Guidance

AAA screening: annual screening technician scanning competence assessment guidance

Updated 27 September 2021

1. Overview

The annual scanning competence assessment aims to ensure that screening technicians have the knowledge and practical skills to perform to the standards required to work within the NHS abdominal aortic aneurysm (AAA) screening programme. The assessment is through direct observation of performance in clinic.

Assessments are carried out by clinical skills trainers (CSTs) who have completed CST training as required by the NHS AAA screening programme and who have maintained continuing professional development.

This guidance is for CST assessors.

2. Preparation for assessments

The local service manager or coordinator and CST should plan to carry out the assessment in a clinic where the screening technician will screen invited individuals. To enable the screening technician to scan an individual who has an aneurysm, this must be a clinic that includes individuals on surveillance pathways.

Enough time should be set aside for the assessing CST to give verbal feedback to the screening technician immediately after the assessment.

The assessing CST must check and confirm that the screening technician has completed the knowledge assessment and achieved a minimum score of 80% in both
e-learning units.

The knowledge assessment should be completed every 2 years. It should be completed no more than 4 weeks before that year’s annual scanning competence assessment.

3. Completing the assessment form

The assessing CST must observe the screening technician screening a minimum of 4 individuals, 1 of whom must have an aneurysm.

A single assessment form can be completed for each observed clinic.

The assessment is made up of several assessment criteria, some relating to knowledge and others to performance. Each is within the screening technician scope of practice.

The CST should award a grade for each of the criteria which is an average of the screening technician’s performance across the minimum of 4 individuals screened unless otherwise stated (see section 5.2)

Sections 5 and 6 of the assessment only need to be assessed once. This can be done after the minimum of 4 scans have been observed and assessed.

4. Grading the assessment criteria

There are 2 possible grades for each assessment criteria. These are:

• satisfactory (S)
• unsatisfactory (US)

4.1 Satisfactory

This means the screener performs or explains the skill or procedure competently, independently and safely.

4.2 Unsatisfactory

This means the screener demonstrates limited knowledge and understanding of the skill/procedure, does not recognise own limitations and requires assistance.

5. Assessment outcomes

There are 2 possible outcomes. These are:

• competent
• conditional

5.1 Competent

This means the screening technician has reached the satisfactory NHS AAA screening programme standard for all elements assessed.

This is awarded where the screening technician has no US grades in any of the assessment criteria.

If a screening technician exceeds the satisfactory standard, CSTs are encouraged to include this as part of the feedback to them.

5.2 Conditional

This means the screening technician has not reached a satisfactory standard in one or more of the assessment criteria.

For example, a conditional outcome will be triggered if the screening technician:

• scores 1 or more US grades in the assessment criteria

• does any of the following in any of the observations:
  • fails to correctly identify the individual to be screened
  • uses the colour function of the ultrasound scanner
  • uses coronal scanning
  • fails to identify the aorta when it is visible within the image
• incorrectly positions the callipers which would result in the individual being assigned to the wrong screen result pathway

To ensure the safety of the individual being screened, the assessing CST must step in and assist the screener when necessary.

6. Next steps following assessment

The CST is required to inform the local service manager/coordinator and clinical lead of the outcome of the assessment by the next working day. This should be done by email. The local service manager/coordinator should confirm receipt of the email.

6.1 Next steps: competent outcome

The assessment should be repeated every 12 months. Internal quality assurance processes must be followed to ensure the ongoing quality of the screening technician’s work.

Where the CST identifies areas for development, this must be documented in the feedback and an action plan agreed. The actions identified should be completed within 12 weeks of the assessment date.

An example of an action plan and template are available in the recovery training portfolio.

The screening technician should continue to demonstrate and maintain improvement. This can be assessed through the internal quality assurance processes.

The screening technician and the local service are advised to keep copies of the assessment and action plan documentation.

6.2 Next steps: conditional outcome

The screening technician must have a repeat scanning assessment within 12 weeks. This should follow a period of recovery training (see section 6.3).

Local services must inform their regional screening quality assurance service (SQAS) if a screening technician’s performance is assessed as ‘conditional’ to ascertain if there is a patient safety risk that requires further investigation.

If the clinical lead decides the screening technician should continue to actively screen, this needs to be documented.

If the screening technician continues to actively screen, all their subsequent scans must be quality assured within 7 days of the screen until the screening technician has had a scanning competence reassessment and awarded an assessment outcome of ‘competent’.

Before the reassessment, the screening technician should complete a period of recovery training.

6.3 Recovery training requirements

The following are the minimum requirements. Local services can add to these depending on the screening technician’s needs.

1. 10 hours of directly supervised training with the CST.

2. A minimum of 20 documented scans where the screener is directly supervised by the CST. A minimum of 5 of these scans must have an abdominal aortic aneurysm.

3. Reflection on learning from the directly supervised training.

4. Complete a recovery training portfolio which includes an action plan that addresses all the specific elements of the assessment where the screener scored US, and any additional areas for development identified.

The screening technician and the local service are advised to keep copies of the scanning assessment and recovery training documentation.