Competency Assessment for giving a Saline Nebuliser

Name:
Clinical Assessment Area (s) :
Name of Assessor:
Assessment Date:
Competency criteria / Competency level / Comments /
recommendations
1 / 2 / 3 / 4 / 5 / 6
1. Can locate and demonstrate awareness of employers policies
relevantto saline nebuliser administration
See appendix 1 Professionals Only
2. Can carry out an assessment of the Child or young person (CYP)
See appendix 2
3. Can demonstrate and discuss indications for and contraindications to salinenebuliseruse
See appendix 3
4. Understands the difference between giving regular saline nebulisers and ‘as required’ (PRN) saline nebulisers
See Appendix 4
5. Demonstrates and discuss knowledge of when further interventions are required
See appendix 5
6. Demonstrates correct administration ofsaline nebuliser
See appendix 6 OSCE assessment
7. Demonstrates cleaning and management of equipment after a saline nebuliser has been administered
See appendix 7
8. Demonstrates the ability to assess the child post nebuliser
See appendix 8

Competence Level - Key

  • Competence Level 1 – Has observed this activity
  • Competence Level 2 – Has been involved in this activity with the support and assistance of experience professionals (Maximum level of competence for 3rd yr student nurse until assessed as competent)
  • Competence Level 3 - Can perform this activity satisfactorily without the need for supervision or assistance (Maximum level of competence for parents, carers and non-medical professionals)
  • Competence Level 4 – (Professionals only) can perform this activity satisfactorily in a timely manner
  • Competence Level 5 – (Professionals only)can perform this activity, safely, in a timely manner while showing initiative and flexibility in response to the child and families needs
  • Competence Level 6 – (Professionals only) can perform this activity safely, in a timely manner, whilst responding to the needs of the child and family. Can lead and supervise others in performing this activity (Minimum level of competence for all assessors)

Declaration

  • This competency assessment tool is to be used in conjunction with the NMC and CSP Code of Conduct.
  • Competency Level requirements are indicated for both qualified and unqualified staff.
  • For the practitioner / learner to be deemed competent – the indicated level must have been consistently achieved.
  • Once competence has been achieved a record of the training and assessment must be documented and logged.
  • Competency assessment must be reviewed annually.
  • Practitioners are reminded that they should not attempt to carry out tasks which they are not competent or confident to do.

Carers/ Parents Only

This competency is for Child (name) ______only

This competency certifies Parent/ Carer: ______

I the above named Carer / Parent certify that I am able to carry out the above procedure within the competencies detailed.

  • I understand the scope of these competencies.
  • I will only use this training in respect of the child specifically named on the front of this form
  • I will not carry out procedures, which are contrary to or not covered by this training.
  • I will seek further training if I have any concerns about my competency and in any event six weeks before the expiry date on the front of this form renew my training.
  • Upon the date of expiry of this competency, if my training has not been renewed, or if I have concerns about my competency, I will discontinue undertaking the procedure detailed in this document and seek appropriate advice from a suitably qualified clinician and or my employer.
  • I am aware that is my responsibility to ensure that I access appropriate training and updates as required by my employer or as agreed with my employer in order for me to continue to operate within these competencies.

Verification of Competence

•I confirm that the individuals above have been assessed as competent at level 3 in administering a saline nebuliser on the CYP detailed above.

Guidance notes

Appendix 1

For Professionals only who will have access to the Trust Intranet.

The Practitioner should discuss policies relevant to nebuliser administration, including the infection prevention and control policy (C15), consent to examination or treatment (C7), hand decontamination (C14), administration and prescribing of oxygen (C38), Paediatric Early Warning System Policy (C40) and resuscitation (C23).

Appendix 2

The Practitioner should assess the following with reference to the Trust policy ‘Paediatric Early Warning System Policy’(C40). Assessment of the child and young person (CYP) includes taking account of:

  • Colour
  • Respiratory rate and pattern
  • Signs of respiratory distress
  • Heart rate
  • Chest expansion
  • Palpation
  • SpO2
  • Effectiveness of cough
  • Pallor
  • Cyanosis
  • Irritability
  • Panic
  • Recession

Appendix 3

A saline nebuliser may be administered as prescribed on a regular basis to keep secretions loose and easy to cough up (where the CYP has a cough reflex). This is a preventative measure. Saline nebulisers are also usually prescribed ‘as required’ (or PRN) and can be given extra when secretions become thick, difficult to cough up or suction. In a child with a tracheostomy or nasopharyngeal airway sticky secretions can put them at risk of a blocked tube. Saline nebulisers are sometimes given prior to chest physiotherapy to help loosen secretions.

The CYP should be monitored for side effects and consider stopping the nebuliser if symptoms indicate.The nebuliser is not expected to cause any side effects in normal use. Do not use the nebuliser solution unless the product is clear and the pack intact. Discard any surplus solution after use to prevent contamination, causing infection. Patients using nebuliser solutions at home should be aware that if the usual relief reduces or has little effect, they should consult their doctor. Always report adverse reactions to the doctor.

Appendix 4

A saline nebuliser may be administered on a regular basis, as a preventative, to keep secretions loose and easy to cough up (where the CYP has a cough reflex). Saline nebulisers are also usually prescribed ‘as required’ (or PRN) and can be given extra when secretions become thick, difficult to cough up or suction.

Appendix 5

Observe the CYP during the nebuliser to ensure they are coping. Carry out the assessment as in appendix 2. You may need to stop the nebuliser to suction if they are coughing a lot and the secretions are very loose making the CYP unsettled and /or cyanosed. Be mindful that excessive suctioning can lead to more secretion production. If the CYP is not managing administration of the nebuliser in air, oxygen may be given if prescribed.

Appendix 6

Check the prescribed medication with the prescription sheet. Always check the medicine is the right one for the right CYP, and that it is within the expiry date before it is given.

Procedure

a.The nebuliser comes with 3 parts – a chamber (or pot or acorn), a mouthpiece/tracheostomy connector or mask and tubing

b.The chamber comes in 3 parts – the bottom of the chamber has a gas inlet. This is where the tubing is attached and the medicine goes.

c.The mushroom shaped piece of plastic over the gas inlet (that comes off), is needed to allow the nebuliser to work.

d.The top of the blue chamber screws back onto the bottom, a mask or a mouthpiece fits here (The mask needs to be the right size for the CYP. A tracheostomy mask is used for tracheostomies)

e.Encourage the CYP (if appropriate) to take deep breaths whilst the nebuliser is on to help it work to its maximum. Keep the nebuliser chamber upright and you may need to alter its position every so often so that all the medication can be used.

f.Make sure the choice of air or oxygen is right for the CYP. If oxygen is used it must be prescribed. The flow meter should be set to 6-8L. If using an electronic nebuliser this will create the air for you.

g.The CYP should be observed for side effects

h. Allow 10-15 minutes s to administer the nebuliser. Once the nebuliser has finished you will be able to hear the difference in sound. The machine can then be switched off.

i.Observe the effect of the nebuliser on the CYP and document. They may need suction or additional intervention.

OSCE – Antibiotic Nebuliser Administration
Please greet the student and give him/her the following instructions:
“This patient is prescribed a salinenebuliser, please go ahead and give this”. / Performed adequately or completely / Attempted but incomplete or inadequate / Not
attempted
Introduces self and explains procedure to patient/parent. Awareness shown of psychological impact and encourages involvement if appropriate. / If possible, allows the child or young person some control and choice about the procedure such as using a mask or a mouthpiece, or who should hold the nebuliser / 1 / 0.5 / 0
Demonstrates a basic respiratory assessment / Colour, respiratory pattern and rate, saturations if appropriate. Recognizes the need for intervention – position change, suction, nebuliser / 1 / Fail / Fail
Positions patient appropriate to age and condition of CYP / 1 / 0.5 / 0
States need to wash hands in a systematic manner / 1 / 0.5 / 0
Demonstrates the equipment needed for giving a saline nebuliser and how to set it up / 1 / 0.5 / 0
Draws up the prescribed medicine and checks it with the prescription - right one and the right CYP, dose and expiry date / 1 / Fail / Fail
Discusses the use of face mask, mouth piece, trachestomy mask and nebuliser within ventilator circuit / 1 / 0.5 / 0
Discusses the use of air and oxygen and setting flow rate if applicable / Electronic nebuliser creates air for you
Oxygen should be prescribed / 1 / 0.5 / 0
Recognises when nebuliser has finished. Documents and appropriately acts if further intervention is required / Position change, suction, physio, oxygen, nebulised steroid, / 1 / Fail / Fail
Monitor CYP’s condition for complications and will ask for help, escalates to next level, knows limitations / Physiotherapy assessment, nursing assessment, medical assessment / 1 / Fail / Fail
Demonstrates appropriate cleaning/management of equipment / Filter changed after each administration / 1 / 0.5 / 0
States need to wash hands at the end of the procedure / 1 / 0.5 / 0

On completion, ask: Give one extra mark for each question

What are the signs of needing an extra saline nebuliser?(Give a point for each answer) / CYP upset and unsettled, coughing, little or no secretions, sticky/pluggy secretions
How can you ensure all of the nebuliser is getting used? / Holding the nebuliser upright and then adjusting the position of the nebuliser (listening for the mist).
Pass Mark / Needs further practice comments / Score and signature
9/16 / /16

Appendix 7

Cleaning

a.Disconnect the nebuliser set from the tubing and the flow meter and switch off

b.Separate the nebuliser chamber apart so that it can be cleaned properly

c.Throw away any left over solution as this cannot be used again due to risk of contamination

d.Wash the three parts of the chamber in warm soapy water (washing up liquid). Rinse all three parts well, remove excess water and leave the nebuliser parts in a clean area away from any area where water may splash, to reduce the risk of contamination whilst air drying.

e.Review the condition of the nebuliser set and replace if damaged to ensure effectiveness and prevent infection. The nebuliser set should be changed weekly

f.Clean over the whole nebuliser set once a week with warm soapy water

Appendix 8

Assess the CYP and observe the effect of the saline nebuliser and document. The CPY may need additional intervention, such as suction, steroid nebuliser, additional saline nebuliser, position change.

1

Last updated April 2016 by Paul Ritzon, Alison Flynn, Jennifer Bayliss