“Competency is an expectation of work performance”

Since the User Group in 2002, the Chester Team have evolved their work on training and assessment of competency in their Anticoagulant Service.   

The recent joint recommendations from the British Committee for Standards in Haematology (BCSH) and National Patients Safety Agency (NPSA (www.bcshguidelines.org) highlights the need for identification of required competencies and training for all staff responsible for anticoagulant care.  Further there is the Key Skills Framework (KSF) (www.skillsforhealth.org.uk) aims to help the whole sector develop solutions that deliver a skilled and flexible UK workforce in order to improve health and healthcare. Within this framework there is a guideline entitled “Manage anticoagulation therapy” (HCS_HM15)  

These recommendations, however, are generic and require individual Trusts to develop adequate training packages and assessment tools of performance.  This has been done in Chester, and each member has a level of competence that is defined in writing and understood.  Ongoing assessment is done by checking 10 random anticoagulant dosage books, for each member of her team, on a 4 monthly basis. 

The following competency structure is in place at Chester and is split into two areas:

Non Dosing Tasks:

Demographics

Entry of demographics of DAWN AC, taking and recording of patient queries and acting appropriately, Telephoning dosage and dose changes as directed by a dosing operator.

 Dosing Tasks: 

Level One – Basic Dosing

Staff deal with no dose changes, and there is no change in medication or clinical information. Also to print dosage and next appointment date directly into the yellow books from the book printer.  

Level Two – Senior Dosing:

Staff are expected to deal with dose changes with INR’s out of range, next appointment dates and amend as necessary, they should also phone dose changes and release the yellow books. 

Level Three – Advanced Dosing:

Involves authorising complex doses where manual intervention is required as DAWN AC is unable to calculate a dose (i.e. >5 or <1.3) or when DAWN AC is to be over ridden.  

Level Four – Clinical Opinion Needed:

Is where dosing is referred to a Clinician or a Senior Anticoagulant Practitioner where tasks may involve induction of anticoagulation, INR is out of target in two successive visits or they are known ‘problem patients’ or bleeding. 

The following table shows the dosing level and job position currently at Chester:

Here are some examples of the control paperwork we use: 

This checklist is to be used as a guide and aide memoir for training and assessment review. A printed copy should be given to the BMS being trained / assessed.

Training and Competency Assessment Checklist

Conclusion

Following the identification of the required competencies and the training for staff who are responsible for anticoagulant care, Chester have implemented guidelines, protocols and adequately trained and competent staff for dosing, prescribing, monitoring and administering patients under anticoagulation care.