No.1 JOB BREAKDOWN CHECK OFF SHEET - HEALTHCARE Task: Scrub the Hub Supplies: ETOH prep pads (1 for each hub), clean gloves Equipment & Materials: ‘Employee Nai uN SRT Initial Training Date: Studer Instructor: IMPORTANT STEPS KEY POINTS "CHECK OFF Date [¥ | a hy 7 4, Thumb and index bu 1. Open alcohol pad 2. Pinch and rip 5 3. 1 pad per hub oJ cos 3 7 ] : T vy bul Taper ies |p " 2 sen ae lett liter [3 | ost L In ae | 7 7 1 Ardy yer SH ert or 3 Oy 2. Keep clean 2 w 7 i Cc pA skery e i Version 1BAPTIST MEMORIAL HOSPITAL ~ DESOTO RESPIRATORY CARE SERVICES COMPETENCY STATEMENT. TITLE: Blood Gas Analysis and Reporting NAME: \ Laas DATE: 3 1, Washes hands, implements Standard Precautions 2. Verifies “ready” mode on the analyzer 3. Logs onto the computer 4, Performs analysis 5. Corrects for temperature, if applicable 6. Documents patient information, oxygen/ventilator settings on the computer system 7. Documents ABG results across interface 8. Reports ABG results: + Acknowledges/reports critical values + Verifies sample integrity and ID if delta check is prompted * Verifies and releases results to patient care unit 9. Disposes of syringe and gauze according to infection prevention guidelines 10, Cleans counter tops and equipment according to infection control guidelines *COMMENTS: Cheek if acceptable EVALUATOR’S SIGNATURE: EMPLO¥EE'S SIGNATURE: student *Any criteria not met should have an explanationBAPTIST MEMORIAL HOSPITAL - DESOTO, RESPIRATORY CARE SERVICES COMPETENCY STATEMENT TITLE: Extubation of Artificial Airway NAME: ame, S' DATE: 03} a Check itacceptable 1. Washes hands, implements Standard Precautions Obtains appropriate equipment and supplies, ensure presence of re-intubation equipment Verifies physician’s order or writes an order if on Respiratory Care Consult Correctly identifies patient Ilias Introduces self and identifies department N education at 6. Explains procedure to patient using age specific guidelines and provides patient/fa appropriate 7. Properly assembles post-extubation equipment; checks gas flow and Flo2 8. Pre-oxygenates and hyp. inflates patient 9. Suctions trachea, oropharnyx, and nasopharynx 10. Verifies presence of airway reflexes during suctioning, 11, Deflates cuff 12, Removes endotracheal tube 13. Immediately administers oxygen/aerosol therapy 14. Modifies procedure as needed based upon patient response 15, Takes appropriate and timely action for an adverse response to extubation 16. Immediately obtains a patient airway and manually ventilates patient in respiratory distress 17, Monitors post-extubation ventilatory pattern and ensures absence of stridor of distress 18, Processes equipment and adheres to Universal Precautions HAKAN KAKA AKAN! 19, Documents procedure *COMMENTS:. EVALUATOR'S SIGNATURE: EMPLOYERS SIGNATURE: Student “Any criteria not met should have an explanationBAPTIST MEMORIAL HOSPITAL ~ DESOTO RESPIRATORY CARE SERVICES COMPETENCY STATEMENT TITLE: NAME: DATE: Check if acceptable Washes hands, implements Standard Precautions Obtains appropriate equipment and supplies Inspects medical records for precautions/complications Verifies physician's order Correctly identifies patient Introduces self and iden fies department Explains procedure to patient using age specific guidelines; provide education if appropriate Properly assembles equipment and selects appropriate sized catheter Pre-checked functions of catheter and negative pressure 10. Hyper-oxygenates / hyper-inflates before, during, and after the procedure I. Maintains sterile technique 12. Suctions patient for not more than 15 seconds 13. Obtains a sputum specimen, if needed 14, Takes appropriate action for adverse response and notifies appropriate personnel 15, Evaluates breath auscultation 16. Monitors ECG or pulse oximeter throughout procedure, if available 17, Terminates procedure when necessary and disposes of catheter and gloves 18. Processes equipment Ick Wale Walenls 19. Documents appropriately *COMMENTS:. EVALUATOR’S SIGNATURE: [ EMPLOYEES SIGNATURE: POW, SRT Cruden “Any criteria not met should have an explanationBAPTIST MEMORIAL HOSPITAL-DESOTO RESPRIRATORY CARE SERVICES COMPETENCY STATEMENT MECHANICAL VENTILATION - Adult name Achteu wil\arns, Cet DATE @ [ze Q Washes hands and implements Standard Precautions Obtains / verifies orders or writes order if on Respiratory Care Protocols 3. Discusses the following with validator: a. Goals / Indications / Hazards b. Modes of ventilation - VAPS, CMV, AC, SIMV, CPAP, PCV, Pressure Support, Peep, Volume Control c. Weaning Protocol . Gathers equipment Verify ID Positions patient Installs ventilator Tests equipment for function ). Adjusts ventilator settings |. Suctions patients if indicated Monitors vital signs a. Heart rate b. Respiratory Rate c. Breath sounds d. SPO2 e. Blood Pressure 12. Sets alarms 13. Documents the following: a. Parameters / Alarms b. Cuff pressure c. Airway type / Size d. Tube placement e. Analyze F102 14. Washes hands Re SSeoanoan 2011 Ventilator Set-up - Adult xls1 Check if acceptable a aa ae ve a o aha Aa ae — eas ae aBAPTIST MEMORIAL HOSPITAL-DESOTO RESPRIRATORY CARE SERVICES COMPETENCY STATEMENT sserres+ CIRCUIT CHANGE “*"*""" 15. Empties condensate from tubing / drain cups x 16. Aseptically changes circuit Z NOTE: This should be completed with enough speed and accuracy to assure the patient does not lose more than two consecutive ventilator breaths or with assistance of a manual resuscitator. 17. Monitors ventilator and patient parameters a 18. Washes hands = 19. Documents procedure Z COMMENTS* EVALUATOR'S SIGNATURE: aul Rel “EMPCOYEE'S SIGNATURE: PDWiuWudno, $8 ctudent “ANY CRITERIA NOT MET SHOULD HAVE AN EXPLANATION 2011 Ventilator Set-up - Adult.xls2BAPTIST MEMORIAL HOSPITAL - DESOTO RESPIRATORY CARE SERVICES COMPETENCY STATEMENT TITLE: ‘Transports the Mechanically Ventilated Patient NAMI ‘S! \ DATE: 3 1, Washes hands, implements Standard Precautions 2. Obtains / verifies order 3. Gathers equipment 4, Checks patient ID 5. Identify self to patient 6. Explains procedure to validator using age specific guidelines 7. Checks the tube placement 8. Ascultates chest 9. Ensures patient safety * Secure 02 « and verify contents 10. Removes patient from ventilator, attaches appropriate device with required settings 11. Monitors chest excursion 12. Transports patient *COMMENTS: (Check if acceptable (IIS AIAN A EVALUATOR’S SIGNATURE; EMPLOYER'S SIGNATURE: “254M not met should have an explanation Page 1 of |BAPTIST MEMORIAL HOSPITAL - DESOTO RESPIRATORY CARE SERVICES COMPETENCY STATEMENT TITLE: Cuff Pressure Measurement NAME: Ashkwy wittians, SRT DATE: B(2 2 Check it acceptable 1. Washes hands, implements Universal Precautions Gathers equipment 3. Verify patient ID 4, Identify self to patient 5. Explains procedure to patient using age specific guidelines 6. Attaches manometer to pilot tube 7. Measures cuff pressure: + MOV technique + Minimal leak technique 8. Disconnects cuff manometer 9. Ascultates chest 10. Cleans cuff manometer 11, Documents procedure *COMMENTS: EVALUATOR'S SIGNATURE O4r— ELT EMPLOYERS SIGNATURE: + REMAGA Tot met should have an explanation Page lof 1BAPTIST MEMORIAL HOSPITAL - DESOTO RESPIRATORY CARE SERVICES. COMPETENCY STATEMENT. ‘TITLE: High Flow Oxygen Therapy NAME: \ RQ DATE: Check ifacceprable 1, Washes hands, implements Standard Precautions 2. Obtains/verifies order or writes order if on Respiratory Care Protocol usses indication/complications with validator Ini 4. Gathers equipment appropriate equipment for age: Aerosol face mask T-piece Trach collar Face tent Venturi mask Non-rebreather face mask ‘Aerosol mist tent Infant hood 5. Verify patient ID 6. Identify self to patient 7. Explain procedure to patient using age specific guidelines 8. Properly assembles equipment and tests equipment funetion prior to patient application 9. Adjusts device to deliver prescribed 02 concentration/ensure adequate total gas flow rate 10. Apply system to patient ensuring snug and comfortable fit IL, Instructs patient/family/caregivers in fire hazards of 02 I isliglylglls 12. Documents procedure *COMMENTS: EVALUATOR’S SIGNATURE: “EMPLOYEE'S SIGNATURE: Gruden “Any criteria not met should have an explanationBAPTIST MEMORIAL HOSPITAL - DESOTO RESPIRATORY CARE SERVICES COMPETENCY STATEMENT. TITLE: High Flow Nasal Cannula Oxygen Therapy NAME: DA’ ‘Cheek If Acceptable 1. Washes hands, implements Standard Precautions 2. Obtains/verifies order or writes order if on Respiratory Care Protocol 3. Discusses indication/complications with validator 4. Explains the weaning process to validator In als sls Gathers equipment appropriate equipment for age: High-flow nasal cannula Humidifier water bottle Humidifier heater column High flow nasal cannula circuit Oxygen supply tubing Pressure relief valve Humidifier & Blender with stand 6. Verify patient by 2 identifiers 7. Introduce self to patient 8. Explain procedure to patient using age specific guidelines 9. Properly assembles equipment and tests equipment function prior to patient application 10. Set to prescribed 02 concentration, gas flow rate (1-40 Ipm), and temperature 11. Apply system to patient ensuring a comfortable fit 12, Instructs patient/family/caregivers in fire hazards of 02 KK II ININIS \ 13, Documents procedure *COMMENTS:. EVALUATOR’S SIGNATURE AND DAT! EMPLOYEE'S SIGNATURE AND DATE: student *Any criteria not met should have an explanationBAPTIST MEMORIAL HOSPITAL ~ DESOTO RESPIRATORY CARE SERVICES. COMPETENCY STATEMENT Cheek if acceptable 1, Washes hands, implements Standard Precautions Obtains/verifies order or writes order if on respiratory care guidelines 3. Obtains and prepares needed supplies: + Heparinized syringe * Biohazard bag * Patient ID label * Ice slush, if applicable 4, Verify patient’s ID using 2 identifiers Identify self to patient and explain procedure using AIDET communication AW 6. Edwards VAMP Collection Sys Drawing Clearing Volume * Release plunger latch, smoothly draw back on reservoir until plunger stops (12mls) * Close shut-off valve ‘© Swab sample site — (TWI Serub-the-Hub) ‘Ensure plunger is depressed to bottom of reservoir © Push cannula with syringe or direct draw unit into sample site * Slowly draw blood sample * Hold cannula, remove syringe/cannula together from sample site, pulling straight out Open shut-off valve Slowly, smoothly and evenly reinfuse the clearing volume Flush VAMP system by pulling SnapTab ‘Swab the sampling site (Scrub-the-hub) 7. Expels air bubble to maintain anaerobic sample, labels and bags sample 8. Disposes of contaminated supplies according to infection control guidelines 9. Transports sample to lab within 15 minutes; within 30 minutes if in ice slush 10. Documents time, conditions, and collection site KAW NnaRABIYS Ky AIS *COMMENTS: EVALUATOR'S SIGNATURE; EMPLOYEES SIGNATURE: Ff Student “Any criteria not met should have an explanation