogue should be ordered using a STOCK REQUISITION or on line.

Other medical equipment which is not found in the catalogue should be ordered by completing a NON-STOCK REQUISITION, and sent to the supplies department at the Bethlem Hospital.

All resuscitation equipment must be ordered from the mandatory stock list which is available on the intranet.

5.1 EQUIPMENT THAT ARRIVES TO AN AREA

All equipment on arrival to an area must be checked by the EBME department and for:

• Relevant documents • Instructions, compliance and calibration certificates, is the device correct, warranty

details, Does the device need decontaminating before first use? • Damage, appropriate CE markings, serial numbers? Functional ability of the device • Does the device function in line with the manufacturer’s instructions or guidance,

does the device need additional accessories, if so which items are compatible, do indicators/ lights operate appropriately when the device is powered up?

• Does the device need an electrical basic safety check prior to use?

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• Has the device been calibrated prior to use or does this need to be done, e.g. glucometers will need calibrating and checking, scales should have a calibration certificate?

• Does the equipment need to be installed? E.g. height measurements that need to be attached to walls need to be fitted via the works department prior to use?

5.2 EQUIPMENT USED BY VISITING PROFFESSIONAL

When services arrange for visiting external services that may use medical devices such as chiropody or dentistry, the directorate must ensure that prior to the commencement of that service that a Health and Safety Risk assessment is completed. The risk assessment must include assurances from the provider that they have systems and assurances that medical devices are decontaminated from the point of generation to decontamination. This risk assessment must be overseen by the infection control team.

5.3 KEEPING A RECORD/LOG OF MEDICAL DEVICES

All clinical areas will have a log book which details the lifespan of all equipment within the clinical area. This will include: • documentation on receipt of an item, • certificates of calibration • warranties • servicing history • repairs history • decontamination certificates if the item has been returned for repair outside the

organisation • cleaning and checking schedules • certificate of disposal

6.0 DECONTAMINATION AND CLEANING

Medical devices may serve as vehicles for the transmission of infection to susceptible hosts. Decontamination is the combination of processes (including cleaning, disinfection and sterilization) used to make a re-usable medical device safe for further use on patients and handling by staff. The effective decontamination of re-usable medical devices is essential in reducing the risk of transmission of infectious agents

• All staff will clean/decontaminate any medical device after use in accordance with

the manufacturers instructions • Ensure that all disposable items for single use are disposed of after single use in the

appropriate manner. NO ATTEMPT SHOULD BE MADE TO CLEAN, STERILISE OR DISINFECT SINGLE USE ITEMS AFTER THEY HAVE BEEN USED

• For all pieces of patient equipment, Vernacare labels must be used. This demonstrates that equipment has been hygienically cleaned and is safe to use. This can be ordered via NHS Supplies catalogue, Single roll - FSE 113, Case of 20 rolls - FSE 113 x 20

• Ensure that all medical devices have a cleaning schedule and that is available as evidence for audit or inspection from both internal and external inspectors see appendix

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• All items repaired and returned to the Trust will be decontaminated beforehand and evidence from EBME or any other manufacturer must be provided see Appendix

• For support and advise about decontamination contact the Infection Control Department

7.0 INCIDENTS RELATING TO MEDICAL DEVICES Any adverse incident involving a device which has or could lead to:

• death, life-threatening illness or injury or the potential for death or injury in the

future • deterioration in health or permanent impairment of body structure or function • the necessity for medical or surgical intervention • hospitalisation • any other device related adverse incidents • any minor faults and discrepancies (these may take on a greater significance

when aggregated with similar events • incidents of human error • the error may be partly (or wholly) due to deficiencies in the design of the device

or instructions for use • they will help prevent repetition of mistakes

• Incidents concerning medical devices may arise due to:

• shortcomings in the design or manufacture of the device itself. • inadequate instructions for use • inadequate servicing and maintenance • inappropriate user practices (which in turn may result from inadequate training) • inappropriate management procedures • the environment in which a device is stored • selection of the incorrect device for the purpose • an incident is an event which gives rise to, or has the potential to produce,

unexpected or unwanted effects involving the safety of patients, users or other persons. Users will immediately take out of commission all devices involved with any suspected adverse incident where the functionality of the device is in question

All incidents relating to medical devices should be reported to The Trust Health and Safety Risk Manager and an incident form completed using Datix.

• Incidents are to include.

• full description of the Medical Device. • serial Number of the Device • makers Name • full synopsis of what happened

8.0 TRAINING

No medical equipment shall be used clinically unless the operators [staff, and in some cases patients], who use the device[s] have received appropriate training. The details of

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the training required will be agreed by the Medical Devices Committee. Particular attention should be paid to the training requirements for new equipment.

A minimum requirement is that all practitioners should have two yearly updates of their skills in using the equipment within their clinical areas

Records of training and verification of competency will be kept by line managers see Appendix H, this will include: -

• neuro-imaging and X ray equipment • ECT and anaesthetic equipment • the nine basic items of equipment as listed within Appendix H • resuscitation equipment

8.1 ASSESSING COMPETENCIES IN THE USE OF MEDICAL EQUIPMENT

• It is essential that all staff using items of medical equipment are competent in the safe and effective use of the equipment and can demonstrate this to their assessor

• It is important that the assessors have the competencies and the skills themselves to assess and verify another individual’s level of competency

• All clinical professionals including doctors are responsible for maintaining competency in the use of equipment.

• The verification competency handbook provides assurances and agreed supervision levels and expectations for all staff in relation to their competencies to use medical devices.

• In addition, the individual verification forms must be signed and dated and kept available for audit, by the Line Manager in the individual’s personal profile/supervision/appraisal records. It will be necessary for medical staff to provide evidence to Ward Managers that they have been verified as competent

• Medical Staff operating ECT equipment will be assessed as being competent by their Clinical Supervisor, see the Trusts ECT Policy.

8.2 WHO CAN ASSESS COMPETENCIES?

Team Leaders, Ward Managers, Nurse Advisors (NAs), Modern Matrons (MMs) and Quality Service Nurses (QSNs).

o It is essential that all assessors are competent in the use of the equipment

themselves. To be deemed competent assessors must have attended one of the following: � on site training facilitated by the suppliers of the equipment or by the Trusts

patient safety officer

o It is important that the assessors have recognised skills in assessing another person. To be deemed competent in this you must have attended one of the following: � Mentorship training � Supervision and Appraisal training � A teaching course

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Flow chart of the Assessment Process

8.3 COMPETENCY VERIFICATION

� The individual must read the appropriate chapters in the Royal Marsdens Clinical handbook. This is available on line via the Nursing and Education Directorate intranet page

� The individual being assessed should be informed that the assessments will be taking place in advance. The assessor should ensure that the individual has plenty of opportunities to practice using the equipment/kits and understands all of the health and safety requirements for the safe use of the equipment. If concerns are raised about the individuals competency regarding a piece of equipment, clear action plans must be written with the individual to address the problem, through coaching and further training and opportunities to practice the skills

� There must be a record of competency achievement related to all items of equipment being used. If the equipment being used changes through upgrading or because other systems have replaced it, then there will be training implications for the use of the equipment

8.4 HOW OFTEN DOES COMPETENCY ASSESSMENT NEED TO TAKE PLACE?

There must be a record of competency achievement related to all items of equipment being used. If the equipment being used changes through upgrading or because other systems have replaced it, then there will be training implications for the use of the equipment.

A minimum requirement is that all practitioners should have two yearly updates of their skills in using the equipment within their clinical areas.

9.0 POLICY STANDARDS

These standards are in line with the care quality commissions and MHRA recommendations for the management of medical devices.

Modern Matrons, Quality Service Nurses, Clinical Co-ordinators, Nurse Advisors. Will Assess

Clinical Staff, Community and Ward Staff.

Team Leaders, Ward Managers, Senior Nurses. Will Assess

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� To measure the success of these standards, performance targets will be: 100%

Measure Number

Improvement measure Assurances

MD1 Al clinical areas have the Trusts’ mandatory items of equipment

Annual Nursing Audits EBME PPM

MD2 All clinical areas have checked the resuscitation/ emergency equipment weekly

Patient safety annual audit of resuscitation equipment.

MD3 All equipment in clinical areas have been audited and checked annually by the appropriate EBME service

EBME annual audit and inspection records reported to medical devices committee

MD4

There is a log book which details the receipt of equipment, servicing history and disposal

Log book Annual medical devices audit

MD5 All equipment is cleaned and decontaminated

Decontamination audits Monthly cleaning and decontamination checklists Commode and mattress audits. Annual medical devices audit

MD6

All staff responsible for medical devices have completed .their medical devices competency

Mandatory training and competency records Annual medical devices audit.

10.0 IMPLEMENTATION OF POLICY, INCLUDING DISSEMIN ATION, AND TRAINING

The CAG directors are responsible for the implementation of the policy within their own CAGs.

The policy will be available on the Trust’s Intranet, and disseminated to staff via the infrastructures within each of the corporate and service directorates.

It is the responsibility of all staff to self assesses their competency within the requirements of their roles and should identify their continuing professional development needs through appraisal and supervision.

Information regarding medical devices is available on the Trusts’ intranet site http://sites.intranet.slam.nhs.uk/resus/default.aspx Staff should access this site for up to date information regarding medical devices.

11.0 MONITORING COMPLIANCE WITH AND THE EFFECTIVEN ESS OF POLICY, INCLUDING AUDIT AND REVIEW

The Medical Devices Committee will monitor the compliance and effectiveness of the policy and report to the Risk Management Committee and the Clinical Effectiveness Committee; evidence of compliance of the policy will be achieved by collecting assurances from;

• Trustwide annual audits of the medical devices standards. • EBME audits

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• Annual work programme of the medical devices committee • Incidents • Central Alert System (CAS) from the Medical and Healthcare Product Regulatory

Agency (MHRA) and the National Patient Safety Agency (NPSA).

12.0 REFERENCES

MHRA (2006) Managing Medical Devices Guidance for healthcare and social care organisations.

MHRA (2006) Single Use Medical Devices: Implications and Consequences of Reuse.

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MEDICAL DEVICES COMMITTEE

TERMS OF REFERENCE

AIM To ensure that the Trust adheres to and is compliant with MHRA regulations and standards.

OBJECTIVES Strategic overview of medical devices, developing systems and reviewing evidence in monitoring the Medical devices Policy Resuscitation Monitor EBME services Safety Alert Actions Competency and training of equipment Standardising equipment

WORKPLAN • To develop clear lines of accountability for medical devices management throughout the organisation.

• Ensure that the Trust’s medical devices policy and resuscitation policy are up to date and reflect current good practice and guidance.

• Develop a list of standard issue Trust items of equipment.

• Develop mechanisms to ensure that the acquisition of medical devices conforms to Medical Healthcare Regulatory Agency and National Audit Office recommendations. Establish procedures for the formal acceptance and procurement of new equipment prior to clinical use.

• Ensure that systems of maintenance of all devices used within the Trust are robust, including contractual arrangements with acute Trusts Key Health Solutions.

• Develop a system or inventory to record all new

purchases and verify the existence of all medical devices employed in the Trust.

• Develop a training plan to ensure that all users of

medical devices are competent to use them safely and adequate training capacity is available to meet requirements of Trust policy.

• Ensure that all adverse incidents involving medical

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devices are reported and recorded in line with the Trust incident policy.

• To evaluate and monitor safety alerts and

reporting.

• Develop strategy for communicating developments and medical devices management policy decisions to the appropriate Trust personnel.

Chair: Assistant Director of Nursing, Physical and Public Health

Members: • Assistant Director of Nursing, Physical and Public Health

• Trust Health and safety advisor • Doctor • Infection Control • Deputy director of Patient Safety • Heads of Nursing • Head of Supplies • Patient Safety Officer • Bethlam Site managers • Occupational Health • Business manager

Co-opted group for standardising equipment for the Trust

• Ward managers/ team leaders • Education and training • Health and safety Advisors

• Key health Solutions representative co-opted to meeting as required

• Doctors • Pharmacy • Clinical Coordinators • Practice development nurses

Membership of this group should be the same person each time to achieve consistency except for the standardisation of equipment.

Responsible to: Clinical Risk Committee 6 monthly report to be provided

Roles and ResponsibilitieS

As per TOR’s

Frequency of Meetings:

Bi-monthly meetings Venue – Maudsley

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Quorum: 1 other non nursing professional

1 Assistant Director of Nursing

3 Modern Matrons/QSNs or Clinical Co-ordinators/ heads of Nursing

Record Keeping:

Minutes will be taken at the meeting and will be circulated within two weeks of the meeting

Lifespan of Group:

Ongoing. Group will be reviewed annually to measure progress against aims and objectives.

Links to: Physical Health Care Forum, Resuscitation Steering Group, Competencies medical devices working group.

Medical Devices Committee Lines of Reporting

Trust Board

Patient Safety Committee

Clinical Risk Committee

Medical Devices Committee

Medical devices Competencies

Resuscitation Advisory Group

Physical Health Committee

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APPENDIX A

MANDATORY MEDICAL DEVICES EQUIPMENT FOR INPATIENT A ND CLINICAL ROOMS

Examination couch Ophthalmoscope/Auroscope Stethoscope Sphygmomanometer Different size BP Cuffs Pulse Oximeter Tympanic Thermometer Tendon hammer Snellen chart Tuning fork (256Hz) Height measure Weighing scales Disposable non latex gloves Urinalysis sticks Blood sugar monitoring device Peak flow meter Access to Urine Drug screening Syringes with retractable needles Dressings Suction machine and equipment Emergency Bag Clinical observation charts Sharps boxes Pathology bottles/vacutaners/ retractable butterflies Alcometer Desirable equipment for inpatient specialist settin gs Urinary catheters Co2 monitors 2. Community Teams Stethoscope Sphygmomanometer Thermometer Urinalysis sticks Syringes with retractable needles Dressings Sharps boxes Disposable gloves Blood sugar monitoring device Ophthalmoscope/Auroscope Height measure Weighing scales Pathology bottles/vacutane/ retractable butterflies Equipment for community teams that perform vaccinations: Pulse oximeter Emergency bag/, suction equipment and Oxygen

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APPENDIX B REPORTING NEW AND FAULTY EQUIPMENT • Key Health Solutions Limited 08700 420 735 • Leave a message if required [answerphone]. • State that you are a SLAM service • Give service name, your name, and contact details. • State exact location of equipment. • Give bar code number of equipment item or make and model if no bar code number. • Give a brief description of the problem. This contract covers all medical equipment with the exception of • equipment still under warranty- contact the supplier • Weighing scales- contact the manufacturer. • Equipment in ECT suites – including anaesthetic machines. • Neuro-imaging and x-ray department equipment.

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APPENDIX C DECONTAMINATION AND CLEANING Medical devices may serve as vehicles for the transmission of infection to susceptible hosts. Decontamination is the combination of processes (including cleaning, disinfection and sterilization) used to make a re-usable medical device safe for further use on patients and handling by staff. The effective decontamination of re-usable medical devices is essential in reducing the risk of transmission of infectious agents A list such as this cannot include all items of equipment. If advice on the correct

decontamination procedure is required, please contact the Infection Control Team. EQUIPMENT

RECOMMENDED DECONTAMINATION PROCEDURE

Auriscope ear pieces Wash with detergent and dry Wipe with alcohol wipe after washing

Baby changing mats Always replace mat if it is ripped or damaged Protect with disposable paper and change after each use Clean at the end of the session or when contaminated, with detergent and hot water Follow with a hard surface disinfectant wipe if contaminated with blood or body fluids

Baby weighing scale As above

Baths Clean after each use with a general purpose detergent [GPD]. Follow with a 10,000 ppm solution if contaminated with blood or body fluids then clean as usual. [Dilute following manufacturer’s instructions]

Bath mats Clean under running water after use Hang up to dry between uses

Bed frame and accessories To be cleaned between patients with GPD and dry. Follow with a 10,000 ppm solution if contaminated with blood or body fluids then clean as usual.

Bedpans, commode pans Use disposable bedpans and macerator where provided Wash non-disposable bedpans with GPD and hot water and dry thoroughly. Wipe with a 10,000ppm Hypochlorite solution.

Bowls (washing) Wash and dry, store inverted and separated Store in the patient's own room and keep for individual patient use where possible

Brushes (lavatory) Rinse thoroughly in toilet flush and hang to dry in open sided holder

Commodes Where possible, keep for individual patient use Clean with GPD and hot water on a regular basis or when visibly dirty Follow with a Hypochlorite solution 10,000 ppm if contaminated with body fluids

Crockery & Cutlery Wash in hot water with GPD Rinse thoroughly in running water (approximately 80oC) Drain until dry before storing

Denture mugs Wash, dry and store inverted if non-disposable Keep for individual patient use only

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Duvets Plastic covers must be used. Wipe all surfaces GPD and hot water. If visibly soiled clean as above then wipe with a Hypochlorite solution, 10,000 ppm

Feeding cups (adults) See crockery

Floors and walls Wipe with GPD and hot water, leave to dry. If soiled with blood or body fluids wipe with a 10,000 ppm Hypochlorite solution then clean as usual.

Furniture Usual domestic cleaning with detergent and water If soiled with blood or body fluids, seek advice from Infection Control Team

Mattresses Ensure cover remains in good condition Clean with GPD and hot water and dry

Medicine pots Wash in ward dishwasher, ensuring that they are thoroughly dried prior to returning to the medication room.

Nailbrushes Use single use disposable brushes only.

Pillows As for mattresses

Ripple beds As for mattresses

Shaving equipment Where possible use patients own equipment. If not available use disposable razors (DO NOT ALLOW SHARING) Ensure safe disposal in sharps box

Stethoscope earpieces

Wash thoroughly with GPD and hot water and dry. Wipe with alcohol wipe after washing.

Suction machines Wipe chassis with damp cloth and GPD. Empty carefully in sluice or into toilet. Rinse thoroughly with GPD and hot water, dry and store dry. Dispose of all single use/disposable parts e.g. liner and tubing as Clinical Waste bag.

Thermometers (clinical) Wipe thoroughly with 70% isopropyl alcohol impregnated swab, store dry

Toys Clean with detergent and hot water and dry thoroughly on a regular basis or when visibly contaminated Do not use soft toys in areas where laundry facilities are not available Launder soft toys on a regular basis or when visibly contaminated

Treatment couch Protect with disposable paper and change after each use Clean at the end of the session or when contaminated, with detergent and hot water Follow with a hard surface disinfectant wipe if contaminated with blood or body fluids

Trolleys (dressing) Before daily dressings, wash with detergent and water and dry Before use and between dressings wipe top with 70% isopropyl alcohol impregnated swabs If visibly contaminated wash with detergent and water and

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dry thoroughly

Urine bottles As for bedpans

Work surface Clean at the end of the session or when contaminated, with detergent and hot water Follow with a hard surface disinfectant wipe if contaminated with blood or body fluids

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Appendix D Declaration of decontamination status Certificate of Decontamination To be completed (in duplicate) by person in charge of ward/department or an authorised person prior to inspection, servicing, repair or return of medical and laboratory equipment Ward/Department: …………………………………………………………………………………….. Description of equipment: ……………………………………………………………………………. Model/Serial Number: ………………………………………………………………………………… Tick one of the following

This equipment has not been in contact with blood, other bodily fluids or pathological samples. It has been cleaned using

………………………………………………………………………………………

This equipment has or may have been in contact with blood, other body fluids or

pathology samples. It has subsequently been correctly decontaminated using

…………………………………………………………………………………………. and work can be carried out safely.

This equipment could not be decontaminated. Standard precautions are necessary.

Signed: …………………………………………………….. Date: ………………………………. Position Held: ……………………………………………… To be completed by the person carrying out the deco ntamination This equipment has been dealt with according to instructions contained in the policy for the

decontamination of medical devices prior to service or repair. Signed: …………………………………………………….. Date: ………………………………. (Top copy to be affixed to equipment. Second copy to be retained on ward/unit]

Page 25

Appendix E Mattresses guidelines

1. Introduction 1.1 The safety of patients is paramount within the Trust. The impact of HCAI on

patients in terms of morbidity and mortality and for the Trust in terms of adverse media attention cannot be under estimated. Most significant is the affect it can have on the individual and their families, in particular the frail and elderly.

1.2 Closely linked to reducing HCAI is ensuring a clean environment, decontamination

compliance, equipment safety and maintaining a clean and hygienic environment in accordance with Trust protocols, the Health Care Act 2006 and national decontamination standards.

2. Management of Mattress Stock 2.1 Ward staff are responsible for visually checking the mattress during linen changes;

this is to ensure that there are no obvious damages or tears to the outer protective lining. This is mandatory whenever there is a linen change, in between and after each patient use, i.e. following a transfer or discharge and/or a mattress clean.

3. Mattress audit and inspection 3.1 A mattress audit should be undertaken on a six monthly basis by the ward based

clinical team, using the proforma shown in Appendix 1. It is the responsibility of the Modern Matron to ensure the clinical area is compliant with this standard.

3.2 The following must be checked as part of the formal mattress inspection:

(a) The mattress must be inspected for visible tears or stains. (b) The mattress should be impermeable to fluids. Tearing, staining or areas

where the material has worn ‘thin’ indicate that the integrity of the mattress is compromised.

(c) The date of the mattress should be checked. 3.3 To pass the integrity test the mattress must be less than five years old, have no

stains or tears or evidence of wearing ‘thin’ and be impermeable to fluid (waterproof). If the mattress is damaged or shows signs of being compromised, it must be condemned and withdrawn from service.

4. Mattress disposal and replacement 4.1 Undamaged mattresses can be disposed of via the normal domestic waste route.

A decontamination certificate needs to be attached and the mattresses placed in a non clinical area to await disposal. The decontamination certification can be found in the decontamination policy.

Page 26

4.2 Condemned or contaminated mattresses should be removed and clearly labelled and marked on both sides as CONTAMINATED, in indelible ink.

4.3 Damaged/torn or heavily stained mattresses need to be disposed of as clinical

waste. They need to be put into a clinical waste mattress bag and placed in a non clinical area to await disposal.

5. Responsibilities 5.1 Ward Managers To ensure that when mattresses are identified as being faulty i.e. torn, stained etc.

that a replacement is immediately ordered. 5.2 Modern Matrons Ensure that the six monthly audit has been carried out on all mattresses on all wards

within their responsibility. To report any issues with the decontamination, purchasing or condemning of mattresses

to the Infection Control Team. 6 Turning Suggested Turning Procedure (except for Westeria High pressure Relieving Mattresses MARK MATTRESS COVER ON ’SIDE 1’ AS SHOWN TURN OVER AND MARK ‘SIDE 2’ AS SHOWN

2.

4.

Page 27

1.

3.

SIDE 1 SIDE 2

Page 28

APPENDIX F Checklist Audit of Commodes

Clinical Area: Site: Date:

Items Yes No

Breaks working

Lids fitting & Intact

Evidence of rust

Disposable bedpans

Armrests intact & clips in working order

Footrest Intact

Vernacare Labels attached & signed & dated

The commode appears to have been disinfected in line with policy - (no dust collection, no evidence of spillage or contamination – e.g. under the seat)

Any faults need reporting : Immediate Actions: Recommendations Circle ass appropriate:

Fit for purpose Yes No Suspend use Yes No Condemned Yes No Signed: Dated: Review date: (Monthly)

Page 29

APPENDIX G PROCUREMENT OF MEDICAL DEVICES Procurement The Trust’s standard financial instruction for procurement will be followed. A “Capital Manual” is also available from the Finance or Projects Directorates which covers in detail the Trust’s procedures for managing large capital purchases. Standardisation There are many advantages to minimising the variety of equipment manufacturers and models in use within the Trust such as; quality of product, inter-changeability, staff training, availability of spare parts, more cost effective service contracts, etc. The Medical Devices Group will work with supplies and other relevant parties to identify preferred and/or approved models or suppliers for certain types of equipment, and will develop an approved list of products. The end user will always have the ability to make the case to the Medical Devices Group for purchasing their own choice of device where justifiable on functional or cost benefit service grounds. The consolidation of service contracts from any given supplier to the Trust will be pursued, by managers, and Procurement and contracted EBME services. Selection The final selection of standard equipment will be made by the Trust Medical Devices Committee in close consultation with those responsible for its clinical use, taking into account relevant technical and financial information. Revenue consequences (maintenance, consumables, etc.) must be fully considered. Details of the warranty and availability of technical support must also be taken into account. Safety The European Community has issued various Directives on Medical Devices which have been implemented by specific UK legislation. After 13th June 1998, all new medical devices purchased, apart from those used for the examination of substances derived from the human body, are legally required to comply with the Medical Devices Regulations. All equipment purchased must comply with the relevant European and National standards for performance and safety. Acceptance In some instances and especially for more expensive and sophisticated items, it may be appropriate for the purchaser to establish a specific set of performance criteria with the supplier against which the equipment will be judged before it is accepted and payment authorised. In all cases, it is the responsibility of equipment purchasers to ensure that inspection and safety checks in accordance with national recommendations are performed before equipment is used clinically. These checks should be designed to establish that the equipment is functioning correctly for its intended purpose and that it is safe to use. The contracted EBME service will be able to provide assistance with this process

An Organisation-wide Policy for the Development and Management of Procedural Documents

SLAMFNHST medical devices policyJanuary 2011

APPENDIX H CONTACT DETAILS

Title email

Chair of the medical devices committee [email protected]

Trusts Health and Safety Risk Manager [email protected]

Patient safety officer [email protected]

Supplies [email protected]

Infection control [email protected]

EBME services

Key Health Solutions Limited

08700 420 735

An Organisation-wide Policy for the Development and Management of Procedural Documents

SLAMFNHST medical devices policyJanuary 2011

Verification of Competency Framework and Medical Devices (Safe

Use)

South London and Maudsley NHS Foundation Trust

SLAMFNHST medical devices policy April 2007

32

Contents

Page

1 Introduction

3

2 Background

3

3 Structure of Framework

4

4 Competencies levels and description of groups 7



33

5 Verification of Competencies and safe use of Medical Devices

11-45

6 Members of the Medical Devices Working Group

46

7 References

47

8 APPENDIX 1

Individual record of Competency Assessment

48



34

Introduction

This document sets out a framework of competencies for recognising and responding to acutely ill patients in hospital and in the Community. It responds to recommendations made in the document by the Department of Health (2009) Competencies for Recognising and Responding to Acutely ill Patients in hospital and NICE (2007) Acutely ill patients in hospital / (CG50) and supports the implementation in South London and Maudsley NHS Foundation Trust. The purpose of the document aims to ensure staff are competent and confident in the management of patients who become acutely physically unwell or are at risk of becoming unwell. Staff caring for patients in SlaM should have competencies in monitoring, measurement and interpretation of vital signs, equipped with the knowledge to respond to deteriorating health and respond effectively to acutely ill patients appropriate to the level of care the Trust provides. There are many recommended guidelines that make reference to recording the vital signs of services users to ensure Patient Safety eg Maudsley Prescribing guidelines 2009, NICE CG50 and Rapid Tranquillisation. Mental Health workers have a key role in implementing and sustaining the physical health care agenda. We have a responsibility to facilitate physical health and well-being in clients with severe mental illness. Policy Background “Patients who are admitted to hospital believe that they are entering a place of safety, where they, their families and carers have a right to believe they will receive the best possible care. They should feel confident that should their condition deteriorate they are in the best place to receive prompt and effective treatment and care”. (NICE 2007) Often patients receive sub-optimal care due to:

� Their signs and symptoms of deterioration are not recognised at the right time � Indications of deterioration are not appreciated as potentially critical. � There is a lack of knowledge and skills in the management of the acutely ill patient � Communication of deterioration is not articulated sufficiently to highlight the

urgency /severity of the situation therefore action is delayed. � Patients are not assessed appropriately over a given time to assess if there is a

clinical picture of deterioration



35

NICE CG50 recommends that hospitals implement an Early Warning Scoring System using a Track and Trigger (TT) approach to recognise early deterioration of a patient becoming acutely unwell. The guidance outlines the importance of a full clinical assessment and of tailoring the written monitoring and management plans to the individual personal circumstances. It also ensures that routine measurements are accurately taken and recorded by staff that understands their clinical relevance and by linking these observations to a graded Track and Trigger system; care can be escalated to a clinician with greater knowledge. The foundations for patient safety are laid through doing and recording simple measurements well and having agreed response strategies. Track and Trigger Track and trigger systems have been widely used in the UK and USA in acute hospitals since approximately 2001. A systematic review of these tools which supports both their reliability and increased sensitivity (as number of abnormal parameters increases) NICE state that no one system is superior than another and that local areas need to adopt a model of care that is appropriate to their client needs, though these systems must provided a graded response strategy. Since 2008 SLaM has developed training and implementation of Physical Observation charts using Modified Early Warning Scores (MEWS)/Track and Trigger System. The Story Observation Signs andStory Observation Signs andStory Observation Signs andStory Observation Signs and Symptoms (SOS)Symptoms (SOS)Symptoms (SOS)Symptoms (SOS) reporting system is used to ensure effective communication to recognise and prevent further deterioration of physically unwell patients.

Rapid Tranquilisation (RT) and Physical Interventio n In October 2009, it was reported following a Trustwide audit that only 10% of patients who were involved in a physical intervention and who received Rapid Tranquilisation had records of vital signs monitoring. Promoting Safe and Therapeutic Services (PSTS) and the MEWS Training references that all patients must have a set of physical observations completed both during and following RT in keeping with Trust Policy. Structure of the Framework The competencies define the Knowledge and Skills required for safe effective treatment and care It is likely staff will have different levels of competencies required in relation to their job role and clinical environment. Staff will be able to move either up or down a level depending on competency. There will be generic competencies eg accessing patient records, recording accurately and communication skills when escalating concerns by using the SOS framework as per MEWS Chart.



36

One key element of all levels will be the ability to refer on to a more senior clinician with greater knowledge . The framework is to be used during clinical supervision and appraisal, assessing educational requirements and should be incorporated when re-evaluating service provision. It is good practice that staff have Medical Devices competencies assessed when they join the Trust or starting a new role that may be different from their current one followed by two yearly updates. Description of the Competency Levels Level 1 Calls for help and able to refer on Eg. Non-clinical, admin staff or clinical staff with no experience Level 2 Recognises device, records with Early Warning Scores (EWS) Track and Trigger (TT) protocol following competency assessment and able to refer on eg HCA, Non-Nursing, Non-Medical Level 3 Same as level 2 in the context of the patient and following advanced competency assessment eg Registered nurses Level 4 Delivers a response and intervention, knows when to refer on Eg. Medical doctor Specialist nurse, dietician or Therapist The case studies below demonstrates how the levels may work in practice Case Study 1 Mr Smith was admitted to hospital following a relapse of his Bi- Polar Disorder. He is commenced on Olanzapine medication. After 2 days on the ward Mr Smith complains of feeling breathless and is coughing as he chats to the ward administrator in Reception area. Level 1 The administrator reports the situation to the Health Care Assistant

Level 2 The HCA recognises that Mr Smith appears breathless, records measurements in keeping with the Physical Observation /MEWS chart and assigns a score > 3 and follows protocol by reporting to the nurse in charge Level 3 Nurse in charge (band 6) identifies potential causes for Breathlessness and re checks observations MEWS score is now 4 and refers to the ward doctor Institutes a care plan Level 4 Ward doctor examines Mr Smith and requests further tests eg ECG Formulates a clinical management plan and refers to the Chest Clinic



37

Case study 2 (Generic MDT) Mrs Jones is a 78 years old lady who was assessed regarding concerns about her memory. In the subsequent MDT meeting the assessment was discussed and a diagnosis of probable Alzheimer’s disease was agreed. A decision was made that she would be suitable for the commencement of acetocholinestrase inhibitors (memory enhancers). Her allocated care co-ordinator is a social worker by profession and will therefore meet with Mrs Jones to discuss the diagnosis and offer the option of medication. Her care co-ordinator will also carry out the pre-medication Blood Pressure and ECG. Level 2 The care –coordinator is aware of the indication for ECG and BP Explains the procedure and prepares the patient Performs ECG and BP Collates these results along with medical history and blood test results to discuss with medical staff member with regards to suitability for starting medication as agreed. Level 3 As above in context of patient and following advanced competency assessment. Will interpret BP and advise care co-ordinator on follow up action Level 4 Interprets ECG results along with medical history, blood test rests and

instigates management plan and treatment and knows when to refer on for further investigation and treatment



38

Competency Framework

Competency

Levels

Level 1

Eg. Admin,

nursing assistants with no/basic training

Level 2

Eg. HCA,

Non- nursing

Non- medical

Level 3

Eg.Registered nurse

bands 5-8

Level 4

Eg.Medical doctor

Specialist nurse, Dietician, Therapist

Description of groups

Calls for help and able to refer to appropriate person

Recognises device, records with Early Warning Scores

(EWS)

Track and Trigger (TT) protocol following competency assessment and able to refer on

Same as level 2 in the context of the patient and following advanced competency assessment

Delivers a response and intervention, knows when to refer on



39



40

Description

Level 1

Level 2

Level 3

Level 4

RESPIRATORY

RATE

Able to measure, record Respirations with knowledge of normal values, able to refer on

Able to measure, record, interpret, care plan,

using action protocol to refer on

Has knowledge of normal or abnormal values. Responds, with intervention eg

Prescribes medication or

refers on

PULSE OXIMETRY

Recognise Pulse Oximeter

Recognise Pulse Oximeter Able to measure, record Oxygen saturation with knowledge of normal parameters, able to refer on



Determines need for Oxygen therapy

and able to administer


Iniates further investigation, Prescribes Oxygen or

refers on

OXYGEN THERAPY

• HIGH FLOW OXYGEN EMERGENCY USE

• CONTINOUS

• NEBULISER

• USE WITH

Recognise correct medical gas, knows how to request

able to know the indications for oxygen use, risks and hazards when handling oxygen

able to know the indications for oxygen use, risks and hazards when handling oxygen Able to turn on, change flowmeter, administer in emergency situation, knows how long cylinder lasts for, is aware of accessories used during administration


Initiates further investigation, Prescribes Oxygen or

refers on



41

AIR

able to refer on,

PULSE

Able to measure, record radial pulse with knowledge of normal values, able to refer on

Able to measure, record, interpret rate, rhythm and volume, care plan,




refers on

BLOOD PRESSURE

Recognise BP apparatus

Recognise Blood Pressure apparatus Able to measure, record BP with knowledge of normal values, able to refer on





refers on

ECG

Recognise ECG

Uses machine to perform 12 lead ECG, familiar with loading paper and accessories able to refer on

Level 2

Able to identify common abnormalities, able

to refer on

Formulates diagnosis, evaluates effectiveness of treatment Responds, with intervention eg


refers on

Level 4



42

Description

Level 1

Level 3

TEMPERATURE

Able to recognise tympanic thermometer

Able to measure, record and monitor temperature and refer on

Able to interpret causes of abnormalities, care plan, treat or refer to Level 4

Responds, with intervention eg

prescription,

refer on

BLOOD GLUCOSE

MEASUREMENT

Recognise glucometer

Able to measure, record quality control and BM with knowledge of normal values, able to refer on

Able to measure, record quality control and BM ,recognise hypo/hyper-

glycaemia able to able to refer on

Has knowledge of Diabetic Pathway in Slam Responds, with intervention eg


refers on

SUCTION

Recognise suction machine

Able to know when suction is used and the rationale

Able to know rationale for use and procedure to suction a patient. Has knowledge of safe use

Responds, with intervention eg


refers on

WEIGHING SCALES

• CHAIR

Able to recognise types of scales

Able to measure weight, record as per TT chart, monitors weight concerns, able to refer on

Able to interpret causes of weight loss gain, care plan, refer to Level 4

Dietician/doctor

Or other responds and delivers intervention



43

• COLUMN

able to refer on

HEIGHT

Recognise equipment

Able to measure, record Height





refers on

URINALYSIS

Recognise

Multi-stix

Able to measure, record knowledge of abnormalities detected able to refer on

Able to measure, record, interpret, care plan, further blood sugar testing




refers on

ALCOMETER

Recognise equipment

Able to supervise patient using alcometer, record with knowledge of normal values, able to refer on





refers on



44

Description

Level 1

Level 2

Level 3

Level 4

URINE DRUG SCREEN

Recognise Urine Drug Screen

Able to take urine sample and , able to refer on





refers on

PEAK FLOW METER

Recognise Peak flow meter

Able to supervise patient performing peak flow measurement and records

Able to measure, record, interpret reading and initiate a care plan,

Able to refer on

Has knowledge of additional tests and formulates care plan

Able to

refers on

PHYSICAL OBSERVATION

Recognise charts Able to record accurately, use the SOS

Able to measure, record, interpret reading and initiate a



45

CHART

MEWS/TRACK AND TRIGGER CHART

reporting system care plan,

Able to refer on

Respirations

I=interview O=observed N/A= not applicable

Clinical Competence for Level 2, 3, 4



46

Skills Description

Achieved Y/N

Give reasons for not achieved and what needs to be done to improve(give dates)

Clinical knowledge

Demonstrates knowledge of the normal parameters for respirations 12-20 breaths per minute in adults I

Demonstrates an understanding of the rational for assessment of respiration To establish a baseline, and to monitor fluctuations I

Recognises that assessment of respiration considers the quality, rate, depth and pattern of respirations. I

Describe how to characterise the quality of respirations eg effortless, laboured, silent, wheezing I

Describes different respiration patterns and recognise their clinical significance Eg, Tachypnoea, bradypnoea, apnoea, hyperventilation and Cheyne-Stokes I (3&4)

Ensures Privacy and Dignity of the patient during the procedure is maintained 0 Demonstrates how to measure respiratory rate, takes at same time as pulse

1. Does not announce the procedure to patient, as this can produce changes in the respiratory rate

2. Ensures patient comfort 3. Observe movement of chest wall. The rise and fall

of the chest counts as one breath. 4. Evaluate breathing sounds 5. Count chest movements for 60 seconds. 6. Record number of respirations.

I/O



47

Accurately records respirations once measured I/O

Is able to report to nurse in charge/doctors if parameters are abnormal or deviate from baseline. I/O

Is able to describe emergency actions if patient develops breathing difficulties. I

Decides on frequency of monitoring and updates chart and care plan I/0

Practice hand hygiene before each patient contact. I/0

Date of Assessment: Name and Signature of Assessor: Name and Signature of Candidate:



48

Pulse Oximetry

I=interview O=observed N/A= not applicable Clinical Competence for Level 2, 3, 4 Skills Description Achieve

d Y/N


Recognises signs that may indicate decrease in oxygen saturation and prompt monitoring I

Recognises normal parameters for oxygen saturation I

Ensure Privacy and Dignity of the patient during the procedure is maintained I/0

Can explain procedure to the patient and gain consent I/0

Ensures that the patient is comfortable and warm enough, especially if continuous monitoring is needed 0

Measures oxygen saturation using a pulse oximeter 0

Can accurately record as soon is measured 0

Is able to report to nurse in charge if MEWS score > 2-3 I/0

Is able to report to doctor if MEWS scores >4 I/0


Initiates investigation into possible causes eg asthmatic attack I/0

Determines need for oxygen and administers Oxygen as per Management policy and (levels 3 & 4 ) I/0



49

Medical Device Competency (safe use) PULSE OXIMETER Skill description and outcome (instructions on use of device may vary depending on model available)

Achieved Y/N

Give reasons for not achieved and what needs to be done to improve (give dates)

Is aware of infection control measures when using the pulse oximeter eg

• hand washing before and after procedure • cleaning device and indicating date and time

in log book I/0

Is able to explain safe use for patients needing: • intermittent readings • continuous reading

I

Is able to explain safety checks and precautions to be done before using device eg

• is in working order, check battery • clean inside the probe sensor

I

Is able to state function of indicators on device eg

• display for information I

Is able to interpret prompts on device eg

• ‘error’-internal problem with unit, do not use • amber flash-sensor not detecting pulse

I

Is able to demonstrate using the device by • selecting a suitable area for the probe (usually

finger) and place the probe as directed by the manufacturer’s instructions

• Switch pulse oximeter on • Make sure that the probe sensor is detecting

the pulse and it corresponds to the patients pulse which is usually indicated by a beep in time with each detected pulse

• Take the reading of oxygenation saturation • Document in patient’s notes

0



50

Demonstrates knowledge of possible causes of low oxygen saturation readings eg

• Probe sensor is damaged or dirty • Probe sensor not fitted correctly on finger

I

Is aware of how to order a new device and how to report for contractual servicing I




51

Oxygen Therapy

I=interview O=observed N/A= not applicable Clinical Competence for Level 2, 3, 4

Skills Description Achieve

d Y/N


Can locate the Oxygen Policy O

Can select correct gas cylinder size and type 0


Can explain procedure to the patient I/0

Can explain the indications for oxygen use in patient care I

Can describe how oxygen should be prescribed I/0

Is able to demonstrate how to connect tubing to flow regulator 0

Is able to turn on oxygen safely I/0

Is able to state what additional equipment may be required and why ( nasal tubing/ ventiri masks/ high concentration mask) I/0

Is able to describe how oxygen should be stored in a clinical environment I

Is able to describe how oxygen should be stored in a storage area safely I

Able to describe how oxygen should be transported from storage to a clinical area I



52

Is able to describe the risks when transporting a patient from one clinical area to another who requires ongoing oxygen I

Can connect/ change a flow regulator safely 0

Medical Device Competency (safe use) OXYGEN Is able to state to state how long the cylinder lasts when set at 15 litres I

Can interpret the information on the collar label O

Checks to ensure no grease or oil ( including hand cream/barrier creams ) on hands or equipment O

Is able to name the hazards associated with oxygen cylinders I

Is able to identify potential risks with oxygen in a mental health setting I

Able to turn off cylinder when not in use and store in safe well ventilated place I




53

Pulse

I=interview O=observed N/A= not applicable Clinical Competence for Level 2, 3, 4 Skills Description

Achieved Y/N


Clinical knowledge Knowledge of normal parameters for pulse I

Demonstrates an understanding of the rationale to record pulse I

Recognises symptoms that may indicate abnormal pulse I 3&4

Demonstrates an understanding of where a pulse can be palpated I

Demonstrates an understanding of possible physiological reasons for abnormal pulse. I 3/4

Is able to report to nurse in charge/doctors if parameters are abnormal and record appropriately on MEWS chart. I/0

Decides on frequency of monitoring and updates chart and care plan I/0 3&4

Ensure Privacy and Dignity of the patient during the procedure is maintained 0

Can explain procedure and rationale for taking a pulse to the patient and gain consent 0

Can accurately record using a watch with a second hand and plot as soon is measured I/0

Is aware of infection control measures when taking a pulse hand washing before and after procedure I/0



54

Medical Device Competency (safe use) PU LSE Skill description and outcome (instructions on use of device may vary depending on model available)

Achieved Y/N


Can describe the steps for taking a pulse; • ensure patient is relaxed • measure the pulse under the same conditions

each time • place the first, second or third finger along the

appropriate artery and apply light pressure until the pulse is felt

• press gently against the peripheral artery being used to record the pulse

• the pulse should be counted for 60 seconds • record the pulse on appropriate

documentation O

Demonstrates knowledge of possible causes of an unexpected reading;

• applying too much pressure to pulse • trying o palpate pulse in wrong place in the

wrong place • Irregular and/or weak pulse • Patient movement/ anxiety • Restrictive clothing may impair blood flow

I




55

Aneroid Sphygmomanometer

I=interview O=observed N/A= not applicable

Clinical Competence for Level 2, 3, 4

Skills Description

Achieved Y/N


Clinical knowledge Knowledge of normal parameters for blood pressure (identifying difference between systolic and diastolic) I

Demonstrates an understanding of the rationale to record blood pressure I

Recognises symptoms that may indicate abnormal blood pressure I 3&4

Demonstrates an understanding of the rationale and circumstances when using a:

• Manual sphyg • electronic device

I

Demonstrates an understanding of possible physiological reasons for abnormal blood pressure. I 3/4

Is able to report to nurse in charge/doctors if parameters are abnormal and record appropriately on MEWS chart. I/0



Can explain procedure and rationale for taking BP to the patient and gain consent 0



56

Can accurately record and plot as soon is measured I/O

Is aware of infection control measures when taking a blood pressure

• hand washing before and after procedure • ensuring clean cuff & stethoscope • use of single use only equipment where

possible • cleaning device and attaching vernicare label

as per guidelines after use I/0

Medical Device Competency (safe use) Sphygmomanomet er Skill description and outcome Staff are expected to be assessed using the manual BP apparatus unless otherwise agreed by manager (instructions on use of device may vary depending on model available)

Achieved Y/N


Is able to explain safety checks and precautions to be done before using device e.g

• is in working order • no obvious rips pr punctures to cuff

I

Is able to state function of indicator dial and cuff release button;

• to allow cuff to deflate • to indicate systolic and diastolic pressures

I

Can describe the steps for taking a blood pressure; • Open valve and ensure cuff is fully deflated • Close valve • Remove any restrictive clothing • Place cuff around upper arm • Locate brachial artery • Ensure artery marker on cuff is in line with

brachial artery • Locate radial pulse, inflate cuff until you can

no longer palpate the radial • pulse and add approximately 20mmhg • Listen for Korotkoff’s sounds • Remove cuff

O



57

Demonstrates knowledge of possible causes of an unexpected reading;

• Cuff deflated too quickly • Stethoscope in the wrong place • Pressing too hard on the stethoscope, placing

too much pressure on the brachial artery • Irregular and/or weak pulse • Patient movement/ anxiety • Sphygmomanometer not calibrated • Equipment damaged • Restrictive clothing may impair blood flow • Poor understanding of Korotkofft’s sounds

I




58



59

Electrocardiogram (ECG)

I – Interview O-Observed N/A-not applicable Clinical competence level for 2, 3, 4 Skills Description (Instructions on use of device may vary depending on model available)

Achieved Y/N


Identifying and understanding of the equipment: Able to recognise said medical device O

Able to recognise accessories and relevant disposable items applicable to the device O

Awareness of indications for ECG and when to use, including for medication. I

User instruction guide location-Safety notes chapter must be read I

Identifying and demonstrating a knowledge of the following parts, functions and patient care:

Using the On/Off button O

Identifying settings and functions. O

Patient Preparation: Communication/Skin Prep to place the patient at ease and gain consent

• Personal Protective Equipment-gloves • New disposable sheet is placed on couch • explain what an ECG is and the procedure

entailed to minimise anxiety • ensuring patient’s dignity is maintained • shaving excess hair, wiping area with alcohol

swab to obtain best possible trace • Identifying when appropriate to shave. • Assembly of Equipment and correct ECG

electrode placement to perform efficient trace to aid assessment

O

Identifying leads off indicators I/O

Entering Patient Data- ensure patient details are accurately recorded on ECG.

Printing and stopping a rhythm strip O



60

Post Performance of ECG-

• remove electro tabs and dispose safely • reposition patient comfortably • inform patient/carer a doctor will review the

ECG • Pass reading to appropriate level 4 clinician

for interpretation O

Understanding and identifying operating issues, maintenance and cleaning requirements

Charging the battery I/O

Inserting printing paper-red stripe I/O

Clearing paper jams I/O

Cleaning the equipment –refer to manual I/O

Interpretation or ECG reading Interpret reading and make a decision of necessary follow up based on reading Level 4 only




61

Tympanic Thermometer


Skills Description Achieved Y/N


Recognises signs that may indicate temperature changes and prompt temperature monitoring I

Recognises normal parameters for core body temperature I


Can explain procedure to the patient I/0

Measures temperature using tympanic thermometer 0

Can accurately record as soon is measured 0

Is able to report to nurse in charge if MEWS score > 2-3 I/0

Is able to report to doctor if MEWS scores >4 I/0


Initiates investigation into possible causes eg urinalysis I/0 3&4

Determines need for antipyretic medication I

Administers antipyretic medication safely as per Medication Management policy 0

Is aware of environmental and physical methods used to control raised temperature eg cool environment using a fan, tepid sponging, removing bed clothes I/0

Is aware of infection control measures when taking



62

a temperature eg • hand washing before and after procedure • discard used probe and replace new probe

cover following procedure, • cleaning device and attaching vernicare label

as per guidelines I/0

Medical Device Competency (safe use) THE RMOMETER Skill description and outcome (instructions on use of device may vary depending on model available)

Achieved Y/N


Is able to explain safety checks and precautions to be completed before using device eg

• is in working order, • clean probe cover

I

Is able to state function of buttons and indicators on device eg

• scan temperature button • mode button • display for information

I

Is able to interpret prompts on device eg • ‘press scan’-thermometer ready to take a

reading • ‘wait’-Thermometer not ready to take a

reading • ‘error’-internal problem with unit, do not use • ‘use new cover’-replace cover after use/unit

left for 30 seconds with probe cover on

Is able to demonstrate using the device by • checking display shows core • attaching correctly fitting probe cover • Placing probe into ear, sealing opening • Pressing scan button • On hearing 3 bleeps removes from ear • Takes 2 or 3 measurements recording the

highest reading • Releases and disposes probe cover into

clinical waste 0

Demonstrates knowledge of possible causes of low temperature readings eg



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• Probe tip or cover damaged or dirty • Probe not sealed in ear • Probe removed before ‘done displayed’ or

before bleeps heard • Thermometer in wrong mode

I Is aware of how to order a new device or replacement probes and how to report for contractual servicing I




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Glucometer

I=interview O=observed N/A= not applicable Clinical Competence for Level 2, 3, 4 Skills Description

Achieved Y/N


Clinical knowledge Knowledge of normal parameters for capillary blood glucose I

Demonstrates an understanding of the rational to record capillary blood glucoses I

Demonstrates an understanding of indicators that may indicate abnormal blood glucose readings I 3&4

I/0 Is able to describe the presentation of patient experiencing a hypoglycaemia or hyperglycaemia episode I/0 3&4

Demonstrates and understanding of the rational and circumstances when:

• Using Trust device • Using a patient’s own device

I

Is able to describe the rational and frequency for Quality Control checking the glucometer. I

Is able to report to nurse in charge/doctors if parameters are abnormal I/0

Is able to describe emergency actions if patient is in a hypoglycaemia and locate emergency medication I/0

Demonstrates appropriate site and location of obtaining a blood sample. I/0




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Can explain procedure to the patient 0

Explains to patient the need to have clean hands I/0

Can accurately record and plot as soon is measured I/0

Is aware of infection control measures when taking a capillary blood glucose eg

• hand washing before and after procedure • discard used lancets and waste • use of single use only equipment • cleaning device and attaching vernacare

label as per guidelines I/0

Is aware of the risks associated with patients’ own lancing device pens and pens for the administration of insulin, in a hospital setting. I

Medical Device Competency (safe use) GLUCOMETER Skill description and outcome (instructions on use of device may vary depending on model available)

Achieved Y/N


Is able to locate the standing operating procedure for blood glucose recordings I/O

Is able to perform a quality control check for both high and low solutions.

Is able to state function of buttons I/O

Is able to order • new sticks • Quality control solutions (High and Low) • Batteries • Single use lancets • QC log book

I/O




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Oropharyngeal Suctioning

I=interview o =observed n/a not applicab le Clinical Competence for Level 2, 3, 4

Skills Description Achieved

y/n


Clinical Knowledge

Knowledge of rationale and indications and objective for use of suction

I

Knowledge of cautions to be taken when undertaking the procedure

I

Able to understand the procedure is clean rather than aseptic

I

Able to ensure privacy and dignity is maintained

I/O

Able to explain and demonstrate procedure

1. Wash hands before and after procedure

2. Personal Protective equipment



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-Google and gloves

3. Attach suction tubing to suction machine and yankaeur sucker to suction tubing, ensuring a tight fit

4. If the patient is unconscious, place on his/her side, facing nurse

5. Place towel under the patient’s chin

6. Switch machine on and set suction level max 120mmHg-should be gentle so the mucous membranes are not damaged

7. Assist patient to open mouth

8. Insert Yankeur Sucker into mouth along one side and guide it along the inside of the cheek towards the oropharynx without applying suction

9. Apply suction by unkinking the tubing or occluding the hole in the Yankeur sucker and remove secretions and debris from the mouth as required.

10. Release suction and remove oral sucker from the mouth. Oral suction should not be undertaken for prolonged periods as it can be distressing for the patient 10- 15 seconds

11. Allow patient to rest for 30 seconds if further suctioning is required and ask the patient to cough between suctions so secretions can rise to the upper airway

12. Ensure Patient is comfortable

I/O



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Able to Clean and Maintain Suction machine

1. Disconnect used parts into yellow clinical waste

2. Replace Abbott liner and suction tubing

3. Reusable collect container should be washed with warm water and normal detergent and must be dried thoroughly, and check if any signs of damage

I/O

Able to document the following: quantity, colour, consistency and odour of secretions

I/O

Medical Device Competency (Safe Use) SUCTION

Skills description and outcome

(Welmedical BSU2010 and Laerdal Suction)

Achieved

y/n


Able to identify on/off switch

I

Able to identify parts of suction unit

I/O

Able to state function of parts

I



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Able to clean and maintain as above

I/O

Able to report when faulty and procedure involved re decontamination of equipment I/O

Able to ensure it is charged up at all times by ensuring it is plugged into the mains

I/O

Able to re-order replacement tubing and yankeur probe

I/O


WEIGHING SCALES

I – Interview O-Observed N/A-not applicable Clinical competence level for 2, 3, 4 Skills Description Achieve

d Y/N


Explain the safety checks and precautions to be done prior to using the scales

Scales stable on the ground O

Brakes applied (chair scales) O

Seat secure (chair scales) O

No other objects touching platform I/O



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State the correct use of the scales Scales read zero before patient mounts I/O

Patient’s feet or hands not resting on other surfaces O

Patient weighed with appropriate clothing O

Patient does not move during measurement I/O

Patient comfort and dignity Ensure patient and the scales are in a private area. I/O

Explain the purpose of the weighing and the procedure to the patient I/O

Causes of unexpected reading Patient weighed with different clothing I

Patient’s feet/hands on surrounding surfaces I

Scales not zeroed I

Patient movement during reading I

Scales not calibrated I

Follow up and response

Be able to explain and describe causes of weight loss and weight gain in mental health. I

Know what weight changes warrant further investigation and management plan. I

Able to develop initial management plan regarding weight management. (level three and four only) I

Be aware of when to refer for specialist input. I

Ensure weight is accurately documented in correct place. I/O

Date of Assessment: Name and Signature of Assessor:



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Name and Signature of Candidate:

HEIGHT

I – Interview O-Observed N/A-not applicable Clinical competence level for 2, 3, 4 Skills Description Achieve

d Y/N


Identifying and understanding the equipment Able to recognise the device O

Explain the reason for the equipment and when it is to be used I

Explain the correct method of measuring height I/O

Ensure that patient is wearing the correct clothing, ask patient to remove shoes I

Ensure the patient is standing correctly O

Ensure the patient does not move during the procedure O

Ensure that the measurement takes place in a private area to preserve dignity O

Explain the purpose and procedure to the patient. O



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Understanding maintenance and cleaning requirements

Understanding the results I

Record results O

Ensure height measure is attached to wall and at correct level from floor I/O




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Urinalysis

I = Interview O = Observed N/A = Not Applicable Clinical Competence for Level 2, 3, 4



Clinical Knowledge

Demonstrates an understanding of the rationale and indications for conducting urinalysis.

I

Demonstrates an understanding of the causes of abnormal test results

I 3&4

Is able to describe the procedure for the collection of

� Mid Stream Urine Specimen

� Clean Specimen of urine

� Collection of Catheter Specimen

I/O 3&4

Demonstrates an understanding of the rational and circumstances when to initiate urinalysis i.e. baseline admission procedure, previous abnormal results, signs of infection i.e. acute delirium acute change in patient mental state presentation i.e. due to



74

substance misuse

I

Is able to describe the procedure for ensuring the following.

� The correct specimen bottle for collection of urine

� Correct storage of specimen bottles

� Correct storage and checking of the reagent strips.

� Demonstrates the appropriate site and location for catheter specimen urine.

I



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Can explain procedure to the patient and rationale

Ensure the Privacy and Dignity of the patient is maintained during collection of the specimen

I/O

Able to describe the significance of visual appearance of urine

Able to describe the significance of colour indicators and any changes that occur on testing.

I

Is able to describe emergency actions or monitoring required if urinalysis results indicate that physical health may be compromised ie high readings of blood or glucose

I/O

Is able to report to nurse in charge/doctors if parameters are abnormal

I/O

Decides on frequency of monitoring and updates chart and care plan

I/O 3&4

Can accurately record and plot as soon as is measured



76

I/O

Is aware of infection control measures when conducting the urinalysis..

� Universal precautions-using gloves and aprons

• Hand washing before and after procedure

• Use of sterile or clean specimen bottles or containers for urine collection

• Discard used specimen bottles and containers.

• Discard used test strips.

• Ensure that test surface area is cleaned of any spillage that may have occurred while carrying out the procedure.

I/O

Medical Device Competency (Safe Use) URINALYSIS

Skill Description and Outcome (instructions on use of device and test strips used may vary depending on model available)

Achieved Y/N


Is able to describe the procedure for conducting urinalysis

I



77

Has an understanding of the colour indicators on the test strip and comparison of the test strips against the reference colours on the outside of the strip bottle.

Is able to state the reasons for the colour codes on the test strips.

I

Is able to order:-

Reagent strips

I

Specimen bottles for collection of urine.




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Alcometer I=interview o =observed n/a not app licable Clinical Competence for Level 2, 3


y/n


Clinical Knowledge

Has knowledge of normal values

Understands the rational for using a breath alcohol instrument

I/O

Demonstrates correct use of the Alcometer Technique:

1. Explains procedure to patient and gains consent

2. Ensure patient Privacy and dignity is preserved

3. Wash and dry hands

4. Collect and assemble equipment-attach mouthpiece to meter

5. Switch on, automatic self check, ready within 15 seconds, at any temperature

6. Sit patient in upright position



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7. Ask the patient to take a deep breath in and place their lips around the mouthpiece

8. Record readings from illuminated display (range within 0.02 to 2.00mg/litre BrAC. An over range indication is given at higher levels

9. Return patient to a comfortable position

10. Discard used mouthpiece into clinical waste

11. Wash hands to minimise risk of cross infection

12. Document readings on EPJ, noting time of reading and update care plan accordingly

I/O

Medical Device Competency (Safe Use) ALCOMETER


Make and model may vary eg Alcolmeter Lion SD- 400

Achieved

y/n


Able to reorder Mouthpieces

I/O

Ensure the device is calibrated annually

I



80

Able to recharge

I/O




81

Urine Drug Screen




Recognises signs that may indicate the need for a urine drug screen I


Can explain procedure to the patient and gain consent For a supervised urine sample I/0

Can explain to the patient the possible outcome for them should the result be positive I/0

Test the urine using a drug testing kit 0

Can accurately record as soon as the urine is tested 0

Is able to report to nurse in charge if the urine drug screen is positive I/0

Is able to report to the patient sensitively the urine drug screen results and explain any outcome as a consequence of the result I/0

Determines need for any medical intervention I

Is aware of infection control measures when using the Urine Drug Screen Kit eg

• hand washing before and after procedure I/0



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Medical Device Competency (safe use) URINE DRUG SCR EEN Skill description and outcome (instructions on use of device may vary depending on model available)

Achieved Y/N


Is able to explain safety checks and precautions to be completed before using Urine Drug Testing Kit eg

• that the kit is undamaged • fit for purpose

I

Is able to state function of indicators on UDTK eg

• peel label to view results I

Is able to interpret the results after use: • Negative • Positive • Invalid

Is able to demonstrate using the device by • Taking the Urine Drug Testing Kit out of the

package • Collecting the urine specimen • Waiting 5 minutes (or less depending on

manufacturer’s instructions) • Reading the results • Disposing of the sample appropriately -sluice and place used UDS in the clinical waste bag

0

Demonstrates knowledge of the causes of a false positive result I

Is aware of how to order a new Urine Drug Screen Kits I




83

Peak Flow Meter I=interview o =observed n/a not applicable Clinical Competence for Level 2, 3


y/n


Clinical Knowledge

Has knowledge of the respiratory system

I

Has knowledge of respiratory diseases

I

Has knowledge of normal parameters

Has knowledge of infection control measures to minimise cross-infection

Has knowledge of Nebulization Therapy

Demonstrates correct use of Manual Peak Flow Technique:

I/O

13. Explains procedure to Patient and gains consent

14. Establishes patient’s current peak and best peak flow readings

15. Wash and dry hands



84

16. Collect and assemble equipment-attach mouthpiece to meter

17. Move indicator to zero mark prior to reading

18. Sit patient in upright position

19. Ask the patient to take a deep breath in and place their lips around the mouthpiece

20. Repeat process

21. Record readings, use the best of three readings

22. Return patient to a comfortable position

23. Discard used mouthpiece into clinical waste

24. Wash hands

25. Document readings on observation chart and EPJ, noting time of reading and any nebulized therapy

Medical Device Competency (Safe Use) PEAK FLOW


Manual Peak Flow Meter

Achieved

y/n


Able to reorder Meters and Mouthpieces(single use items)



85

Is aware patient can experience light- headedness when using the Peak Flow Meter




86

Physical Observation Chart

Vital signs monitoring using Modified Early Warning Scoring System (MEWS) / Track and Trigger System (TT) I=interview o =observed n/a not applicable Clinical Competence for Level 2, 3, 4


y/n


Clinical Knowledge

Has knowledge of rationale for using MEWS Chart/Track and Trigger System

I

Has knowledge of background Policy

NICE CG50

I

Has knowledge of SOS reporting system, action protocol and communication system

I

Demonstrates correct use of the chart ensuring all sections are complete:

26. Patient details

27. Record results of Urinalysis and ECG

28. Use correct codes



87

29. Frequency of Observations

30. Review in ward round

31. Consecutive dates and times recorded

32. Add up total scores correctly

33. Knowledge of normal parameters

34. Signs for accountability

35. Completes Food and Fluid Balance chart

36. Total over 24 hours period

37. Blood Sugar recordings

38. Weight measurement and Body Mass index

39. Understands when to use modifications and where to record on chart

40. Record Score 4 on EPJ and management Plan on EPJ

I/O

Able to Verify competency and safe use of Medical Devices

1. Temperature

2. Blood Pressure



88

3. Pulse

4. Respiration

5. Oxygen Saturation

6. Levels of Consciousness using AVPU

7. Glasgow Coma Scale

8. Fluid and Food Balance

9. Weight Measurement

10. Blood sugar Monitoring

11. Urinalysis

12. ECG monitoring (levels 3,4)

I/O

Medical Device Competency (Safe Use) MEWS /TT CHART


MEWS CHART

Achieved

y/n


Able to reorder MEWS charts

I

Able to file old charts by scanning onto EPJ

I/O



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Members of the Medical Devices Competencies Working Group The group is a sub group of the Trust Medical Devices Committee, established in July 2009 and comprises of nursing and non-nursing professions with a variety of clinical and managerial experience both in hospital and community settings. Chris Tritschler (chair) Clare Ellis-Smith Amanda Broughton Natalie Warman Stacy Dangare Tom Culligan Delores Williams Karen Brown



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References NICE (2007) Acutely ill patients in hospital. Recognition of and response to acute illness in adult hospitals. London: www.nice.org.uk/CG50 Department of Health (2009) Competencies for Recognising and Responding to Acutely ill Patients in hospital. London Royal Marsden Manual On-line 7th edition http://www.rmmonline.co.uk/ SLAM (2009) Medical Devices Policy Ihttp://sites.intranet.slam.nhs.uk/resus\default.aspx Slam (2005) Medical Equipment Resource Folder Yellow book [email protected] http://www.slam.nhs.uk/coursemill/index.jsp Food, Nutrition and Hydration in Health and Social Care http://www.corelearningunit.nhs.uk/signin.aspx British Hypotension Society (2006) Blood Pressure Management British Thoracic Society (2008) British guideline on the management of Asthma www.diabetes.org.uk Resuscitation Council UK (2004) Intermediate Life Support Course Manual. London: RCUK.



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www.resus.org.uk Nash, M (2010) Physical Health and Well-Being in Mental Health Nursing Slam Policies Physical Healthcare Policy 2008 Infection Control Policy 2008 Resuscitation Policy 2007 Prevention and Management of Violence and Aggression Policy 2008 Medication Management Policy



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Appendix A: VERIFICATION OF COMPETENCY & (SAFE USE) OF MEDICAL DEVICES EQUIPMENT

Name of Candidate………………………………. Job title/Band……………… ……………….. Ward/Team………………….. Clinical Academic Group……………………….. Name of Manager…………………………………Job Title/Band……………………… …………. Level agreed…………………. Description of Competency/Medical Device Level/NA Date of Name of Assessor Intls Signature of Candidate Assessment (PRINT)

1 RESPIRATION 2 PULSE OXIMETRY 3 OXYGEN THERAPY 4 PULSE 5 BLOOD PRESSURE (MANUAL) 6 ECG 7 TEMPERATURE

8 GLUCOMETER 9 SUCTION 10 WEIGHING SCALES 11 HEIGHT MEASURE 12 URINALYSIS 13 URINE DRUG SCREEN 14 ALCOMETER 15 PEAK FLOW METER 16 PHYSICAL OBSERVATION/

MEWS CHART

Other