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/depts/uwhealth/ambulatory-education/staff-driven-competency-model/resources/Example-Step-2-Competency-Worksheet.pdf

20180110

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UWHC,UWMF,

Departments & Programs,UW Health,Ambulatory Education,Staff Driven Competency Model,Resources

Example Step 2 Competency Worksheet

Example Step 2 Competency Worksheet - Departments & Programs, UW Health, Ambulatory Education, Staff Driven Competency Model, Resources



Updated December 2017


Step 2
2018 Competency Worksheet

***Please complete one worksheet per competency from Step 1 Brainstorming Worksheet

Name of Competency: _Heparin drip management_________________________________________________

Reason(s) for identifying this competency: _Increased number of PSNs related to heparin drips;
high alert medication; new changes to IV/IV MAR flowsheet related to drip titration and
documentation.

Roles that need to complete competency (RN, MA, TECH, etc): __RN____________________________

Unit/Department: _____________________________________________________________________

Targeted Patient Population(s) for this competency: _Adults___________________________________

What do staff members need to demonstrate upon completion of this competency (specific skill,
behavior, etc.)?_Successful titration with rapid and gradual algorithms; line reconciliation
with IV pump and MAR; document “rate verify” in MAR; proper IV/IV MAR documentation
with new flowsheet choices.

Outcome Measurement:
How will you determine the success of your competency completion? _Decrease in PSNs related to
heparin drips

Suggested validation method(s):
Please suggest validation methods for this competency
Validation Method Suggestions

_X_Post Test
_X_Case Study
___Return Demonstration
___Exemplar
___Discussion/Reflection Group
_X_Observation


___Self-Assessment
___Mock Event/Survey
___QI Monitoring
___Peer Review
___Presentation

Identify a key contact within your unit/dept. for this competency:
Name: _____________________________________ Role: ____________________________________

Return Completed Worksheet to: (by March 30
th
, 2018)


Updated December 2017


Nursing Education Department (Mail Code 9305)
Ambulatory Education (Mail Code 1035)


Updated December 2017


Step 2
2018 Competency Worksheet

***Please complete one worksheet per competency from Step 1 Brainstorming Worksheet

Name of Competency: _?mergency Response _______________________________________________________

Reason(s) for identifying this competency: _?odes are infre煵ent but very high ris?. ?hey are
also time? sensitive in that there is no time to review a chec?list or resources before
performing the s?ills. It was identified during code debriefing that there were delays in
placing pads? placing the bac?board and defibrillating due to ine?perience/lac? of comfort
with emergency e?uipment.

Roles that need to complete competency (RN, MA, TECH, etc): __RN____________________________

Unit/Department: _?eneral _____________________________________________________________

Targeted Patient Population(s) for this competency: _Adults and pediatrics ____________________

What do staff members need to demonstrate upon completion of this competency (specific skill,
behavior, etc.)?_?fficient and effective response to emergency situations including?
• ?alling emergency response number
• Starting chest compressions
• Placing pads
• Placing bac?board
• Defibrillating

Outcome Measurement:
How will you determine the success of your competency completion? _Increase in staff comfort
with emergency response situations by two points on a ? ? ㄰ ?i?ert scale; decrease number
of deficiencies reported during code debriefings.

Suggested validation method(s):
Please suggest validation methods for this competency
Validation Method Suggestions

___Post Test
___Case Study
_X_Return Demonstration
___Exemplar


___Observation
_X_Mock Event/Survey
___QI Monitoring
___Presentation



Updated December 2017


Identify a key contact within your unit/dept. for this competency:
Name: _____________________________________ Role: ____________________________________

Return Completed Worksheet to: (by March 30
th
, 2018)
Nursing Education Department (Mail Code 9305)
Ambulatory Education (Mail Code 1035)