An Overview of Cough & Cough Assessment Sally Cozens Respiratory Specialist Physiotherapy
On Call Physiotherapy Competency Framework · 3 Introduction Respiratory care is a core...
Transcript of On Call Physiotherapy Competency Framework · 3 Introduction Respiratory care is a core...
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Contents
Introduction................................................................................................................................. 3
Using this package ..................................................................................................................... 3
On call courses........................................................................................................................... 3
On call preparation ..................................................................................................................... 4
Infection control .......................................................................................................................... 4
Competency Levels .................................................................................................................... 4
Self Assessment......................................................................................................................... 5
Competency 1 - Respiratory Assessment .................................................................................. 7
Competency 2 - Respiratory Techniques ................................................................................. 12
Competency 3 - Airway Management ...................................................................................... 16
Competency 5 - Non-invasive Ventilation................................................................................. 20
Competency 6 – Tracheostomy Care....................................................................................... 23
Competency 7 - Suctioning ...................................................................................................... 26
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Introduction
Respiratory care is a core physiotherapy skill however there are many challenges associated
with treating respiratory patients out of hours. The patient can often be unwell; you may be in
an unfamiliar environment or you may not regularly work with respiratory patients. This
competency package is designed to support you in this situation and aims to enhance your
learning by identifying key competencies that are required in order to deliver safe and effective
patient care.
Using this package
As healthcare professionals we are responsible for updating and maintaining our skills.
Supported by the senior respiratory physiotherapy team, this package will provide you with the
resources needed to highlight and support your ongoing learning and development.
The package has been divided into essential and optional skills denoted by a **. We would ask
you to complete the self assessment grid on pages 4 and 5. If you identify a learning need,
please contact the medical/surgical physiotherapy team on the following numbers:
Emma Humberstone Bleep 1102
Helen Redford / Jenna Nixon Bleep 1628
Naomi Roberts Bleep 1627
Leah Gallon Bleep 1462
They will identify when there is an opportunity for that learning need to be met and book this
with you. Subjects will be covered in various training options, these include in-service training
sessions, shadowing a senior respiratory physiotherapist and the on call courses which run
annually.
On call courses
As part of the new on call policy, there will be on call courses run annually which all
physiotherapists on call must attend. There will be three courses run each year, allowing
choice of which course you are able to attend due to departmental work pressures. It is
mandatory that all on call physiotherapists attend one course per year and maintain their
competence for being on call.
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The courses will cover core subjects for the on call physiotherapist and you will be provided
with a comprehensive handbook to use as a resource, to help you prepare for your on call and
maintain competence and confidence.
On call preparation
This is covered in the on call policy – please be familiar with this prior to your on call.
Infection control
In terms of infection control, physiotherapists whether on call or not follow the trusts
infection control policy and as a member of this trust you should be familiar with this
policy.
Competency Levels
You will be assessed during various teaching and learning experiences. All
physiotherapists on the on call rota must have completed the competency framework
unless they are a senior respiratory physiotherapist within the trust.
During the on call courses your competencies will be reviewed and signed off as able
by the senior respiratory physiotherapy team. Any areas needing ongoing work will be
addressed with booking time with the senior respiratory physiotherapy team.
All of your competencies need to be signed off at level 4 or 5 for you to be deemed
competent to undertake on call. It is not acceptable for you to not do on calls because
you are not competent, there are numerous opportunities for these learning needs to
be met, so your participation in the on call rota will be ongoing.
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Self Assessment
Competency
section
Training required Update required Preferred method of learning
i.e. Personal reading, shadowing, teaching sessions
Yes No Yes No
Competency 1
Patient history
Patient assessment
Auscultation findings
Communication
Documentation
ABG interpretation
CXR interpretation
Competency 2
ACBT
Positioning
MT
Assisted cough
Postural drainage
Manual hyper-inflation
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Competency
section
Training required Update required Preferred method of learning
i.e. Personal reading, shadowing, teaching sessions
Yes No Yes No
Competency 3
Airway management
Competency 4
Oxygen and humidification
Competency 5
IPPB**
CPAP
BiPAP
Modes of Ventilation
Competency 6
Tracheostomy care
Competency 7
Nasophanageal suction
Oral suction
Tracheostomy suction
Closed suction via ETT
** Optional skills
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Competency 1 - Respiratory Assessment Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step instruction
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Observable criteria
Circle
assessment
outcome
Date Assessors
Signature
5 4 3 2 1
Patient History
1. Able to obtain and document HPC,
PMHx, DHx, SHx and understand
the significance of it.
2. Aware and able to explain the
difference between subjective and
objective assessment findings.
3. Aware to document information
received from other sources, such
as nursing staff.
Patient Assessment
1. Gains consent from the patient to
assess and treat.
2. Evaluates and comments on the
patients airway.
3. Evaluates and comments upon the
patients RR, breathing pattern and
work of breathing.
4. Able to explain signs of respiratory
distress which the patient may be
showing.
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5. Able to comment on the patients
ventilatory support, including
oxygen amount and saturation
levels.
6. Ability to recognise and
understand the significance of the
patients last CXR.
7. Understands and evaluates the
importance of the latest ABG
result.
8. Evaluates and comments on the
patients cardiovascular system,
including BP, HR and Temp.
9. Comments on the patients fluid
balance.
10. Refers to the patients medication
chart and understands the
relevance and significance of this
11. Refers to the patients pain
assessment score (if indicated)
12. Able to assess for responsiveness
using AVPU or GCS level.
Auscultation findings
1. Can identity normal breath
sounds.
2. Can discuss the significance of
bronchial breath sounds.
3. Can discuss the significance of
absent breath sounds.
4. Can discuss the significance of
crackles and their location.
5. Can the discuss the significance
and what different conditions can
cause wheeze.
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Arterial blood gas interpretation
1. Able to list the normal ABG
parameters
pH
Pa02
PaC02
HCO3
Base excess
O2 saturations
2. Able to discuss the causes of
acidosis and alkalosis **
3. Able to interpret an ABG result
and suggest if NIV is indicated and
which type of NIV - CPAP or
BiPAP
CXR interpretation
1. Describe the indication for a chest
X-ray
2. Able to discuss the differences
and clinical significance of
interpreting a PA, AP, erect and
supine film
3. Able to Identify:
Lung margins
Heart
Aortic arch
Pulmonary trunk
Diaphragm
Horizontal fissure
4. Able to comment on:
Rotation
Penetration
Lung fields
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Heart size and shape
Mediastinum
Diaphragm
Costophrenic angles
Trachea
Bone and soft tissue
5. Demonstrates a systematic
interpretation of a chest X-ray
Communication
1. Maintains patient dignity.
2. Explains each and every
procedure to the patient and gains
consent each time.
3. Demonstrates the ability to
effectively communicate with
members of the multi-professional
team
4. Demonstrates the ability to
prioritise care and act on findings
Documentation
1. Demonstrates the ability to
produce accurate, clear and
legible patient records as per the
CSP and trust guidelines.
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Learning log
To be completed by the assessor when all the sections above have been signed confirming
that the above named person has been assessed at level 4 or above and is therefore
competent.
Assessment outcome: Pass Refer
Assessed by:
Name: Grade: Date:
Trainee’s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team.
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Competency 2 - Respiratory Techniques Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step instruction
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Observable criteria
Circle assessment
outcome
Date Assessors
Signature
5 4 3 2 1
ACBT (active cycle of breathing technique)
1. Can discuss the indications for
using ACBT
2. Positions the patient for optimum
treatment benefit
3. Explains the procedure and gains
the patients consent
4. Demonstrates the correct
technique
5. Demonstrates how to adjust and
modify the therapy to the patients
condition
6. Assesses the patients response
to therapy
MT (manual techniques)
1. Can discuss the indications for
using MT
2. Can discuss the precautions and
contra-indications for using MT
3. Positions the patient for optimum
treatment benefit
4. Explains the procedure and gains
the patients consent
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5. Demonstrates the correct
technique
6. Demonstrates how to adjust and
modify the therapy to the patients
condition
7. Assesses the patients response
to therapy
Assisted cough
1. Can discuss the indications for
using the assisted cough
2. Can discuss the precautions and
contra-indications for using the
assisted cough
3. Positions the patient for optimum
treatment benefit
4. Explains the procedure and gains
the patients consent
5. Demonstrates the correct
technique
6. Demonstrates how to adjust and
modify the therapy to the patients
condition
7. Assesses the patients response
to therapy
Postural drainage
1. Can discuss the indications for
using postural drainage
techniques
2. Can discuss the precautions and
contra-indications for using
postural drainage techniques
3. Positions the patient for optimum
treatment benefit
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4. Explains the procedure and gains
the patients consent
5. Demonstrates the correct
technique
6. Demonstrates how to adjust and
modify the therapy to the patients
condition
7. Assesses the patients response
to therapy
Manual hyperinflation (bagging)
1. Can discuss the indications for
bagging
2. Can discuss the precautions and
contra-indications for bagging
3. Positions the patient for optimum
treatment benefit
4. Able to demonstrate how to set up
the circuit correctly including a
manometer
5. Explains the procedure and gains
the patients consent (if able)
6. Demonstrates the correct
technique
7. Demonstrates how to adjust and
modify the therapy to the patients
condition
8. Able to explain specific
observations post MHI which
need to be observed.
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Learning log
To be completed by the assessor when all the sections above have been signed confirming
that the above named person has been assessed at level 4 or above and is therefore
competent.
Assessment outcome: Pass Refer
Assessed by:
Name: Grade: Date:
Trainee’s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team.
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Competency 3 - Airway Management Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step instruction
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Observable criteria
Circle assessment
outcome
Date Assessors
Signature
5 4 3 2 1
Airway Management
1. Discusses the common causes of
partial airway obstruction
2. Discusses the common causes of
total airway obstruction
3. Can list the signs and symptoms
of airway obstruction.
4. Is able to explain the technique
for securing an airway and who to
contact if an airway is not patent.
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Learning log
To be completed by the assessor when all the sections above have been signed confirming
that the above named person has been assessed at level 4 or above and is therefore
competent.
Assessment outcome: Pass Refer
Assessed by:
Name: Grade: Date:
Trainee’s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team.
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Competency 4 – Oxygen and Humidification Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step instruction
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Observable criteria
Circle assessment
outcome
Date Assessors
Signature
5 4 3 2 1
Oxygen and humidification
1. Is able to explain the different
oxygen delivery systems
2. Is able to explain the differences
between high and low flow
oxygen
3. Is able to recognise when a
patient is not on the correct
oxygen amount and how to
correct this
4. Is able to explain the importance
of pre-oxygenation prior to
suctioning
5. Able to articulate the limit on flow
rates for nasal cannulae
6. Able to recognise when oxygen
should be humidified
7. Able to explain the different
humidification systems available
8. Demonstrates knowledge of
precautions with oxygen therapy
with some patient groups
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Learning log
To be completed by the assessor when all the sections above have been signed confirming
that the above named person has been assessed at level 4 or above and is therefore
competent.
Assessment outcome: Pass Refer
Assessed by:
Name: Grade: Date:
Trainee’s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team.
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Competency 5 - Non-invasive Ventilation Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step instruction
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Observable criteria
Circle assessment
outcome
Date Assessors
Signature
5 4 3 2 1
IPPB (intermittent positive pressure breathing)
1. Can discuss the indications for
using IPPB
2. Can discuss the precautions and
contra-indications for using IPPB
3. Can demonstrate how to set up
the machine**
4. Demonstrates how to establish
the patient onto IPPB**
5. Demonstrates how to adjust and
modify the settings accordingly
6. Assesses the patients response
to therapy
CPAP (continuous positive airway pressure)
1. Is able to define the term CPAP
2. Is able to explore the
physiological effects of PEEP
3. Is able to discuss the indications
for CPAP
4. Is able to discuss the precautions
and contraindications for CPAP
BiPAP (Bi-level positive airway pressure)
1. Is able to define the term BIPAP
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2. Is able to explore the
physiological effects of EPAP
3. Is able to explore the
physiological effects of IPAP
4. Is able to discuss the indications
for BIPAP
5. Is able to discuss the precautions
and contraindications for BiPAP
Modes of Ventilation (including the oscillator)
1. Is able to explain what controlled
ventilation means
2. Can explain what is meant by
pressure support
3. Can explain the differences
between PS and P-SIMV
4. Is able to explain what the
oscillator is and why a patient
may be on one
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Learning log
To be completed by the assessor when all the sections above have been signed confirming
that the above named person has been assessed at level 4 or above and is therefore
competent.
Assessment outcome: Pass Refer
Assessed by:
Name: Grade: Date:
Trainee’s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team.
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Competency 6 – Tracheostomy Care Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step instruction
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Observable criteria
Circle assessment
outcome
Date Assessors
Signature
5 4 3 2 1
Tracheostomy care
1. Define the term tracheostomy
2. Discuss the difference between a
tracheostomy and laryngectomy
3. Discuss the indications for a
tracheostomy tube
4. Identify the essential bedside
equipment
5. Discuss two different types of
tracheostomy tubes used in the
Trust
6. Explain the function of the inner
tube and relate this to suctioning
7. Explain the function of the cuff
8. Explain why a patient may be
unable to speak
9. Discuss the different methods of
achieving effective
communication
10. Discuss the signs and symptoms
of respiratory distress in a patient
with a tracheostomy
11. Identify 3 complications that may
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occur immediately after insertion
12. Identify 3 complications that may
occur after 36 hours of insertion
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Learning log
To be completed by the assessor when all the sections above have been signed confirming
that the above named person has been assessed at level 4 or above and is therefore
competent.
Assessment outcome: Pass Refer
Assessed by:
Name: Grade: Date:
Trainee’s signature: Date: Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team.
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Competency 7 - Suctioning Method of assessment: Questioning and observation Independent in practice 5 Requires occasional guidance 4 Requires frequent guidance 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step instruction
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Observable criteria
Assessment
outcome
Date Assessors
Signature
5 4 3 2 1
Suctioning
1. Discuss the clinical indications
for suctioning
2. Demonstrate knowledge of
what techniques should be
tried prior to suctioning
3. Able to explain the different
routes in which suctioning can
be done
4. Able to explain to the patient
the procedure with relevant
information
5. Able to set the correct suction
pressure
6. Is able to discuss the
indications for the insertion of
a nasopharyngeal airway
7. Is able to discuss the
precautions and
contraindications for the
insertion of a nasopharyngeal
airway
8. Demonstrates the correct
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selection of a nasopharyngeal
airway
9. Demonstrates the correct
insertion technique for a
nasopharyngeal airway
10. Is able to list precautions and
contraindications for each type
of suctioning
11. Demonstrates the correct oral
suctioning technique using a
yankeur
12. Demonstrates the correct
suctioning technique for a
nasopharyngeal airway
13. Demonstrates the correct
suctioning technique using a
closed suction unit via an ETT
or tracheostomy
14. Demonstrates the correct
technique for suctioning via a
tracheostomy
15. Is able to evaluate the
effectiveness of suctioning
16. Is able to identify and discuss
complications that may
associated with suctioning
17. Is aware and able to discuss
the infection control policy
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Learning log
To be completed by the assessor when all the sections above have been signed confirming
that the above named person has been assessed at level 4 or above and is therefore
competent.
Assessment outcome: Pass Refer
Assessed by:
Name: Grade: Date:
Trainee’s signature: Date:
Please place one copy in your professional portfolio and a second copy will be kept by the senior respiratory team.