P191
HIGH DEPENDENCY UNIT CLINICAL COMPETENCIES
McGuire, C, Smith, H, Allen, L, Selby, N
Royal Derby Hospital
PROBLEM:
High Dependency Unit (HDU) patients admitted to specialist areas require competent and
knowledgeable staff. Following the opening of four Medical HDU beds alongside our existing Renal
HDU, we found that patients often required nursing skills that extended beyond the traditional renal
skill set. This provided an opportunity for cross pollination of skills between medical HDU and renal
HDU nurses.
PURPOSE:
We aimed to develop HDU specific clinical competency packages to enable staff to develop
knowledge, competence and clinical skills as well as recognise areas for further education and
training.
METHODS:
We performed an audit of all HDU nurses’ baseline skills using a specially developed questionnaire,
designed to identify areas that required further training. A gap analysis was conducted to identify
areas for clinical development. Following this, competency packages were designed to address
theoretical and practical training needs as well as providing an individual training record.
RESULTS:
Baseline audit and gap analysis demonstrated that the main areas needing development was the
assessment of patients admitted with complex respiratory and cardiology requirements. A
questionnaire was created for all staff caring for HDU patients 26 of which were completed. The
survey established that 59% of staff required enhancement of their respiratory knowledge, 57% of the
nursing staff were confident in interpreting arterial blood gases and 70% of nurses considered they
required further invasive lines and cardiac monitoring training. From this, we divided up the subjects
into three separate core competencies, Cardiovascular, Respiratory and Basic Care & Bedside Safety.
At the same time pre-existing packages covering Acute Kidney Injury and delivery of renal
replacement therapies were targeted to medical HDU nurses without previous experience in these
areas. The specific elements covered by the new packages include indication for the use of inotropes,
development of HDU-specific noradrenaline guidelines, care of arterial lines and non-invasive cardiac
output monitoring (NICOM), non-invasive positive pressure ventilation (NIPPV), chest auscultation,
interpreting blood gas results, diabetic ketoacidosis and management of poisoning. Competence is
achieved by demonstrating safe clinical practice and answering theory based questions. We plan to
repeat staff confidence and knowledge assessments after the full role out of these competency
packages.
RELEVANCE:
Competency packages may impact positively on patient care, improving timely interventions and
ensuring consistency across the nursing workforce. Staff will be equipped with more knowledge and
confidence to use an expanded range of clinical skills and judgement in both renal and medical HDU
areas.