Title: Alaris IV Infusion Pump Competency
Date Effective: Sept 2019
Date Revised:
Issue Number: 1
Page 1 of 3
ORIGINAL DOCUMENT: DO NOT REPRODUCE OR PRINT FOR USE OUTSIDE
OF AHD WITHOUT PERMISSION
Employee Name: __________________________ Employee Number: _____________
Department: ________________________________ Date: _____________
METHOD OF ASSESSMENT
Observation DO
Return Demonstration RD
Written test WT
Verbal Review VR
Simulation SIM
Criteria Met Not Met Comment
Task and description
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
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.
Title: Alaris IV Infusion Pump Competency
Date Effective: Sept 2019
Date Revised:
Issue Number: 1
Page 2 of 3
ORIGINAL DOCUMENT: DO NOT REPRODUCE OR PRINT FOR USE OUTSIDE
OF AHD WITHOUT PERMISSION
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 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.
Title: Alaris IV Infusion Pump Competency
Date Effective: Sept 2019
Date Revised:
Issue Number: 1
Page 3 of 3
ORIGINAL DOCUMENT: DO NOT REPRODUCE OR PRINT FOR USE OUTSIDE
OF AHD WITHOUT PERMISSION
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 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
On this date, the nurse named_______________________ has demonstrated his/her ability to meet
the competency criteria for Alaris Infusion Pumps using Guardrails.
Assessor Signature: __________________________________Date:__________________
I am competent in using the Alaris Infusion Pump using the Guardrails. I have read and understand the
information supplied to me. I have met all criteria satisfactorily.
Employee Signature: _________________________________Date:_________________
