Download UCHC Competency Checklist: ORIENTATION

PATRAN Competency Checklist: ORIENTATION (TEMPLATE)
Position Title: ________________
Employee Name & #:
Area:
Method of Instruction Key:
P = Protocol/Procedure Review
E = Education Session
S = Self Learning Package
C = Clinical Practice
D = Demonstration
Method of Evaluation Key:
O = Observation (in clinical setting)
RD = Return Demonstration
T = Written Test
V = Verbal Review
_____________
Unit: _____________
Self-Assessment by Employee
Never
Done
Needs
Review/ Competent
Practice
Validation of Competency
Method of
Instruction
(Use
Instruction
Key on Left)
Date
Initials
Evaluation
Method
(Use
Evaluation
Key on Left)
A. INSERTION AND REMOVAL
Log-roll Insertion
Tucking Insertion
Unfolding Insertion
Burrito Roll Insertion
Pre-surgery/transport insertion (raised upper body but preventing patient from
sliding down)
Removal
B. SAFETY PRECAUTIONS
PATRAN is for single-patient, multiple use. Not multiple patient use.
Do NOT leave around children or depressed patients (suffocation hazard).
Do NOT leave under patients long term (overnight) or under unattended patients.
Do NOT use to lift patients.
Do NOT allow PATRAN to touch open wounds. PATRAN is not sterile.
Do NOT send PATRAN home with untrained patients or caregivers.
Caregiver understands and demonstrates proper ergonomics in moving patients.
C. MOVING TASKS
Lateral transfer between flat surfaces.
Lateral transfer from an upper body raised surface such as EMS stretcher.
Boosting
Turning on side to prevent pressure sores
Turning to get into or out of bed
Moving a fallen patient
Initials
Revised 12/2008
Signature
Initials
Signature
Initials
Signature
Page 1 of 3
PATRAN Competency Checklist: ORIENTATION (TEMPLATE)
Position Title: ________________
Employee Name & #:
Area:
Method of Instruction Key:
P = Protocol/Procedure Review
E = Education Session
S = Self Learning Package
C = Clinical Practice
D = Demonstration
Method of Evaluation Key:
O = Observation (in clinical setting)
RD = Return Demonstration
T = Written Test
V = Verbal Review
_____________
Unit: _____________
Self-Assessment by Employee
Never
Done
Needs
Review/ Competent
Practice
Validation of Competency
Method of
Instruction
(Use
Instruction
Key on Left)
Date
Initials
Evaluation
Method
(Use
Evaluation
Key on Left)
ERCP proning
Changing sheets while laterally transferring patient (often surgery/obgyn)
Chair boosting
Putting on slings (patient sitting)
Putting on slings (patient lying down)
Sliding linen or air transfer mattresses under patients
Moving patient out of or into wheelchair
Dressing patients/putting on and removing compression stockings
Centering patient on a commode
Straightening slumped patient
Getting patients in and out of vehicles
D. REHAB/MOBILITY TASKS
Heel and toe exercises
Hamstrings and quad exercises
Core exercises
Stroke rehabilitation
Spine alignment
E. RADIOLOGY SPECIALTIES
Sliding x-ray cassette holder under patient
Transferring into/out of CT SCAN or MRI with or without slideboard.
Boosting on imaging bed/table
Initials
Revised 12/2008
Signature
Initials
Signature
Initials
Signature
Page 2 of 3
PATRAN Competency Checklist: ORIENTATION (TEMPLATE)
Position Title: ________________
Employee Name & #:
Area:
Method of Instruction Key:
P = Protocol/Procedure Review
E = Education Session
S = Self Learning Package
C = Clinical Practice
D = Demonstration
Initials
Revised 12/2008
Signature
Method of Evaluation Key:
O = Observation (in clinical setting)
RD = Return Demonstration
T = Written Test
V = Verbal Review
Initials
Signature
_____________
Unit: _____________
Self-Assessment by Employee
Never
Done
Needs
Review/ Competent
Practice
Validation of Competency
Method of
Instruction
(Use
Instruction
Key on Left)
Initials
Date
Initials
Evaluation
Method
(Use
Evaluation
Key on Left)
Signature
Page 3 of 3