Delegated Healthcare Task Competency Assessment & Sign-Off (HR-F041) DELEGATED HEALTHCARE TASK COMPETENCY SIGN-OFF (HR-F041) Contact DELEGATED HEALTHCARE TASK COMPETENCY SIGN-OFF Delegated Healthcare Task Competency Assessment & Sign-Off (HR-F041)SECTION 1: THE DELEGATION TRIANGULATION & ACCOUNTABILITYTitle- Select -MrMrsMissMsMxOtherStaff Member NameStaff_IDJob TitleCare Worker / Support WorkerComplex Care WorkerSenior Care Worker / MentorField SupervisorCare Coordinator / Rota SchedulerClinical LeadQuality Assurance / Compliance OfficerHR / Recruitment AdministratorImplementation ResearcherDeputy Care ManagerRegistered Care ManagerOperating Local Authority- Select -HaringeyIslingtonBarnetWaltham ForestCamdenHackneyBrentHarrowRedbridgeNewhamCity of LondonWestminsterTower HamletsBarking and DagenhamHaveringKensington and ChelseaHammersmith and FulhamEalingHillingdonHounslowSouthwarkLambethLewishamGreenwichWandsworthRichmond upon ThamesMertonKingston upon ThamesSuttonBexleyBromleyCroydonOtherName of Service UserExact Equipment/Model Used for Assessment- Select -Enteral / PEG / JEJ Support (Connection/Disconnection of Feeds & External Hygiene Only)Stoma / Colostomy / Ileostomy Care (Emptying, Bag Change & External Hygiene Only)Urinary Catheter Care (Emptying, Bag Change & External Hygiene Only)Respiratory / Ventilation Support (Routine CPAP/BiPAP Mask Fitting & Comfort Only)Oxygen Therapy Management (Cylinder/Concentrator visual checks & safe positioning)Advanced Postural Management / Specialist Hoisting (Under OT direction)Specific Delegated Support Task (Social/Hygiene Elements Only)- Select -Enteral Feeding Pump (e.g., Nutricia Flocare Infinity, Kangaroo)Stoma/Catheter Consumables (e.g., Coloplast, Hollister, Bard)Respiratory/Ventilation Device (e.g., ResMed, Philips Respironics)Specialist Postural Equipment (e.g., specific active/passive hoists or slide sheets)Delegating External Healthcare Professional Role- Select -NHS District Nurse / Community MatronSpecialist Nurse Practitioner (e.g., Stoma, Respiratory, or Tissue Viability Nurse)Allied Health Professional (e.g., Dietitian, Speech & Language Therapist, Occupational Therapist)General Practitioner (GP)Professional PIN/Registration Verification- Select -NMC Registered - Active PIN Verified via RegisterHCPC Registered - Active PIN Verified via RegisterGMC Registered - Active PIN Verified via RegisterDelegation Accountability Status- Select -Local NHS TrustCommunity District Nursing TeamLocal Authority Brokerage / Therapy TeamEmploying Organisation- Select -External Professional assumes full clinical delegation and signs belowSECTION 2: THEORETICAL KNOWLEDGE & ABSOLUTE BOUNDARIES (Safe QS6) The Assessor must verbally assess the Care Worker's understanding of the strict limits of their competency prior to practical observation.Anatomy & Purpose: Can the Care Worker explain the basic anatomy related to the task and why the social care intervention is required?- Select -Yes - CompetentNo - InadequateN/AEquipment Integrity & MHRA Alerts: Can the Care Worker identify all required equipment, verify expiry dates, and explicitly explain the procedure for quarantining and reporting a faulty medical device?- Select -Yes - CompetentNo - InadequateN/AThe 'Red Flag' Boundary: Has the Care Worker correctly identified the absolute clinical limits of this delegation?- Select -Yes - CompetentNo - InadequateN/ASpecify the exact 'Hard Boundary' for this specific task- Select -EnteralCatheterStomaRespiratoryTissue ViabilityInfection Prevention & Control (IPC): Did the Care Worker explain the correct clean technique required, including clinical waste disposal protocols?- Select -Yes - CompetentNo - InadequateN/AFluctuating Capacity & MCA: Does the Care Worker know the exact location of the formal Best Interests decision/documentation if the service user lacks capacity to consent to this support?- Select -Yes - CompetentNo - InadequateN/A - User has capacityN/ASECTION 3: PRACTICAL OBSERVATION (Effective QS2) The Assessor must silently observe the Care Worker performing the task. Do not intervene unless safety is compromised.Consent & Communication: Explained the procedure and obtained valid consent before commencing?- Select -PassFailN/APreparation & Hygiene: Washed hands, prepared a clean field, and donned correct PPE?- Select -PassFailN/AProcedural Accuracy: Followed the agreed support protocol step-by-step without prompting or hesitation?- Select -PassFailN/ADignity & Comfort (Caring QS1): Maintained dignity throughout the procedure (e.g., minimising exposure, checking for pain)?- Select -PassFailN/ACare Documentation: Accurately recorded the intervention in the digital care notes (Nourish/Birdie), logging exact fluid outputs, skin observations, or any anomalies to report to the NHS team?- Select -PassFailN/ASECTION 4: EMERGENCY PROTOCOLS, ESCALATION (Safe QS1, QS2) & GRADING Mutima Care - care workers operate alone and must know exactly what to do when complications arise.Scenario Test: "I presented a complication scenario (e.g., 'The PEG site is suddenly bleeding', or 'The catheter is completely blocked')." Did the Care Worker correctly identify the immediate escalation pathway?- Select -Yes - Knew to dial 999 immediately.Yes - Knew to contact the District Nurse / GP Out of Hours.Yes - Knew to contact the Mutima Care Office for escalation.No - Failed to identify the correct urgency/pathway.Delegating External Professional Declaration- Select -I confirm the exact emergency contact numbers for this specific complication are documented in the Service User's home file and digital care plan.Assessor's Feedback & Minor Corrections- Select -None - Exemplary care practice and boundary awareness demonstrated.IPC FocusCommunicationDocumentationEquipment CheckCritical FailureOverall Competency Grading- Select -PassPendingFailDynamic Voiding Triggers: "I acknowledge that this competency is IMMEDIATELY VOIDED, and I must request a re-assessment, if any of the following occur:"- Select -The service user's underlying health condition significantly changes or deteriorates.The service user is discharged from the hospital following a related admission.The brand, model, or type of medical equipment/device is changed.DateSECTION 5: TRIPARTITE DECLARATIONS & ACCOUNTABILITYEmergency Pathway Confirmed- Select -I confirm that I have trained and observed this Care Worker. I am satisfied they are competent to safely undertake the social and hygiene elements of this specific delegated task. I retain professional accountability for the decision to delegate, while the Care Worker is accountable for their actions in executing it safely according to my instruction.Delegating Professional NameCare Worker Declaration- Select -I confirm I feel confident and competent to perform this support task. I understand the absolute boundaries of my competency, that I must never undertake a clinical or invasive procedure, and I will immediately escalate any concerns. I confirm I will NOT perform this task on any other service user, nor use different equipment, without a separate formal assessment.Care Worker NameCare Worker Declaration- Select -Registered Manager / Rostering AuthorizationNext Review Date:SUBMIT FORM
