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APNA 29th Annual Conference Session 3036: October 30, 2015 Corbo 1

Sally Ann Corbo, Ed.S., APN‐BC, NEA‐BC sacorbo@epicare.com October 30, 2015 Epicare Associates, Inc. www.epicare.com

No Disclosures

• There have been NO influential relationships disclosed

in the planning of this session.

• Session planning has NOT been influenced by

commercial support.

• There is no commercial support for this activity.
• No off‐label use of FDA approved products will be

discussed in this session.

If you are responsible to educating staff, chart the course of regulatory standards for psychiatric nursing staff. Learn the federal, national, state and professional requirements along with effective methods to teach and document training. Measuring outcomes of education will be discussed as we turn the jungle ride into smooth sailing. At the completion of this program the learner will be able to: 1. State the mandatory training requirements for psychiatric mental health nurses and advanced practice nurses. 2. Differentiate between Competency Assessment and Performance Appraisal/Evaluation. 3. Employ effective documentation techniques to meet the required standards. 4. Implement clinical outcome measurement of education and training.

Purpose and Objectives

APNA 29th Annual Conference Session 3036: October 30, 2015 Corbo 2

 Ideally, one person within the organization interprets the standards and disseminates them; during a survey this is the person who should speak to the rationales.  A centralized approach works best to ensure that staff within the same job title/responsibilities are given the same training and evaluation method. This will also enable an aggregate measurement of outcomes. Training programs need to improve clinical practice and keep staff up to date on changes.  There needs to be a tracking system/learning management system (LMS) to ensure 100% compliance. The responsibility for tracking can be de‐centralized.

Achieving Success with Regulatory Training

 Become familiar with the standards and its intent.

 Internal versus External standards  Networking can be very helpful

 Is the purpose of the standard to provide information or to measure competency?  The difficulty is that many standards leave it up to the

• rganization to decide the frequency and method.

 This may be determined by State Laws.  In many cases there is no “right” answer; however, consistency and adherence to the organization’s own standard is key.

Interpreting Standards and Regulations Regulations for Training and Education

Employer

 Center for Medicare/Medicaid

• Restraints/Seclusion

 Federal

• CDC
• FDA
• HIPAA
• FEMA
• FBI

 The Joint Commission

• CAMBH – Behavioral Health
• CAMH ‐ Hospital

 State Department of Health Practitioner  License

• CE for Re‐licensure
• State specific: refer to download

 APRN

• CE for Re‐licensure
• Psychopharmacology CE

 Certification

• Application & Renewal
• ANCC
• 150 hours every 5 years/75 hrs must

be CE

• APN’s must have 25 contact hours

for pharmacology

Source: http://www.nursecredentialing.org/RenewalRequirements.aspx

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Types of Programs Program Curriculum

Bloom’s Taxonomy  Cognitive  Psychomotor  Affective

Source: Bloom, B. S. (1956). Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain. New York: David McKay Co Inc.

Evaluation Methods

 Paper and Pencil Tests

• Online tests

 Demonstration/Re‐demonstration

• Skills Labs
• Clinical Observation

 Interpersonal Interactions

 Role Play  Group Facilitation

Competency Assessment versus Performance Appraisal

Competency Assessment

 New staff have their competence assessed as part of the employment process, prior to being given a patient care assignment.  The competency of each staff member is assessed through an ongoing process.  The competency assessment process and performance review system are utilized to assure competency of all staff.

Performance Appraisal

 Assesses how well a staff member actually performs their job duties/responsibilities according to their job description.  Annual competency assessment can be added to performance appraisal.

APNA 29th Annual Conference Session 3036: October 30, 2015 Corbo 4

Designing an Annual Competency Program

Determinants

 New/Updated regulations  Organizational Strategic Plan  Divisional/Departmental Goals  PI Data/Findings  Sentinel Events  Staff Incidents/Injuries

Competencies

 Standard or Universal

• Applies to everyone

 Core – Divisional

• Within the same role/job description

 Critical

• Decided annually
• Based on changes, high risk, problem

prone

• PI data/findings

Training Process

Assessment/Gap Analysis

 Federal, State, TJC Requirements  Job Description  PI Data  Strategic Plan  Assessing Learning Needs

• New and Transferred Employees
• Educational Background
• Previous experience
• Learner’s Perceived Needs
• Skills Checklists/Documentation

Program Planning

 Who has to be trained  What do they need to learn  When are they available  How should they be taught  Why do they have to learn this

Training Implementation

Implementation

 Type of training required  Available resources

• Instructional
• Competency Day
• Topic of the Month
• Technology
• E‐Learning
• Financial
• Grants

 Total # of staff to be trained  Amount of time for training

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Training Evaluation

Evaluation

 Method of Evaluation

• Correlation to objectives

 Determining Outcomes

• Terminal Objective

 Measuring Outcomes

• Use available data
• HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems
• HBIPS – Hospital Based Inpatient Psychiatric Services
• Patient Satisfaction
• Code statistics
• Medical
• Behavioral
• Restraints/Seclusion

Tests for knowledge  Standardized Versus Facility specific  Passing Grade – Must Be Consistent  Failures

• Number of retakes; time interval; can they continue to work

e.g. Constant Observation; Medication Administration Skills Demonstration  Skills/Competency Checklist Affective Behaviors  Observation/Feedback Form  In Class Role Play  Unit Based Interactions e.g. Groups

Documentation

The current focus is away from measuring objectives to measuring outcomes.  Rather than ‘state’, ‘identify’, ‘apply’…  … ‘the participant of the review course will successfully pass the ANCC certification exam.’

Measuring Outcomes

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Kirkpatrick’s Four Levels of Evaluation

What level is measured by:

• Written Tests
• Demonstrations
• Observations
• Focus Groups
• 360 Feedback
• Organizational Metrics

Analyzing Results

Successes

 Which results most dramatically suggest:

• Program’s potential strengths?
• Successfully achieved the learning
• bjectives?

 Did the program produce any positive, but unexpected

• utcomes?

Opportunities

 Which results:

 Provide evidence that some learning objectives were not met?  Suggest any negative, unexpected

• utcomes?

 Suggest a need for additional follow‐up i.e. on the job coaching, mentoring, job aids?

Restraints and Seclusion

• Verbal De‐escalation

Workplace Violence

• Active Shooter Training

CPR Training Contract Employees Forensic Staff Transferred Employees

Challenging Regulations

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 Questions?

Questions