QA and skills review

[kathrn99]

Hello everyone. I need some information please. I am in ACNP school and have an assignment to describe how I will maintain my skills adequately after graduation. Also, how will I develop a QA plan for demonstrating my skills level. Is it a requirement to have a QA plan in place? Also how do you keep your skills, such as Central line placement up to date?

Thanks in advance for any help. I've searched the Internet and emailed my board if nursing without success in finding answers.

[DidiRN]

There are seminars out there for NPs for things like this. I can't remember the name of the one company that does them off hand though. A local college in my area is doing something like this as well.

[Corey Narry, MSN, RN, NP]

Since you're not in clinical practice yet it's hard to figure out what skills you need to maintain competency for aside from the general acute care nurse practitioner skills of physical examination, evaluation of labs and diagnostic tests, differential diagnosis, and assessment and planning. As you know, not all ACNP's work in ICU's and those who do not do so would not need to maintain skills in placing central lines for example. Does the assignment allow you to write skills based on a hypothetical situation that you could be faced with in clinical practice?

As an ACNP working in critical care, I am required to maintain a set of skills related to the specialty beyond the general skills I mentioned previously. This does include central line placements, arterial line placements, intubations, and providing procedural conscious sedation. These skills are maintained by making sure all NP's who are credentialed to do such procedures maintain annual number of cases at a minimum each year. In cases when the NP did not meet the minimum annual numbers, the procedure has to be supervised by a physician. The NP is also responsible for making sure the procedure is performed using national safety standards.

For example, national safety standards when placing central lines include handwashing and maximum sterile barriers (full body drape to patient; cap, mask, sterile gown, sterile gloves for provider) should be utilized. In addition, ultrasound guidance and confirmation of venous placement (i.e., manometry) should be employed in appropriate situations. These are steps the NP should make sure are followed when placing central lines among a long laundry list of steps that must be done.

In our setting, these are part of an in-house QA that the institution enforces and typically the nurse will have a checklist of these required steps while they observe and assist the provider in placing these lines. Another QA that our institution utilizes with central lines is monitoring the incidence of central line associated bloodstream infections though this in particular encompasses the entire care of these line which obviously does not end with just placement alone.

[kathrn99]

Thanks so much. I really appreciate your help. The assignment is to choose a procedure we are learning this semester and describe the pros and cons, the procedure, etc. The part I'm having difficulty with is that we are to explain how we will maintain that skill and how we plan to monitor the QA of performing it.

Thanks