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Skill/Learning Not all skills are applicable to all (University of California, Davis)

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Scan Page and email to: hs-cppn@ucdavis.edu
REVISED JANUARY 2020
BD Alaris IV Infusion System Skills Checklist #DAHS-NSCBD18-ALARIS
Page 1 of 4
Name:
PPS#:
Unit:
Title:
Due Date:
New hire: prior to end of unit orientation period: / / .
Current Staff:
These skills will be considered complete when all below performance criteria are completed and pages 1, 2, 3 and 4 have been scanned and emailed to: hs-cppn@ucdavis.edu
Skill/Learning
Not all skills are applicable to all Nursing areas – if not applicable mark as N/A
BD Alaris IV Infusion System Skills Checklist #DAHS-NSCBD18-ALARIS
Method of
Instruction:
Date
Initials of
Preceptor
Method of
Evaluation:
References:
1.
Complete the assigned Alaris eLearning modules in UC Learning.
BD Alaris IV Infusion System policies and procedures reviewed.
Alaris™ Pump module
Demonstrate Pump Setup
− The patient’s heart level should be in line with [CHANNEL SELECT] key.
− Closes the administration set roller clamp when the safety clamp is open, to prevent free flow.
− Does not use needles or blunt cannulas to access a SmartSite™ Needle-Free Valve.
− Swabs the SmartSite™ Needle-Free Valve with a sterile 70% isopropyl alcohol wipe prior to any connection.
Demonstrate System Start Up and Operation
− Understanding of what happens when [NEW PATIENT] is selected.
− Understanding of the Patient Care Profile and how to change it.
Demonstrate Programming with Guardrails™ Safety Software
− Programming a primary infusion on the Alaris™ Pump module.
− Responding to a Guardrails™ Soft or Hard Limit alarm with audio alerts and visual prompts.
− Programming an intermittent infusion on the Alaris™ Pump module.
− Programming a Volume/Duration infusion on the Alaris™ Pump module.
− Use of the ”RESTORE” feature (previous programming, VTBI, bolus).
− Programming a medication bolus and describing the “Rapid Bolus” infusion feature.
− Pausing an infusion by pressing the [PAUSE] hard key on the pump module and the PC unit.
− The appropriate head height differential when hanging a 2° medication bag, or a 2° medication bottle.
Demonstrate Basic Programming Without Guardrails™ Safety Software
−
Programming of a Basic Infusion. Verbalize safety concerns when this mode is used.
Alaris™ Syringe module
Demonstrate Syringe Module Setup
The patient’s heart level should be in line with [CHANNEL SELECT] key.
− Priming the set using the Syringe Channel Option feature “Prime Set with Syringe.” (Infant and Child Only)
− Proper priming technique when using an administration set with Pressure Sensing Disc tubing. (Infant and Child
Only)
Scan Page and email to: hs-cppn@ucdavis.edu
REVISED JANUARY 2020
BD Alaris IV Infusion System Skills Checklist #DAHS-NSCBD18-ALARIS
Page 2 of 4
PPS#:
Title:
Due Date:
New hire: prior to end of unit orientation period: / / .
Current Staff:
These skills will be considered complete when all below performance criteria are completed and pages 1, 2, 3 and 4 have been scanned and emailed to: hs-cppn@ucdavis.edu
Alaris™ Syringe module (Continued)
Method of
Instruction:
Date
Initials of
Preceptor
Method of
Evaluation:
− Clamping the tubing after priming to prevent uncontrolled flow.
− Loading and unloading a syringe into the Alaris Syringe module.
− Correct selection of syringe manufacturer and size.
− Recommend measures to help reduce start-up delays. (Infant and Child Only)
Demonstrate Basic Programming Without Guardrails™ Safety Software
− Programming of a Basic Infusion. Verbalize safety concerns when this mode is used.
Demonstrate and Verbalize Measures to help Reduce Start-Up Delays (Infant and Child Only)
− Use the smallest syringe size possible (e.g., if infusing 2.3 mL of fluid, use a 3 mL syringe).
− Use compatible components which have the smallest internal volume or “dead space”.
− Ensure the device is as close to level of the patient’s heart as possible. Patient’s heart should be in line with
[CHANNEL SELECT] key.
− Use the [PRIME SET WITH SYRINGE] channel option on the Alaris™ Syringe module to speed up the
engagement of the device’s mechanical components and decrease the syringe’s internal friction.
− If utilizing a pre-run infusion practice (to allow for medication equilibration prior to connection
to the patient), ensure
the distal end of the administration set is level with or higher than the device.
− Avoid use of manifolds with ports containing high pressure valves. These valves require at least 50-200 mmHg
pressure to open and allow fluid flow. These high-pressure valves may cause a significant delay in therapy
followed by a sudden bolus once the value is opened, particularly at low infusion rates.
− Note: These recommendations are especially important when infusing high-risk or life- sustaining
medications at low infusion rates (for example, <5mL/h and especially at flow rates <0.5mL/h).
Alaris™ PCA module
Demonstrate PCA Module Setup
− The patient’s heart level should be in line with [CHANNEL SELECT] key.
− System Start Up and Security key lock feature.
• Use of the security key or security code when installing a new syringe or changing the syringe.
− Priming the set using the “Prime Set with Syringe” feature
• Prime set prior to attaching to patient.
• The tubing should be clamped to prevent inadvertent or uncontrolled flow with a primed administration set.
− Loading the syringe into the Alaris™ PCA module
• Hold the installed syringe plunger to prevent accidental push on the plunger when lowering the drive head.
• Clamp off fluid flow to the patient before loading and unloading a syringe.
• Check that the installed syringe matches the manufacturer and size displayed on the pump.
Demonstrate Programming the Alaris™ PCA module
− Programing the following
• PCA dose + Continuous dose infusion
Scan Page and email to: hs-cppn@ucdavis.edu
REVISED JANUARY 2020
BD Alaris IV Infusion System Skills Checklist #DAHS-NSCBD18-ALARIS
Page 3 of 4
Name:
PPS#:
Unit:
Title:
Due Date:
New hire: prior to end of unit orientation period: / / .
Current Staff:
These skills will be considered complete when all below performance criteria are completed and pages 1, 2, 3 and 4 have been scanned and emailed to: hs-cppn@ucdavis.edu
Alaris™ PCA module (Continued)
Method of
Instruction:
Date
Initials of
Preceptor
Method of
Evaluation:
− How to modify PCA parameters during an active PCA infusion (PCA dose, Lockout interval, Continuous dose,
Maximum limit).
Demonstrate Accessing Patient History and the Alaris™ PCA module
− How to view and clear patient history.
− Verbalize that patient history data is stored as a rolling 24-hour time period.
− Verbalize what actions will delete the PCA patient history.
Demonstrate Pausing the infusion, Changing the syringe and Restoring the infusion
− Clamping off fluid flow to the patient before loading and unloading a syringe.
− Pause the infusion, change the current syringe, and then use the [RESTORE] key to restore the previous
programming parameters.
− Verbalize that the [RESTORE] key should only be used if the Drug, Therapy, Concentration and Dosing Units
remain the same.
Demonstrate Understanding of the Alaris™ PCA Pause Protocol
The Alaris™ PCA module will pause when hospital-established parameters on the Alaris™ etCO
2
module are met
.
Demonstrate Understanding of the near end of infusion (NEOI) option.
− Near end of infusion (NEOI) option allows an alert to sound at a hospital-established remaining syringe volume
before the infusion is complete (Empty Syringe alert).
− An audio prompt will sound at NEOI, which requires being silenced just once, and will not re-occur following the
initial silencing until the empty syringe alert sounds.
I am not responsible for the PCA module.
Alaris™ EtCO
2
module
EtCO
2
Monitoring
− Understanding of the basic parameters monitored using the Alaris™ etCO
2
module, including basic
Ventilation vs. Oxygenation and a normal etCO
2
waveform.
− Locating the Gas Inlet on the Alaris™ etCO
2
module and attach the disposable.
Using the directions for use insert as a reference before attaching the disposable to the patient.
Alarms and Limits
− How to view etCO
2
alarm limits, RR alarm limits, and etCO
2
waveform from the main display.
− How change etCO
2
, RR, and No Breath limits.
Scan Page and email to: hs-cppn@ucdavis.edu
REVISED JANUARY 2020
BD Alaris IV Infusion System Skills Checklist #DAHS-NSCBD18-ALARIS
Page 4 of 4
Name:
PPS#:
Unit:
Title:
Due Date:
New hire: prior to end of unit orientation period: / / .
Current Staff:
These skills will be considered complete when all below performance criteria are completed and pages 1, 2, 3 and 4 have been scanned and emailed to: hs-cppn@ucdavis.edu
Alaris™ EtCO
2
module (Continued)
Method of
Instruction:
Date
Initials of
Preceptor
Method of
Evaluation:
Demonstrate Pre-silencing Alarm
− Understands that this mode will only pre-silence the monitoring alarm for 2 minutes and will not
silence infusion alarms.
Demonstrate Viewing EtCO
2
Trend Data
− Understand how to view the trend data.
•
How to tell which value has triggered an alarm (bell icon).
•
If there is no data for time period displayed, dashes (---) will be displayed.
− Current patient data will not be displayed while Trend Data feature is being viewed
Demonstrate Understanding of Alarms/Alerts/Troubleshooting
− Verbalize meaning and response to:
•
Auto zero in progress Alarm
•
Disposable Disconnected Alarm
•
Clearing Disposable Alarm
•
Disconnect Occluded Disposable Alarm
− Verbalize possible causes and possible actions to:
•
Low etCO
2
Alarm
•
High etCO
2
Alarm
•
High FiCO
2
Alarm
No Breath Detected Alarm
I am not responsible for the etCO
2
module.
PRECEPTOR SIGNATURE
Signature and Printed Name of Preceptor or other verified personnel who have initialed on this form:
Initial: Print Name:
Signature:
PRECEPTEE STATEMENT AND SIGNATURE:
I have read and understand the appropriate UC Davis Health Policies/Procedures and/or equipment operations manual, I have demonstrated the ability to perform the verified skills as noted, and I
have the knowledge of the resources available to answer questions.
Printed Name
Signature
Date
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Completed 1 April 2021

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