RN Annual Competency 2015

Annual competency this year for all emergency department registered nurses will be held on
February 24, 25, 26 and March 3, 4, 5. This will be only for the nurses. There will not be a
physician present during the simulations. This is a mandatory requirement and a condition of
employment. Successful completion of 80% or higher in each station will need to be obtained
in the following areas. Every RN and new hire RN will need to attend this competency training.

Adult Simulation Station: For this competency it will be an interactive team approach
involving 5 RNs at a time. An adult critical scenario will be presented to the team. The team
will need to treat the patient according the American Heart Association ACLS guidelines. Video
Taping of the Simulation will take place using the new Studio Code Equipment. Review of the
taping will take place immediately following the simulation. Each team will take part in
evaluating their performance.
Here are the following concepts you will be graded on during the scenario:
Demonstrates Teamwork and Leadership Skills:
Clear established leader
Clear established roles for each individual
Input from the team
Calm and control during times of stress
Effective Communication Skills:
SBAR used
Shared Mental Model: Thinking Out Loud
Clear orders
Read back of orders
Closed loop communication
Situational Awareness:
Avoids Task Fixation
Reevaluates situation frequently
Demonstrates assertion when important information is identified
Cognitive Skills:
Quick assessment and management of ABC
Frequently summarizes condition and response to treatment
Considers others diagnosis when patient does not respond to treatment
Prioritizes tasks appropriately: O2, IV, Monitor, Correct Drugs
Critical Medical Management actions completed including BLS

Correct treatment modality for the scenario presented

No Medication Errors
Psychomotor Skills:
Quickly locates critical equipment
Demonstrates competency with equipment: Alaris Pump, EZ IO, Artic Sun
Tips to prepare for the Adult Simulation:
Complete AHA Precourse Self-Assessment for Adults:
Log on: www.heart.org/eccstudent Password: compression
Know your ACLS algorithms
Refer to your 2010 ACLS provider manual
Know how to operate the Philips Defibrillator
Be familiar with the supplies in the Adult Crash Cart
Know how to operate the Alaris Pump (There is an interactive KP Learn Module titled
Carefusion/Alaris if you need to review)
Know how to operate EZ IO
Know how to apply and operate Artic Sun

Pediatric Simulation Station: For this competency it will be an interactive team approach
involving 5 RNs at a time. A pediatric critical scenario will be presented to the team. The team
will need to treat the patient according the American Heart Association PALS guidelines.
Cognitive Skills:
Quick assessment and management of ABC
Frequently summarizes condition and response to treatment
Considers others diagnosis when patient does not respond to treatment
Prioritizes tasks appropriately: O2, IV, Monitor, Correct Drugs
Critical Medical Management actions completed including BLS
Correct treatment modality for the scenario presented
No Medication Errors
Psychomotor Skills:
Quickly locates critical equipment
Demonstrates competency with equipment: Alaris Pump, EZ IO
Tips to prepare for the Pediatric Simulation:
Complete AHA Precourse Self-Assessment for Pediatrics:
Log on: www.heart.org/eccstudent Password: palsprovider
Know your PALS algorithms
Refer to your 2010 PALS provider manual

Know how to operate the Philips Defibrillator

Be familiar with the supplies in the Pediatric Crash Cart
Know how to operate the Alaris Pump (There is an interactive KP Learn Module titled
Carefusion/Alaris if you need to review)
Know how to operate EZ IO

Skills Stations
EZIO: You will be tested on landmarks and appropriate needle size and use of lidocaine for the
conscious patient.
Tips to prepare for the EZIO station:
Watch the training Videos:
Option 1: Log on to: http://www.vidacare.com/EZ-IO/Clinical-Applications-Online-Training.aspx
and watch the training videos. They are only a couple minutes in length.
Option 2: Download arrow ezio from the app store for you smart phone and watch the videos.
These too are only a couple minutes in length
Review the Procedural Steps for Lidocaine Injection for the Awake Conscious Adult Patient:
Supplies Needed:
Preservative Free prefilled 2% Lidocaine 100mg
2 prefilled 10ml Normal Saline Flushes
3-way Stopcock
Extension Tubing from the EZ IO Training Set
Procedure:
1. Waste 40mg (2ml) of the pre filled Lidocaine
2. Attach the 3-way Stopcock to the extension tubing
3. Attach the remaining 60mg of the prefilled Lidocaine to the 3-way stopcock
4. Prime the extension tubing with 20mg (1ml) of the prefilled Lidocaine
5. Utilizing the Stabilizer attach the extension tubing to the needle
6. Slowly over 1 minute IVP 20mg (1ml) of the prefilled Lidocaine
7. Attach a 10ml prefilled Normal Saline Flush to the 3 way Stopcock
8. Slowly over 1 minute IVP 1ml of the prefilled Normal Saline Flush
9. Power flush the remaining 9ml of the prefilled Normal Saline Flush
10. IVP the remaining 20mg (1ml) of the Lidocaine into the extension tubing
11. Remove the empty Normal Saline Flush and Attach a new 10ml prefilled Normal Saline Flush to
the 3-way Stopcock
12. Slowly over 1 minute push the last 10ml of the prefilled Normal Saline Flush

Rhythm Recognition: You will be identifying 10 rhythms in this station

Tips to prepare for rhythm recognition:
The American Heart Association has a precourse self-assessment on the following websites:
Log on to: www.heart.org/eccstudent
Password: compression
This has 20 rhythms that you can review
Log on to: www.heart.org/eccstudent
Password: palsprovider
This has 10 rhythms that you can review

Arctic Sun: You will be tested on placement of pads and how to turn the equipment on. You
will also need to be able to drain the pads and turn the equipment off and back on.
Tips to prepare for Arctic Sun:
Log on to this website for training: http://www.medivance.com/AS5000TrainingModules
User Name: arcticsun

Password: arcticcircle

There is also a tutorial on the actual machine as well that you can watch when you turn it on.

Alaris Pump/High Alert Medication Station: You will demonstrate how to place a
patient on the pump, putting in the correct cost center along with showing a continuous
infusion and secondary infusion.
Tips to prepare for the Alaris Pump:
KP Learn has a self-learning module titled Carefusion/Alaris Pump that is interactive and goes
through all the features of this pump if you need a refresher.
Tips for High Alert Medication:
Review standardized concentrations, dosing and titration for the following drugs: Levophed,
TPA, Propofol, Nicardipine, Versed, and Dopamine
You will also need to know the Pediatric Dosing for Insulin and how to infuse it.

Core Measures: You will need to know the process for our core measures.
Tips to prepare for the Core Measure Station:
Review all of the Core Measure Forms in department, ex Code ROMI, Stroke Alert, Sepsis Alert,
and CAP Alert. Be able to articulate the process. Know who is responsible for what. Know the
difference between an alert and a code.

Chest Tube Set UP: You will demonstrate how to properly set up the Atrium Chest Drainage
System.
Tips to prepare for the Atrium Chest Drainage System:

Go to the ED Website: Click on the quick links tab titled Lippincott Procedures. Under the
nursing tab in the search box type in chest tube. Double click chest tube drainage system
setup and review.

Porta Cath Access: You will demonstrate how to properly access an implanted port.
Tips to prepare for the Implanted Port Insertion:
Go to the ED Website: Click on the quick links tab titled Lippincott Procedures. Under the
nursing tab in the search box type in implanted ports. Double click Implanted port insertion,
assisting.

Level One Rapid Infuser: You will demonstrate how to properly set up the level one rapid
Infuser.
Tips to set up the Level One Rapid Infuser:
Go to this link: www.youtube.com/watch?v=Tca97szG6n8
Watch this video. It is very easy to understand and it is only 3:27 long.
You can also go to this link: http://dmcededucation.weebly.com/ and click onto the
presentation to see the step by step instructions

Powered Air Purifying Respirator (PAPR) and Personal Protective Equipment

(PPE): For this station there will be a demonstration on the use of the PAPR and PPE. You will
then demonstrate how you would use the PAPR and the correct donning and doffing of the PPE.

Downtime Process and Recovery: This will be an interactive station covering the
downtime process and recovery here at Kaiser DMC.