Competency During COVID: Three Tips for Developing a SNF Training Competency Program

This post is based on our recent webinar “The Three C’s – COVID-19, Care Paths, and Competencies for Long-Term Care.” Watch the on-demand recording here.

The COVID pandemic has made organizations reevaluate the importance of infection control strategies and competency surrounding quality, safety, and compliance. This especially rings true for long-term care facilities and their residents, which have been hit hard by the virus¹. With a heightened and necessary focus on health and safety measures, it’s vital to determine staff competency and to verify that the new or updated processes and requirements are understood and followed.

Ensuring your staff has the knowledge, skills, and abilities to maintain a safe environment is key and a foundational step to help stop the spread of the virus. If you don’t have one in place already, designing a fresh infection control competency-based training program is a great way to reassess your current status and determine specific training needs, so your organization is aligned with the current infection prevention and control requirements.

Here are three tips for developing a competency-based training program for your long-term facility.

1. Create a training and competency program

Creating and adhering to an education plan will ensure your organization is properly trained to work safely in your organization. With so much information out there today surrounding COVID-19, it’s important to have reliable sources for designing your education program, like CMS, the CDC, and WHO (World Health Organization), provider associations, partners such as the hospital system you work with, as well as your team. Education and competencies are crucial in all areas of long-term care today.  Now more than ever, Infection Prevention and Control competency is essential for quality, safety and compliance during the COVID-19 Pandemic.  Determining staff competency needs follows a general guiding principle process:

• Based upon the facility assessment and mandatory requirements
• Competencies are related to your facility mission
• Current policies and procedures for resident care and quality outcomes
• Utilize policies and procedures as a foundation for competency development
• Follow the KSA approach (Knowledge, skills and ability) needed for individual performance and improvement needs
• Incorporate competency process into your overall training plan
• Align competencies with staff job descriptions
• Incorporate competency review and monitoring process per the facility Quality Assurance and Performance Improvement Plan

When forming a COVID-19/Infection Prevention education plan, keep these key components in mind:

• Policies and Procedures
• Hand hygiene
• PPE
• Transmission based precautions
• Standard precautions
• Infection criteria
• Linen Handling
• Identification of signs and symptoms of infection
• Communicating, documentation, and reporting

2. Verify Competency Using the Return Demonstration Method

Once an educational plan is in place, verify that your staff understands the safety procedures outlined in the plan by validating their knowledge and understanding of what outcome is expected – one method is a return demonstration. During the return demonstration competency process, staff members will be individually observed while utilizing the best practices procedures laid out in your education plan.

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For example, hand hygiene² is one of the key components of an infection prevention education plan and a critical skill that must be performed accurately. During the return demonstration, the observer would confirm the staff member is properly performing hand hygiene by using both alcohol-based rub and soap and water. Using the CDC guidelines for hand washing, the observer would:

• View the amount of product used following manufacturer’s recommendation for alcohol-based hand rub. It should be enough product to cover hands and if soap is used, enough product to generate adequate lathering for scrubbing.

• Confirm vigorous scrubbing with soap and water or rubbing of hands until product dries if alcohol-based hand rub

• Time hand hygiene process: 20 seconds for soap and water. For soap and water, rinse thoroughly, use clean towel for drying, and turn off faucet with paper towel.

3. Document the Process Using Checklists

In addition to physically observing during the return demonstration process, make sure you’re documenting the results, which may include a competency verification checklist. It’s important to keep a record of the procedures performed during the observation, the results of the observation, and any additional “just in time” training that was needed for adherence with the policy and procedure. A record shows if they understand procedures and have documented proof they’ve been through the process. If your organization isn’t incorporating some type of competency verification documentation for auditing, here are some suggestions to include, using the previous mentioned hand hygiene example:

• Talk with your team and management to outline the best practice procedures for hand hygiene. For example: making sure soap dispensers are replenished and available, performing hand hygiene after handling soiled items, and washing hands with soap for at least 20 seconds.

• Divide the checklist process into sections. Example of sections can be: Preparation, hand hygiene with alcohol-based rub, hand hygiene using soap and water, additional observations.

• Yes/no columns for keeping track of if the procedure was observed and performed correctly.

• A “comments” box for any additional feedback.

Make sure you’re keeping these audits as proof of process surveillance efforts in the facility.

If you’d like to gain more insight into managing COVID-19 within long-term care facilities, listen to “The Three C’s – COVID-19, Care Paths, and Competencies for Long-Term Care” webinar, hosted by therapy industry veterans Susan LaGrange and Lisa Thomson of Pathway Health Services.

Click here to learn about Net Health’s industry leading therapy management software solution for Skilled Nursing Facilities.

[1] JAMA Health Forum, Nursing Homes Are Ground Zero for COVID-19 Pandemic, March 24, 2020

[2] Centers for Disease Control and Prevention, Hand Hygiene Guidance,  January 30, 2020