Competency Statement - Verified

							Competency Statement - Verified Assessment Fisher & Paykel 850 Respiratory Humidifier
Surname: Title (Mr/Mrs/Miss/Dr etc): Job Title/Designation: Dept/Directorate & Ward/Unit: Forename(s): Extension No:

Verification of competence is undertaken by assessment against the following statements: These statements are designed to indicate competence to use this device. Responsibility for use remains with the user, so if you are in any doubt regarding your competence to use the device, you should seek education to bring about improvement. Various methods including, self directed learning, coaching & formal training may be initiated. (Consider local resources, product operating manual, the intranet http://intranet/sQMCInfo/Divisions/Diagnostics/MESU/Product%20Info.htm & discussion with colleagues or the Medical Devices Trainer) You must be able to answer “yes” to all the questions before considering yourself to be competent. If you are not competent, instigate learning & then repeat assessment. Competence must be verified by Authorised Trainers. Questions to ask yourself Initial assessment date: Final assessment date:

Do you know:
Pre-operational inspection and correct set up of the device Ability to operate device safely 1. What external precautions should be considered when setting up the unit to prevent it from alarming? 2. How the humidifier connects with its heated wire circuit? 3. The causes that may trigger the unit to alarm? 4. What information is available from the unit to help troubleshoot the alarm? 5. Which fluid should be attached to the Auto Feed Humidification Chamber? 6. The optimum temperature for the tracheostomy setting? 7. The optimum temperature for the facemask setting? 8. How do you change between the two pre-set modes of delivery? 9. Which parts of the units circuitry are disposable? 10. The potential hazards that using this unit may present? 11. How to use other circuits safely with this unit? 12. When this humidifier should not be used? 13. The optimal position for the unit to be placed? 14. What effect increasing the gas flow through the unit will have and way may happen? 15. How to use this unit safely on neonates and children? (if applicable) Review maintenance and take appropriate action 16. How the humidifier should be cleaned effectively?

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

16. Yes/No

16. Yes/No

Statement - I have demonstrated competence and knowledge relevant to this device and I certify that I am aware of my professional responsibilities for continuing professional development and I am accountable for my own actions. I am competent to use this product without further training. Signature: I require further training before I can use this product in a competent manner Signature: Competence Verified By: Name (Print) Verifiers Signature Date Date Date:

Keep this form in your personal portfolio or training record. Ensure that your manager has seen the form & entered details of your competence in their records.

Medical Device Competency Fisher & Paykel 850 Respiratory Humidifier

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Version: Date Of Issue: Author:

NUH 1.1 June 08 Rupert Murch / John Riddle