Clinical skills policy

1 Introduction

Clinical skills are procedures that have a direct impact on patient care. Therefore, patients receiving this care have a right to expect that colleagues performing these procedures have been trained and assessed utilising evidenced based research to ensure best practice.

This policy outlines the systems in place to ensure that all medical, nursing (registered and non-registered) and allied health professional colleagues are aware of the trust approved standard operating procedures and the clinical skills packages available to develop the knowledge and expertise required to provide quality, competent, safe, and effective services for a diverse range of patients. health professional colleagues are classed as registered and non- registered for example, nurses, physiotherapists, nursing associates (registered) and health care assistants, HCA’s (non-registered).

2 Purpose

The purpose of this policy is to standardise competency and practice in respect of clinical procedures across the trust by all colleagues and support the quality assurance process within the Central Clinical Skills team (CCST.) This will ensure that any training or packages created are approved, implemented and reviewed by the CCST, and all competency assessments are conducted using the care and clinical skills assessment training (CCAST).

3 Scope

This is an overarching policy covering the most commonly used procedures but cannot cover every procedure which may be required. In these situations, guidance should be sought from appropriate clinical experts.

This document applies to and is relevant to all managers with responsibilities derived from it, and all clinical colleagues, including bank, agency and temporary staff who may provide clinical care and students. This policy is also relevant to learners as stipulated in their curriculum.

The CCAST tool and handbook should be read in conjunction with this policy as required. Training to use this tool is provided by the CCST or by colleagues who have attended a train the trainer course (see appendix C for an example of the tool.)

4 Responsibilities, accountabilities and duties

4.1 Chief executive

Will make arrangements to support the safe and effective implementation, monitoring, and review of this policy.
Nominate an executive board member with responsibility for clinical skills services within this trust. This is the director of people and organisational development.
Nominate a suitable committee to oversee the central clinical skills service.
Provide the resources necessary to implement this policy.

4.2 Director of people and organisational development

The director is responsible for implementation and monitoring of the policy within their areas of responsibility.

4.3 Medical director and the chief operating officer

These directors are responsible for implementation and monitoring of the policy within their areas of responsibility.

4.4 Consultants and medical officers

Will ensure that they aware of the policy and that any competency assessments they perform are completed using CCAST.

4.5 Central clinical skills team

Will liaise with managers or modern matrons to formulate suitable staff training programmes to support effective implementation of the policy.
Act as specialist advisors to the trust on clinical skills and related matters.
Support “subject matter experts” with the development and delivery of clinical skills training packages.
Facilitate policy and practice development and organisational learning as a result of audits in line with this policy.
Support clinical excellence and on-going clinical competence through staff development to ensure quality care delivery.
Explore and develop new ways of learning.
Deliver training using current evidence-based guidelines.
Deliver training using variety of teaching methods, allowing practitioners, and learners where relevant, to develop new clinical skills in a safe, non-threatening environment.
Deliver training to enable clinical colleagues to become assessors of clinical competency and provide ongoing support.
Discuss with the managers or modern matrons the approach to be taken with colleagues who do not successfully complete training assessments.
Facilitate a central record of training, for example, electronic staff record, ESR, and deliver and produce reports on training compliance.
Maintain the clinical skills zone on the trust intranet.
Community district nursing staff do not access learning and development for their clinical skills training, but this is done via the community education team.

4.6 Clinical managers or modern matrons

Will proactively seek advice and support from the CSST.
Disseminate, implement, and monitor implementation of the policy within areas of responsibility.
Facilitate, support, and monitor ward or team managers in their responsibilities regarding policy implementation and monitoring.
Identify and allocate resources to comply with this policy.
Manage the on-going availability of clinical assessors in the workplace, releasing colleagues for assessor training as needed.
Make available appropriate and suitably maintained clinical skills equipment, maintaining up to date medical devices inventories in all areas of responsibility.
Facilitate an environment where incidents are reviewed in an open and positive manner, involving colleagues, and learners where relevant, at all levels in improving practice and promoting organisational learning.
Support clinical excellence and on-going clinical competence through staff development to ensure quality care delivery.
Ensure that competency assessment takes place prior to colleagues, and learners where relevant, undertaking supervised and unsupervised practice in the clinical environment to a level of safe, confident practice using the trust’s CCAST.

4.7 Ward or team managers

Will proactively seek advice and support from the CCST.
Maintain a proactive approach to enabling colleagues, and learners where relevant, to practice clinical skills, particularly those skills which are practiced infrequently; this may involve close working or liaison with other clinical areas.
Facilitate effective local induction processes for all new starters and students.
Manage the release of colleagues, and learners where relevant, for training and updating in the skills relevant for their area.
Maintain staff training records for the area.
Proactively identify risks due to lack of training, clinical assessors, or other resources to the manager or modern matron.
Ensure there are sufficient assessors in the work areas under their control.
Manage and maintain the clinical skills equipment in areas under their control and report any equipment issues immediately to the manager or modern matron.
Will not create and implement training packages without input or approval from the CCST (see appendix D).

4.8 Clinical colleagues

Will proactively seek advice and support from the CCST.
Be accountable for, and always work within own limitations.
Maintain a personal record of their own training.
Practice their respective clinical skills regularly to maintain clinical competence and confidence; this may necessitate liaison with other work areas and, or attend simulation training updates.
Support other colleagues, and learners where relevant, in the workplace to help them to develop their own professional competence and confidence.
Report any issues which affect the effective implementation of this policy to their manager, for example, access to training or equipment.
Only use the standardised packages as specified by the Clinical Skills team unless the course is delivered by an external provider.
Identify a clinical skills assessor in the work area prior to applying for clinical skill training.
Identify any clinical skills they already have and participate in a single assessment by a recognised CCAST assessor to reduce delay in completing procedures.

4.9 Subject matter experts

Will work alongside the CCST to develop packages within their specialism.
Participate and conduct peer supervision.
Ensure any training only follows the standardised packages.
Facilitators must ensure attendance records are received by the Learning and Development administration team to update individual ESR learner records.

4.10 Assessors

Will follow the process and complete the assessments as informed in the training and following any updated information.
Attend 3 yearly updates, individuals to monitor when updates are required.
Participate in any peer supervision.
Be aware that the assessment forms are audited to ensure quality.
Ensure colleagues send final assessments to the Learning and Development administration team to update completion of the training.
Ensure CCAST assessment are entered into students’ assessment documentation.

5 Procedure or implementation

5.1 Equipment

The provision of suitable, standardised clinical skills equipment is essential. This standardisation will ensure that training can be provided authentically, to ensure colleagues, and learners where relevant, are familiar, proficient, and confident with the use of equipment in their practice area. Therefore, it is essential that all medical devices be purchased in line with the trust’s medical device purchasing guidelines for this purpose.

Where this is possible clinical skills training will be offered using simulation which may be achieved using manikins, part task trainers or simulated patients to allow colleagues, and learners where relevant, to learn in a safe, low risk environment.

5.2 Training

Following initial simulation training and after being assessed as safe by a clinical skills assessor, colleagues, and learners where relevant, progress to supervised and assessed practice in their workplace. Colleagues are required to complete their clinical skills assessments in practice within 3 months of completing any training in a simulated learning environment. Colleagues unable to complete assessments within the time frame must discuss any issues with their line manager and clinical skills team.

Please note that not all clinical skills require clinical simulation, for example, nurse verification of death.

It is the line manager’s responsibility to maintain the availability of trained trust clinical assessors in the workplace.

5.3 Assessment

The care and clinical skills assessment tool (CCAST) has been developed for use within the trust. All assessments for clinical skills competency must be completed using this tool. Training for the use of the CCAST is provided by the Clinical Skills team and 3 yearly updates for this training are required. The previous assessment tool (LCAT) is now for use under licence only, and therefore should no longer be used within the trust. Previous competence of skills assessed using this tool are still valid but will be updated using the new tool.

Colleagues, and learners where relevant, undergoing training are responsible for the safe keeping of their training package, as this is their evidence of completion (certificates are not issued). It is colleagues’ responsibility to email a copy of their final assessment to the Learning and Development administrative team. This is to enable electronic staff records (ESR) to be updated to reflect that the training has been completed. Learners should ensure CCAST evidence is entered onto their assessment documentation.

6 Training implications

There are no specific training needs in relation to this policy, but the following colleagues will need to be familiar with its contents: all RDaSH clinical colleagues, and learners where relevant, and any other individual or group with a responsibility for implementing the contents of this policy.

6.1 RDaSH clinical colleagues, and learners where relevant

No specific training needs, but need to be familiar with the policy contents.

6.2 Individual or group with a responsibility for implementing the contents of this policy

No specific training needs, but need to be familiar with the policy contents.

As a trust policy, all colleagues, and learners where relevant, need to be aware of the key points that the policy covers. Colleagues, and learners where relevant, can be made aware through a variety of means such as:

all user emails for urgent messages
one to one meetings or supervision
continuous professional development sessions
posters
daily email (sent Monday to Friday)
practice development days
group supervision
team meetings
intranet
local induction

7 Monitoring arrangements

7.1 Clinical skills packages

How: Review as per schedule specified in each individual package.
Who by: Central clinical skills team.
Reported to: Care groups.
Frequency: As required.

7.2 Clinical skills assessment forms

How: Review of assessment forms.
Who by: Central clinical skills team.
Reported to: Individuals report to own care group.
Frequency: As required.

7.3 Clinical skills incidents

How: Via IR1 system.
Who by: Patient safety team and central clinical skills team.
Reported to: Actions are emailed to the reporter or area.
Frequency: As and when received.

8 Equality impact assessment screening

To download the equality impact assessment for this policy follow the link: Clinical skills policy EIA.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

These should be noted within a patients’ records, but to avoid any doubt, discuss any issues with the patient, appropriate relative or the spiritual care team

8.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals’ capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all colleagues working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005)to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005) (section 1).

9 Links to any other associated documents

10 References

Benner, P.E. (1984). From novice to expert: excellence and power in clinical nursing practice. Addison-Wesley, Menlo Park, Calif; London.
Lister, S., Dougherty, L. and Royal Marsden NHS Foundation Trust, (2015). The Royal Marsden manual of clinical nursing procedures.  Ninth, Professional, edition, Wiley Blackwell, Chichester.

11 Appendices

11.1 Appendix A Definition or explanations of terms used

Clinical skills, any action performed by colleagues involved in direct care of patients which impacts on clinical outcomes in a measurable way and includes:
- cognitive or ‘thinking’ skills such as clinical reasoning and decision making
- non-technical skills such as team working and communication
- technical skills such as clinical examination and invasive procedures
Competency, once assessed this provides the level of assurance of a person’s capability, skill, and expertise in each area.
Clinical skills packages, a training package developed in conjunction with subject matter experts using the latest research to educate colleagues in the standard operating procedure (SOP) for a specific clinical skill. Within the trust these are stored on the intranet in the clinical skills zone for ease of access by all.
Learners, learners are identified as any individual who accesses practice placements to gain education and may include:
- learner multi-professional pre-registration learners, post-registration learners
- apprentices
- post 16 learners, specialised diplomas
- nurses who qualified overseas
- trident work experience for school Learners
- widening participation Learner
Simulation, the imitation of a real-world situation or process to allow for safe practice of new skills.
Part task trainer, a piece of equipment that is used to support simulation and clinical skills training, for example a single plastic arm that is not connected to a body (part task)
CCAST training, the trust has identified CCAST as the chosen tool for assessment of clinical skills. CCAST is a core component of competency assessment, and the tool is present in all clinical skills packages. CCAST assessors will have attended a CCAST training session. The tool is broken down into 4 categories: pre-procedure, procedure, post procedure and troubleshooting, this replicates the layout of clinical skills in The Royal Marsden Hospital manual of clinical nursing procedures. The score system works on a 0 to 5 level in the main is based on the work of Patricia Benner in novice to expert. The tool is a vehicle for recording the assessment and is signed by both parties as a true reflection of the assessment.

11.2 Appendix B RDaSH care and clinical skills assessment

Appendix B care and clinical skills assessment tool (CCAST)

11.3 Appendix C Clinical skills packages

Package first draft, written by subject matter expert (possibly jointly with the Clinical Skills team) referenced, linked to policies, and consult the Royal Marden and any other national guidance.
First draft, when happy with first draft, send for consultation to a core group including other subject matter experts and possible future users. Give feedback date. Show on tracking document.
Review, review feedback and complete tracking document making appropriate changes to package.
Send to Clinical Skills team at Almond Tree Court.
Clinical Skills team to include the package on the clinical skills zone. The title of the package will be entered onto a spreadsheet for tracking purposes with regards to review dates.

11.4 Appendix D Values and behaviour framework

11.4.1 Passionate

We work hard to deliver a quality service.
We are determined to do what’s right for people.
We are positive in all that we do.
We endeavour to be our best through personal development.
We do our best to make a positive difference to people.

11.4.2 Reliable

We follow through on what we say we will do.
We take responsibility for things we can do something about.
We take ownership to know and follow best practice.
We are accessible whenever possible.
We turn up on time and complete tasks in the time agreed.

11.4.3 Caring and safe

We promote equality, diversity, and inclusion.
We take a person-centred approach.
We take time to listen with empathy and compassion.
We introduce ourselves.
We make sure we keep people safe and speak up when something is wrong.

11.4.4 Open

We include people in the decisions that affect them and keep them informed.
We give and receive purposeful feedback.
We acknowledge our own biases and learn from others’ perspectives.
We celebrate our successes and learn together from our mistakes.
We are honest and accountable taking responsibility for our actions.

11.4.5 Supportive

We encourage good physical and mental health including promoting a healthy work life balance.
We appreciate and respect other people’s input and ideas.
We value our patients, their families, their carers, and each other.
We work together as #onerdash team.
We help each other to do the best we can.

11.4.6 Progressive

We work together for continuous improvement.
We seek out and share information, knowledge, and experiences.
We are adaptable and flexible, open to innovation and change.
We strive for excellence through identifying and testing new ways of working.
We take responsibility to share and learn from and about each other.

Document control

Version: 2.1.
Unique reference number: 464.
Approved by: Corporate policy approval group.
Date approved: 25 January 2024.
Name of originator or author: Deputy manager and lead facilitator.
Name of responsible individual: Executive director for people and organisational development.
Date issued: 26 January 2024.
Review date: 30 June 2026.
Target audience: All managers with responsibilities derived from the policy and all clinical colleagues with direct patient contact. This policy is also relevant to learners as stipulated in their curriculum.

Page last reviewed: April 15, 2024
Next review due: April 15, 2025

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