PEDIATRIC HEMATOLOGY ONCOLOGY UNIT
(6A)
LICENSED STAFF
EMPLOYEE NAME:
2015-2016
Competency and Compliance Plan
When complete (with included dates), please submit to your unit’s designated repository.
Employees are also accountable for completing any additional Learning Exchange Modules
assigned throughout the year.
This must be completed and submitted no later than April 30, 2016
The information and competency data I submit are complete (with dates), true, and accurately reflects my work and abilities to function as a licensed staff member in my department. If I completed an “Observation of Daily Work” or “Case
Study,” I submitted these items through the designated online submission site. I understand that my ongoing professional
growth is my responsibility and that I will notify my educator or designated department leader if I have further training
Employee’s Signature
Date
CSL/Manager’s Signature
Date
Competency Transition Year: January 1, 2015-April 30, 2016
ORGANIZATIONAL COMPETENCIES
Page 2
Competency
Validation Criteria/Methods of
fication
Veri- Completion
(Dates must be included)
JC HR.01.05.03 EP 3 & VUMC CL 30-08.21 & CL 30-19.22
Clinical Emergency
Response
(RR/Mock Code)
Demonstrates and communicates role in
activating or participating in the Tiered Response Team, STAT Team, and/or Code.
Date_________

2015-2016 CAVE Event OR

Hands On Clinical Safety Event OR

Observation of Daily Work
(Online Submission)

OR
The following training in 2015:
PED: PALS
NICU/NBN: NRP
HR/RR/PACU: PALS
Periop/Procedural Services: PALS
Critical Care: PALS
Acute/Specialty Care: PEARS
NPSG: 01.03.01 & VUMC CL 30-07.06
Blood Administration
Demonstrates ability to administer blood
products according to VUMC policy and
procedure.
Date_________

2015-2016 CAVE Event OR

Hands On Clinical Safety Event OR

Observation of Daily Work
If Mock Event w/ Return Demonstration
(Online Submission)
OR

Mock Event w/Return Demonstration**
(planned with Unit Educator)

Learning Exchange Module:
Name of Trainer:_____________________
Signature: __________________________
Role: ______________________________
VUMC CL 20-07.03 & CL 30-19.02
Basic Arrhythmia
Date_________
“2015-2016 VCH Pediatric Basic
Arrhythmia”
Demonstrates ability to recognize, intervene, and elevate acute events involving
the heart and vascular systems.
VUMC CL 30-06.30 & OP 30-10.04; HR-035
Medication Diversion
Demonstrate knowledge of Safe Medication
Administration and how to act in a situation
where Medication Diversion is suspected.

Learning Exchange Modules:
“Medication Diversion Accountability—
Licensed Staff 2015”
“The Impaired Caregiver—Licensed Staff
2015”
“Safe Medication Administration Practice
2015”
Date_________
Date_________
Date_________
Trouble finding the online submission site for “Observation of Daily Work” and “Case Study”?
Visit Vanderbilt’s Nursing site and type in “Competency.” Children’s competency site can be found under “Ongoing Competencies and Skills.”
DEPARTMENTAL COMPETENCIES
Validation Criteria/Methods of
Verification
Competency
Chemotherapy

2015-2016 CAVE Event
Page 3
Completion
(Dates must be included)
Date_________
OR

Crash Cart Scavenger Hunt 
Observation of Daily Work (Online Submission)
2015-2016 CAVE Event
Date_________
If Mock Event w/ Return Demonstration
Name of Trainer:_____________________
Signature: __________________________
Role: ______________________________
Falls Prevention
Interventions

Observation of Daily Work (Online Submission) Date_________
OR

Case Study
(Online Submission)
Trouble finding the online submission site for “Observation of Daily Work” and “Case Study”?
Visit Vanderbilt’s Nursing site and type in “Competency.” Children’s competency site can be found under “Ongoing Competencies and Skills.”
Page 4
Compliance Requirements
Note: Compliance items require completion on an annual basis and may need to be completed
twice during this competency transition year (1/1/15-4/30/16) to remain compliant.

TB Skin Test

Point of Care Training
________________
(Staff can only re-cert within
3 months of expiration.)
 Glucose
 Hemoccult
_________
 Gastroccult
_________
 Urine Dip
_________
 Urine Pregnancy
_________

N95 Fit Testing

MRI Training
 “Magnetic Resonance Imaging (MRI)
________________
(Staff can only re-cert w/Glucose
when meter prompts.)
________________
________________
Safety”
 MRI Safety Survey
________________
https://www4.vanderbilt.edu/wellness/
OHC/mri.php

Human Resources Annual Modules
 2015 Standards of Conduct and Confi-
________________
dentiality Training
 2015 Privacy and Information Security
________________
(HIPAA)
 2015 Annual Policy Review
________________
VandySafe Modules:
As VandySafe Modules do not get released to staff until the fall, a separate document will be published at that time outlining
the unit specific requirements for completion.