Perfusion Competencies

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November 2009
 
Foreword
There have been significant changes in the Canadian Medical Association’s (CMA) methods of
accreditation of educational programs in designated health science professions in Canada. These changes have brought about a system of accreditation based on the principle of making the programs more responsive to rapid changes in health care. This system will assess whether or not programs prepare graduates with the competencies required for entry into designated health professions in Canada.
 
Each profession affiliated with CMA accreditation is required to complete an entry-level competency profile to fulfill the requirements for the accreditation standards. The Competency Profile is to focus on outcomes rather than content. The CSCP Entry-Level Competency Profile for Clinical Perfusionists is the third profile developed by the Canadian Society of Clinical Perfusion (CSCP). The first profile was developed in 1996, the second in 2003, and the current one in 2009.
 
The work was made possible by financial assistance from the CSCP. The main body of the work was carried out by the Committee on Accreditation, Competency, and Examination (ACE) (five content experts representing pediatric and adult based perfusion across all Canadian regions) in collaboration with Jan White Consulting. This work required review of each of the following documents:
 
·The Clinical Perfusionist Competency Project (2002)
·The Clinical Perfusionist Competency Development Project Final Report (2003)
·The CSCP  National Entry-Level Competency Profile for Clinical Perfusionists (2003)
·The CSCP National Certification Examination Blueprint (2003)
·The CSCP Basic Standards of Practice (2002)
·The CSCP Role of the Perfusionist (2001)
·The CSCP Mission Statement/Code of Ethics
·The Canadian Society of Cardiology Technologists National Occupational Competency Profile (2007)
·The Blueprint Document for the Standards-Based Assessment Tool for Registered Nurses (2000)
·Comments from the Clinical Perfusion Competency Project (2002) survey  respondents
The National survey resulted in a list of eighty-nine (89) entry-level competencies for clinical perfusion in Canada. This profile is a dynamic document which will change as changes in health care occur in Canada. This document, in conjunction with the CSCP National Certification Examination Blueprint will be used to develop the CSCP National Certification Examination for clinical Perfusionists.

Assumptions
 
                                          The Entry-Level Clinical Perfusionist
 
Has successfully completed a Canadian Medical Association (CMA) accredited training program and is eligible for the Canadian Society of Clinical Perfusion (CSCP) national certification examinations.
 
Has developed in-depth knowledge of adult and pediatric cardiovascular anatomy, physiology, and pathophysiology, and extracorporeal circulation technology including adjunctive techniques.
 
Has acquired knowledge in the following areas in relation to clinical perfusion:
    ·anatomy and physiology;
    ·pathophysiology;
    ·pharmacology;
    ·applied sciences (e.g., biochemistry, physics);
    ·hematology;
    ·computer technology; and
    ·research methodology.
 
Practises under the direction of and in consultation with the physician(s).
 
Is proficient in operating and monitoring extracorporeal circulation and cardio/pulmonary support systems.
 
Is familiar with and/or has had exposure to ancillary devices (e.g., blood gas analyzers, autotransfusion devices, etc).
 
Anticipates and responds appropriately to potentially serious situations involving the patient and technical problems that may arise. A high degree of discretion and judgement is essential as perfusionists often make immediate and independent critical decisions to ensure patient safety.
 
Pursues continuous professional education as required by the CSCP for recertification and by using personal initiative to improve practice.
 
Practices in accordance with departmental/institutional policies/protocols and provincial legislation (e.g., transfer of functions through delegated medical acts, controlled acts, etc).
 
Has a professional responsibility to abide by the Code of Ethical Conduct and Recommended Basic Standards of Practice of the CSCP.
 
Is an integral member of the health care team who shares knowledge, promotes learning, and collaborates with other professionals in providing optimal patient care.
 
Maintains a professional relationship with patients, families, and colleagues through the use of effective interpersonal and communication skills.
 
Contributes to the health care education of the patient, family, and public.
 
Respects the dignity and confidentiality of the patient and family.
 
Respects the patient’s right to refuse treatment.
 
Recognizes that clinical competency directly affects the patient’s outcome.
 
The Patient/Family
 
The patient is one of any age who is experiencing an actual or potential life-threatening health crisis that requires the services of a clinical perfusionist.
 
The family or designate is identified to be an important participant in the patient’s care.
 
The Environment
 
The entry-level clinical perfusionist is prepared to work in a variety of settings including, but not limited to, health care and educational institutions.
 
The entry-level clinical perfusionist works in an environment that is dynamic and evolving.
 
The entry-level clinical perfusionist must be prepared to work long, unpredictable hours under intense stress.
 
The entry-level clinical perfusionist is frequently exposed to potentially hazardous chemicals, blood, and other body fluids.
 
Competency Catagories
 
Safe Work Practice
 
 
The clinical perfusionist practices according to established protocols, safety guidelines, and existing legislation to maintain a safe work environment.
 
 
Data Management
 
 
The clinical perfusionist collects, interprets, and evaluates hematological, physiological, and biochemical data.
 
Technical Expertise
(Indirect Patient Application)
 
 
The clinical perfusionist utilizes technical expertise to assemble and prepare cardiopulmonary support systems and ancillary devices.
Clinical Practice
(Direct Patient Application)
 
 
 
The clinical perfusionist operates, manages, and troubleshoots cardiopulmonary support systems and ancillary equipment.
 
The clinical perfusionist manages the patient’s altered physiological functions throughout the procedure.
 
 
 
Quality Assurance
 
 
The clinical perfusionist participates in and promotes a quality assurance program within the workplace.
Professional Responsibilities  
The clinical perfusionist adheres to the Recommended Basic Standards of Practice of Clinical Perfusion and the code of Ethical Conduct as put forth by the CSCP.
 
The clinical perfusionist adheres to the legal and ethical requirements of practice and protects the patient's right to quality care.
 
The clinical perfusionist is an essential member of the
interdisciplinary team who shares and promotes knowledge through education and research, in collaboration with other health care professionals.
                                                       

Clinical Perfusionist Competency Profile 
 
Safe Work Practice
 
SWP01: Maintains a safe and organized work area (e.g., equipment, environment, etc).
 
SWP02: Documents and reports unsafe situations (e.g., equipment, environment, etc).
 
SWP03: Applies the principles of universal precautions and practices aseptic and sterile technique.
 
SWP04:Handles bio-hazardous and dangerous materials (e.g., sharps, inhalation agents,
chemotherapeutic agents, etc).
SWP05: Disassembles, cleans, disinfects, and stores equipment.
 
Data Management
 
DM01: Collects, analyzes, and uses data from patient records relevant to planning and implementing perfusion techniques including: lab values.
DM02: Collects, analyzes, and uses data from patient records relevant to planning and implementing perfusion techniques including: pharmacological agents.
 
DM03: Collects, analyzes, and uses data from patient records relevant to planning and implementing perfusion techniques including: patient demographics.
DM04: Collects, interprets, and evaluates physiological data (e.g., hemodynamics, fluid status, temperatures, etc).
DM05: Records pertinent patient data and perfusion interventions (e.g., perfusion record, etc).
 
Technical Expertise (Indirect Patient Application)
 
TE01: Selects the appropriate medical equipment, supplies, and techniques to meet patient requirements.
 
TE02: Assembles and prepares cardiopulmonary bypass systems (CPB) (e.g., circuitry, oxygenator, etc).
 
TE03: Assembles and prepares blood pumps including: centrifugal pumps.
 
TE04: Assembles and prepares blood pumps including: roller pumps.
 
TE05: Assembles and prepares gas delivery devices and oxygen analyzing devices.
TE06: Assembles and prepares myocardial preservation devices.
 
TE07: Assembles and prepares safety devices.
 
TE08: Assembles and prepares temperature control units, in-line monitoring devices and blood analyzers (e.g., blood gas machine, etc).
 
TE09: Assembles and prepares filters.
 
TE10: Assembles and prepares reservoirs.
 
TE11: Assembles and prepares anticoagulation monitoring devices (e.g., ACT machine, etc).
 
TE12: Assembles and prepares ultrafiltration devices and/or hemodialyzers.
 
TE14: Assembles and prepares hemodynamic monitoring devices.
TE15: Assembles and prepares intra-aortic balloon pumps.
TE16: Assembles and prepares autologous blood processing devices including: cell salvage.
TE17: Assembles and prepares autologous blood processing devices including: blood sequestration.
TE18: Assembles and prepares extracorporeal life support (ECLS) (e.g., veno-arterial and veno-venous ECMO).
TE19: Assembles and prepares ventricular assist devices (LVAD, RVAD, or BIVAD).
TE20: Assembles and prepares equipment for minimally invasive cardiac surgery (e.g., port access, etc).
TE21: Assembles and prepares left atrial to femoral artery bypass systems (LHBP).
TE22: Assembles and prepares devices including: implantable artificial hearts and/or implantable cardiac assist devices
 
Clinical Practice (Direct Patient Application)
 
CP01: Operates cardiopulmonary bypass systems (CPB).
 
CP02: Operates blood pumps including: centrifugal pumps.
 
CP03: Operates blood pumps including: roller pumps.
 
CP04: Operates oxygenation devices.
 
CP05: Operates gas delivery devices.
 
CP06: Operates oxygen analyzing devices.
 
CP07: Operates myocardial preservation devices.
 
CP08: Operates safety devices.
 
CP09: Operates temperature control and monitoring devices.
 
CP10: Interprets and responds to perfusion system parameters (e.g., pressures, flow, volume, temperatures, etc).
 
CP11: Interprets and responds to cerebral monitoring devices.
 
CP12: Procures, interprets, and responds to blood analysis results (e.g., anticoagulation, acid-base balance, hematology, etc).
 
CP13: Determines and utilizes the appropriate priming solutions (e.g., crystalloid, blood, pharmacological agents, etc).
 
CP14: Handles and stores blood products according to established protocols.
 
CP15: Administers blood products according to established protocols.
 
CP16: Determines and administers agents via the extracorporeal circuit (e.g., pharmacological agents, solutions, etc).
 
CP17: Performs relevant calculations (e.g., blood volumes, BSA, flow rates, pharmacological agents, etc).
 
CP18: Operates and responds to in-line monitoring devices.
 
CP19: Operates blood analyzers (e.g., blood gas machine, etc).
 
CP20: Monitors various filters.
 
CP21: Monitors reservoirs.
 
CP22: Operates anticoagulation monitoring devices.
 
CP23: Operates ultrafiltration devices and/or hemodialyzers.
 
CP24: Operates hemodynamic monitoring devices.
 
CP25: Responds to emergencies (e.g., unstable patient, etc).
 
CP26: Responds to unusual situations (e.g., sickle cell anemia, accidental hypothermia, pregnancy, etc).
 
CP27: Assists with the evaluation of patient outcome and recognizes the need for further intervention.
 
CP28: Operates intra-aortic balloon pumps.
 
CP29: Operates autologous blood processing devices including: cell salvage.
 
CP30: Operates autologous blood processing devices including: blood sequestration, component therapy, platelet gel, etc.
 
CP31: Initiates prompt, accurate intervention when a change in patient status and/or perfusion system is detected.
 
CP32: Troubleshoots and resolves equipment malfunctions in a timely manner.
CP33: Communicates effectively during the procedure with all members of the health care team
CP34: Operates extracorporeal life support (ECLS) (e.g., veno-arterial cardiopulmonary support).
 
CP35: Operates extracorporeal membrane oxygenation systems (ECMO) (e.g., veno-venous pulmonary support).
 
CP36: Operates paracorporeal ventricular assist devices (LVAD, RVAD, BIVAD).
 
CP37: Transports the patient requiring cardiopulmonary support (e.g., IABP, ECLS, LVAD, etc).
 
CP38: Operates left atrial to femoral bypass systems (LHBP).
 
CP39: Participates in the implementation and management of devices including:  implantable artificial hearts and/or implantable cardiac assist devices.
 
CP40: Operates equipment for minimally invasive cardiac surgery (e.g., port access, etc).
 
CP41: Ensures the integrity and safety of the circuit.
 
CP42: Adapts techniques to meet patient requirements including: reoperation.
CP43: Adapts techniques to meet patient requirements including: body mass index (BMI)
CP44: Adapts techniques to meet patient requirements including: unusual anatomy
CP45: Adapts techniques to meet patient requirements including: personal beliefs
 
CP46: Operates vacuum assist venous drainage devices (VAVD, KAVD).
 
CP47: Participates in the implementation and/or management of unusual situations (e.g., isolated limb perfusion, visceral perfusion, pacemakers, etc).
 
CP48: Participates in the implementation and management of deep hypothermia and circulatory arrest (DHCA) without supplemental cerebral perfusion.
 
CP49: Participates in the implementation and management of deep hypothermia and circulatory arrest (DHCA) with antegrade or retrograde cerebral perfusion.
 
 
Quality Assurance
 
QA01: Follows established institutional and departmental protocols, policies, and procedures.
 
QA02: Participates in routine maintenance, calibration, and inspections of perfusion-related equipment.
 
QA03: Performs quality control procedures on equipment.
 
Professional Responsibilities
 
PR01: Adheres to the Recommended Basic Standards of Practice of Clinical Perfusion as put forth by the CSCP (e.g., recognizes personal limitations, delegates tasks, etc).
 
PR02: Adheres to the Code of Ethics as outlined by the CSCP (e.g., reports limitations of others, issues of confidentiality, beliefs, dignity, rights, etc).
 
PR03: Promotes the discipline of perfusion through involvement in professional activities (e.g., institutional, regional, and national committees, organizations, recertification process, etc).
 
PR04: Communicates effectively and collaborates with other health care professionals.
 
PR05: Recognizes that clinical perfusion is an evolving profession, and applies new knowledge and skills, and technological innovations to practice (e.g., participates in and responds to clinical research, etc).
 
PR06: Participates in the evaluation of new equipment and techniques.
 
PR07: Pursues opportunities for ongoing education, self-development, and professional growth.
 
 
 

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