on call physiotherapy competency framework · 3 introduction respiratory care is a core...

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Appendix 3

On Call Physiotherapy

Competency Framework

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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.


absent breath sounds.


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


prioritise care and act on findings

Documentation


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

1

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)


using MT

2. Can discuss the precautions and

contra-indications for using MT


treatment benefit



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technique



condition


to therapy

Assisted cough


using the assisted cough


contra-indications for using the

assisted cough


treatment benefit




technique



condition


to therapy

Postural drainage


using postural drainage

techniques


contra-indications for using

postural drainage techniques


treatment benefit

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technique



condition


to therapy

Manual hyperinflation (bagging)


bagging


contra-indications for bagging


treatment benefit

4. Able to demonstrate how to set up

the circuit correctly including a

manometer


the patients consent (if able)


technique



condition

8. Able to explain specific

observations post MHI which

need to be observed.

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Learning log



competent.


Assessed by:

Name: Grade: Date:


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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



competent.


Assessed by:

Name: Grade: Date:


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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



competent.


Assessed by:

Name: Grade: Date:


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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

1

Observable criteria

Circle assessment

outcome

Date Assessors

Signature

5 4 3 2 1

IPPB (intermittent positive pressure breathing)


using IPPB


contra-indications for using IPPB

3. Can demonstrate how to set up

the machine**

4. Demonstrates how to establish

the patient onto IPPB**


modify the settings accordingly


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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physiological effects of EPAP


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



competent.


Assessed by:

Name: Grade: Date:


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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



competent.


Assessed by:

Name: Grade: Date:


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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

1

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


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selection of a nasopharyngeal

airway


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


suctioning technique for a

nasopharyngeal airway


suctioning technique using a

closed suction unit via an ETT

or tracheostomy


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



competent.


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.

on call physiotherapy competency framework · 3 introduction respiratory care is a core...

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