Upper Peninsula Telehealth Network of Michigan

 

COMPETENCEY/SKILLSLIST
Telehealth Clinician

 

01/98  
Self-assessment:

P = Proficient (able to do without help)
R= Need Review
N = Never Done

 

 

 

 C = Competency. You must complete all these competencies by your annual evaluation  Self-Assessment  Clinical Skill Competency
  P R N Validated Date
Signature 
C I. Maintains established organizational and departmental policies and procedures, objectives, performance improvement program, safety, environmental and infection control standards, and patient standards.        
A. Adheres to all policies and procedures of the organization P R N  
   1. Locates policy and procedure books P R N  
   2. Demonstrates knowledge and appropriate use of telehealth specific policies and procedures P R N  
B. Performs safe lifesaving, emergency preparedness, and environment of care procedures according to hospital/department procedures/policies        
   1. Maintains BLS/heart saver certification P R N  
   2. Demonstrates/verbalizes appropriate response(s) to code/emergency situations P R N  
A. Verbalizes correct responses to:        
   1) cardiac arrest P R N  
   2) fire P R N  
  3) bomb P R N  
  4) disaster P R N  
   5) evacuation P R N  
  6) manpower P R N  
   7) tornado warning P R N  
B. Reviews safety manual annually P R N  
C. Demonstrates/verbalizes appropriate procedures to use when handling hazardous materials/wastes P R N  
C II. Collaborates with other telehealth personnel to assure successful consultations.        
A. Completes Telemedicine Intake form. P R N  
B. Assures appropriate physician credentialing prior to consult. P R N  
C. Notifies telehealth coordinator and outlying/consulting physician of request for telemedicine consultation. P R N  
D. Schedules video conference equipment and room. P R N  
E. Confirms date, time, transmission, equipment needed, and staff needs with all clinicians, technical staff, involved with the consult and the family. P R N  
C III. Operates telemedicine/video conference equipment and assists as ordered by the physician during consults as clinic and programming needs dictate.        
A. Assures operation and connectivity.        
1. Identifies risks and safety factors and demonstrates knowledge, set-up, correct use, handling, maintenance and trouble shooting of video conference and peripheral equipment. P R N  
   a. Operates the camera P R N  
   b. Establishes camera pre-sets P R N  
   c. Operates peripheral equipment P R N  
B. Presents patient to consulting physician(s) as ordered. P R N  
C. Demonstrates/verbalizes appropriate action to take in case of a system/utility/transmission failure. P R N  
1. Check LCD display to determine if lines are activated. P R N  
   a. If "down" or "out of service" reboot IMUX or disconnect/reconnect transmission line(s). Redial. P R N  
   b. If "idle" or "ready", reboot main equipment switch. Redial. P R N  
2. Check equipment to assure all cables area connected securely. P R N  
3. If above is not successful, contact MGH telehealth staff or technical consultant for assistance. P R N  
4. Reschedule at alternate site/time as situation warrants. P R N  
5. Refer patient to the Emergency Department or local physician as indicated. P R N  
D. Maintains knowledge of Safe Medical Device Act and reports as appropriate P R N  
C IV. Maintains a safe, comfortable, private, confidential, and  therapeutic environment for patients/families in accordance with hospital standards.        
A. Maintains confidentiality/privacy of patient and family by:        
   1. Discussing patient information only with others involved in the patient's care P R N  
   2. Placing shades over window(s) P R N  
   3. Placing monitors out of view from doors/windows P R N  
   4. Destroying written information used for patient care that is not a part of the patient record. P R N  
B. Introduces all personnel at each site in video conference, identifying their role. P R N  
C. Monitors and controls the environment P R N  
   1. Regulates temperature as indicated P R N  
   2. Adheres to electrical safety policies and procedures P R N  
D. Demonstrates appropriate use of methods to prevent the spread of infection P R N  
   1. Demonstrates correct handwashing technique P R N  
   2. Uses appropriate infection control safety precautions P R N  
A. Use of gloves when appropriate P R N  
B. Use of mask when appropriate P R N  
3. Demonstrates awareness and implementation of various isolation precautions P R N  
A. Standard precautions P R N  
B. Airborne P R N  
C. Contact P R N  
D. Droplet P R N  
E. Neutropenic P R N  
E. Verbalizes understanding of blood borne pathogen exposure plan P R N  
F. Collaborates with infection control practitioner when indicated. P R N  
C IV. Responsible for the creation, storage, maintenance, and release of medical records.        
A. Assures appropriate charting by documenting        
   1. Type of telemedicine consult P R N  
   2. Participants at all sites P R N  
   3. Transmission speed P R N  
   4. Any procedures done or ordered P R N  
   5. Who is responsible for follow up care if any P R N  
   6. Patient/family teaching P R N  
B. Obtains copy of the consulting (outlying) physician's dictated report of the telemedicine consult for patient's medical record as indicated. P R N  
C. Handles/Stores medical record in a confidential manner. P R N  
D. Obtains release of medical record as indicated. P R N  
C V. Assures that patient and significant other are informed regarding the video system, capabilities, and the process that will take place to include the risks and benefits of telemedicine. Assures that informed consents are obtained.        
A. Respects patient rights        
   1. Demonstrates awareness of the individual rights of the patient regarding cultural, religious, and ethical values. P R N  
   2. Verbalizes understanding of functions of hospital ethics mechanism P R N  
   3. Explains telemedicine process to patient/family prior to the video conference, to include the risks and benefits of telemedicine P R N  
   4. Informs patient/family that they have the right to stop the video conference at any time and ask to see their physician in person. P R N  
  5. Obtains consent for telemedicine prior to the video conference. P R N  
F. Obtains consent for taping for all video taped consults. P R N  
C VI. Assists in the data collection, evaluation, reporting, and performance improvement activities as they apply to telehealth.        
A. Uses standardized tools to log and report video conference activity. P R N  
B. Uses standardized tools to collect evaluation data. P R N  
C. Communicates with MGH telehealth staff regarding utilization. P R N  
D. Communicates with administration regarding VCS/Telemedicine usage and reports. P R N  
E. Provides other data and information on VCS/Telemedicine usage as requested for grant related reports and system evaluation. P R N  
C VII. Enhances professional growth and development through  participation in educational programs, current literature, and inservices        
A. Attends telehealth coordinator meetings P R N  
B. Updates telemedicine knowledge by reading circulated literature P R N  
C VIII. Performs other duties as assigned or requested. P R N