NURSING EDUCATION
COMPETENCY-BASED ASSESSMENT
EMPLOYEE NAME: EMPLOYEE ID:
UNIT/AREA:
TITLE Alaris IV Infusion Pump Competency
PRE-REQUISTE TO CHECKOFF Lippincott Professional Development course: Met Not Met
FREQUENCY OF ASSESSMENT Every
Test and Exam (TE), Return Demonstrations (RD), Observation (O), Case Studies (CS)
Exemplars (E), Peer Reviews (PR), Self-assessments (SA), Presentation (P)
METHOD OF EVALUATION
Group Discussion Participation (GDP), Mock Events (ME),
Quality Improvement (QI) Data (DI)
REMARKS √: Met PM: Partially met NM: Not met
Critical point is a step that MUST be performed to pass are in RED or BOLDED Capital
EFFECTIVE DATE September 2023
REVIEWED/REVISED BY
ASSESSMENT TYPE: Initial Assessment Repeat Assessment Frequency Re-assessment
Criteria Method of Validation Remarks
®
Loading the Alaris Pump module Administration Set
Understands the safety clamp on the pumping
®
mechanism of the Alaris Pump module Administration
Set prevents inadvertent free flow when the set is
removed from the module.
Understands that to prevent free flow, the set roller
clamp needs to be closed when the safety clamp is
open.
®
Infusion Sets with SmartSite Needle-Free Valves
Understands to not use needles or blunt cannulas to
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access a SmartSite Needle-Free Valve.
®
Understands when accessing a SmartSite Needle-Free
Valve, with multiple sterile syringes, a swab with a sterile
70% isopropyl alcohol wipe prior to every syringe
connection must be used.
®
Basic Programming with Guardrails Safety Software
Understands that the term "Guardrails" refers to hospital
developed drug and fluid libraries with limits that supports
the hospital's best practice.
Understands that various infusion programming
®
parameters can be established with a Guardrails Limit,
Hard and/or Soft.
Understands that whenever a clinician encounters a
® ®
Guardrails Soft Limit or Guardrails Hard Limit an audio
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NURSING EDUCATION
COMPETENCY-BASED ASSESSMENT
Criteria Method of Validation Remarks
alert sounds with the visual prompt.
®
Understands that a Guardrails Hard Limit requires you to
select 'Reprogram' and to enter in a more acceptable
value.
®
Understands with intermittent programming on the Alaris
Pump module, that the device will automatically enter the
diluent volume in the 'VTBI' field. If clinically appropriate, this
value can be changed.
Understands that some infusion orders are listed to be given
over a designated time frame. The Volume/Duration feature
allows a volume to be infused (VTBI) and duration (infusion
time) to be programmed. The rate will then be automatically
calculated.
Understands that whenever an infusion is programmed
®
above or below a Guardrails Soft Limit a G icon will display
on the main screen for that channel. When the G soft key is
pressed all applicable out-orange limits are displayed.
Understands that 'Rapid Bolus' is the hospital established
fastest rate at which a bolus dose can be delivered and will
automatically calculate the bolus duration.
Understands that a bolus infusion can only be restored if
the previously programmed bolus is complete.
Task and description
®
Basic Programming without Guardrails Safety Software
Understands a Basic Infusion does not offer the safety of
®
Guardrails limits and Basic Infusion programming should
only be utilized if the drug or fluid to be infused is NOT
®
included within any of the hospital developed Guardrails
®
Drugs or Guardrails IV fluid libraries.
Additional Features
Understands that if the infusion has gone to completion (KVO
= 0) the 'RESTORE' feature would recall the originally entered
volume to be infused (VTBI) to simplify programming.
Understands that any infusion can be paused by pressing the
®
PAUSE hard key on the Alaris Pump module.
Understands that any infusion can be paused by pressing the
®
PAUSE soft key on the Alaris PC Unit and if applicable, any
®
Guardrails prompts will need to be addressed before the
system will initiate the pause.
Practical Skills
Able to demonstrate attaching and detaching modules
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NURSING EDUCATION
COMPETENCY-BASED ASSESSMENT
Criteria Method of Validation Remarks
to the pump
Able to demonstrate turning on pump, selection of
channels
Able to demonstrate loading and unloading of the
infusion sets to the pump
Able to demonstrate programming of the pump as per
the fluid/medication order
Able to demonstrate trouble shooting mechanisms
Able to demonstrate turning off channels and pump
COMPETENCY ASSESSEMENT: PASS REQUIRED TO REPEAT
COMMENTS:
Employee Name (print) : Employee ID :
Employee Signature : Date :
Assessor Name (print) : Assessor ID :
Assessor Signature : Date :
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