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You might already know that e-Quip can automatically email nurses, training managers etc. to let them know that refresher training is due. That sounds pretty straightforward doesn’t it, but how do you actually work out when somebody needs retraining on a particular device? The decision involves your policies (possibly based on staff grade, model risk and location) but hinges on when competence is actually deemed to have started.

On the e-Quip TNA screen there are several dates:

Training Date

Assessment Date

Declaration Date

Verification Date

tna

The training date is the simplest – it’s the date that a person was trained. Assessment date is similarly simple – it’s just the date that somebody assessed the person and determined that they were competent to use the device. In the case of self-assessment the assessor will be the person themselves.

If a nurse updates his or her training records directly (using the e-Quip on-line Competence Editor), then the declaration date is the date that she entered her details. Similarly, when a nurse starts work at a new hospital or in a different ward, she may inform her new ward manager of her previous training. The declaration date is this date.

A nurse may well claim to be have been trained and be competent to use certain devices, but then again, I might claim to be Napoleon Bonaparte! (don’t worry, I don’t!) Whether or not you take users declarations at face-value will be determined by your policies. You might, for example, choose to validate any information that is entered via the web. The verification date is the date that this was done.

To know when a competence ends we need to know when it started, so which one of these dates represents this? Again, this will vary with your policy. You could argue that you are at your most competent immediately after a training course, as you haven’t had time to forget anything. On the other hand, you might say that being trained is one thing, but competence comes with hands-on, practical use of the device. An HCA might use a device under supervision for a couple of weeks and then be assessed by a nurse or ward manager.

Your might take different views for different devices. You could train all staff on the use of portable AED’s (the kind you find in supermarkets, stations etc.) but it’s very unlikely that many of them will stumble upon someone having a heart attack and be able to put their skills to use. If this happened and by coincidence an assessor was present then I recommend that both immediately buy a lottery ticket, as this kind of good fortune doesn’t happen that often.

Let’s assume that you use the training date as the basis for working out when refresher training might be due. Is it as simple as just adding some number of years or months onto the training date? Well, it might be, but it might not. Does a Band 6 senior nurse working in HDU with complex devices on a daily basis need refresher training as often as a community midwife? This will be determined by your local policies. e-Quip allows you to record a training validity (a number of months) for both competence groups and for models. We will see later how these can be used to calculate when refresher training is due.

Presumably that HDU Band 6 nurse doesn’t use every device with the same frequency, and not every one of those devices will have the same risk level. You might have a policy which specifies that community midwives have refresher training every 18 months on all devices that they use (probably not that many), while Band 6 nurses in HDU are retrained every 3 years on most devices but every 2 years on high-risk equipment.

The point I’m making is that there is no right or wrong approach, there is only your approach. That’s why e-Quip allows you to be in charge of how refresher training dates should be calculated. The same philosophy applies to RAG (Red, Amber, Green) highlighting of competences. Only your policies can specify whether a person’s competence to use a device is “ok”, “not ok”, or somewhere in between.

In e-Quip, both of these features, calculated refresher training dates and record RAG flagging are user-defined, although defaults are provided.

Let’s look at refresher training dates first. When you look at the TNA matrix or an individual TNA record, there is a field called Calculated Review Date. There is also an Alternative Review Date field which you can use to override the calculation for individuals.

When the calculated review date field is displayed the default calculation is very straightforward. The validity period is the shorter of either the competence group or model-specific validity. If the training date is not empty then the validity is simply added to it. If there is no training date then the assessment date is used. If there is no assessment date then the declaration date will be used. Last of all, the verification date is checked. If all of the dates are empty, then the safest assumption is that refresher training is due now. This will at least alert someone to the problem.

What happens if no validity is specified, either for the competence group or the model? e-Quip has to use something and the value we use is 12 months. If that doesn’t work for you then make sure that a validity is specified somewhere.

Example 1: Mary Brown is a member of the HDU competence group, which has a validity of 24 months. She was trained how to use the Nutricia Infiniti enteral feeding pump on 15th August, 2015. The default calculated review date will be 15th August, 2017.

Example 2: Mary was also trained to use the Signature SEI volumetric infusion pump in August 2015. However, this is a high-risk device which has a model-specific validity of 18 months. There is no record of Mary’s training date, but she was assessed on 2nd September, 2015.  The default calculated review date will be 2nd March, 2017.

These are just the default calculations. If they suit your requirements then there is no need to make any changes. Suppose that your local policy says that HCA’s require retraining and reassessment on Laerdal LSU portable suction units every year.

Example 3: Joyce Smith is an HCA on Juniper Ward. The competence group for this ward has a validity of 2 years, while the validity for the Laerdal LSU is also 2 years. Joyce was trained on 1st July, 2016 and assessed on 3rd August 2016. When is she due to be retrained on the LSU? If the default mechanism is used then the calculated value will be 1st July, 2018, which would be incorrect according to the policy. The correct date is 3rd August, 2017.

e-Quip can be configured to use a local policy by creating two SQL-Server functions CalculateRefresherTrainingDue_Local and CalculateRefresherTrainingDue_RT_Local

Note that this would be done by your system administrators, with the assistance of the e-Quip Help Desk. Don’t worry, if you are a nurse or a training coordinator, you don’t need to know how these work, you just need to know that they can be changed.

Normally, refresher training dates are calculated with the SQL-Server functions CalculateRefresherTrainingDue and CalculateRefresherTrainingDue_RT. The first thing that each of these does is to check to see if a local override (i.e. a function with the same name but with “_Local” after its name) exists. If it does, then it calls the local version instead. It is the local override which takes your policy into account. Your local version of these functions will be customised specifically for you.

On a slightly technical note, you might wonder why there seem to be two versions of the same function (CalculateRefresherTrainingDue) but one has “_RT” after its name. The “RT” stands for “Run Time”. The standard version of the function looks at the database to work out the appropriate date, but that’s no use when you’re editing a TNA record and you change a date field. That new date won’t get written to the database until you eventually click Save, but it would still be useful if the refresher date was updated. The “_RT” version of the function does the same as the standard version, but it uses the dates from the screen rather than those in the database.

It is CalculateRefresherTrainingDue_Local which calculates Joyce’s refresher date as 3rd August, 2017 for the LSU when looking at the TNA matrix and when the TNA property page is first opened. When Joyce is reassessed on 15th August, 2017, it is CalculateRefresherTrainingDue_RT_Local which would calculate the date 15th August, 2018 as soon as the new assessment date was entered.

As a matter of interest, exactly the same mechanism is used to decide what colour the traffic lights should be. There are SQL-Server functions with names like TNAItem_RedTNAItem_Amber, & TNAItem_Green along with “_RT” versions. Just like the date functions, these can all be changed to use local overrides to match your policy.