ACCU-CHEK INFORM SKILLS CHECKLIST - Methodist Healthcare

METHODIST LEBONHEUR HEALTHCARE SYSTEMPEDIATRIC KEYACCU-CHEK INFORM INITIAL TRAINING SKILLS CHECKLISTAssociates Name:______________________________ Associates #________________ Nursing Unit_______________Mark appropriate boxes: Initial Certification Barcode Needed(Date Issued _______Lab use Only)Circle appropriate title: RN LPN PHLEB Paramedic MT MLT1. Assembles equipment: Accu-Chek Inform, Comfort Curve Test Strips, Code Key, Control Solutions, CollectionSupplies2. Demonstrates knowledge of Code Key usage:When changedTrue False The code key must be changed each time a new can of test strips is opened.Proper installation and removal, including verification of code numberTrue False The code key does not have to match the code on the can of test strips.3. Demonstrates proper patient testing techniqueEnters correct patient identification number.The correct patient identification number is FIN# (Barcode on armband)Verbalizes proper collection of specimenTrue False Gloves are not necessary when performing patient or control testing or cleaning.Demonstrates correct dosing of test stripTrue False The first drop of blood from a fingerstick may be used to dose the test strip.True False Additional sample may be added up to 15 seconds after dosing test strip.Understands corrective action for out of range resultsA test result that reads “HI” indicates the glucose value is _____>600 mg/dl______.A test result that reads “LO” indicates the glucose value is ______ 3 Month patient test results 300 mg/dl (Alert value)10. Acknowledges importance of not divulging operator identification number.11. Testing personnel are knowledgeable of the contents of the procedure manual as it pertains to the scope of theirtesting activities.CompletedAssoc.InitialsNotCompletedAssoc.InitialsPART II: Unknown testing Result Control RangeGlucose _________ ____________ Passed Needs to repeatI have been trained to properly use the Inform whole blood glucose monitor. I feel prepared to use the method with confidenceon patient and control samples.______________________________ ____________________________ ___________Trainee Signature Trainer Signature Date of Training

Results are in Red---This is a test key. This is for Trainer only.