8025 - Annual competency skills assessment - DME driver service technician by compliancedoctor

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									                 ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT
                     EVALUATION OF CLINICAL PERFORMANCE
                         DME DRIVER/SERVICE TECHNICIAN

                               1 = Cannot Perform Skills Independently
                               2 = Requires Some Assistance to Perform Skills
                               3 = Can Perform Skill Independently
                               NA = Not Applicable


        What safety procedures do you follow when transporting oxygen?              1   2   3   NA

        How do you promote service and products to the referral sources in the      1   2   3   NA
         community?

        What procedure do you follow to maintain oxygen systems in customer         1   2   3   NA
         homes?

        What is the procedure for reporting malfunctioning/defective equipment?     1   2   3   NA

        Demonstrates a thorough understanding of how to complete documents          1   2   3   NA
         for reimbursement.

        How do you provide education to your customers?                             1   2   3   NA

        What procedure do you follow if you are in a client's home and the client   1   2   3   NA
         exhibits life threatening changes to his/her condition?

        Demonstrates a thorough knowledge of respiratory and HME equipment.         1   2   3   NA

        Maintains a safe driving record.                                            1   2   3   NA

        Define your role as a customer service representative.                      1   2   3   NA

        Demonstrates the ability to complete reports on all home visits.            1   2   3   NA

        What procedure is followed in the event you observe suspected abuse or      1   2   3   NA
         neglect during a home visit?

        What procedure do you follow if you experience a work related injury?       1   2   3   NA

        What is the procedure for transfilling compressed gas?                      1   2   3   NA

        What procedure do you follow when equipment needs repaired?                 1   2   3   NA

        What changes would you like to see in the company?                          1   2   3   NA


© The Compliance Doctor, LLC
ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - DME DRIVER/SERVICE
TECHNICIAN (continued)


       Demonstrates proper body mechanics at all times.                          1   2   3   NA

       What would you do if an elderly customer does not answer the door for a   1   2   3   NA
        scheduled appointment?

       Demonstrates knowledge of DOT standards.                                  1   2   3   NA

       Demonstrates knowledge of equipment use, safety factors, electrical       1   2   3   NA
        requirements and/or problem solving procedures.

       Demonstrates thorough knowledge of set-up, delivery and client/family
        education is use and care (if applicable) of equipment:

               Apnea monitor                                                     1   2   3   NA

               Oxygen tanks                                                      1   2   3   NA

               Liquid oxygen                                                     1   2   3   NA

               Oxygen concentrator                                               1   2   3   NA

               Infusion devices                                                  1   2   3   NA

               Bathroom aids                                                     1   2   3   NA

               Respiratory care equipment                                        1   2   3   NA

               Hospital beds                                                     1   2   3   NA

               Traction equipment                                                1   2   3   NA

               Ambulatory aids                                                   1   2   3   NA

               Wheelchairs                                                       1   2   3   NA

               Home phototherapy devices                                         1   2   3   NA

               Continuous passive motion devices                                 1   2   3   NA

               Others                                                            1   2   3   NA

       Documentation - Able to provide/demonstrate thorough knowledge of:

               Client Visit Reports                                              1   2   3   NA

               Authorization forms                                               1   2   3   NA

               Purchase orders                                                   1   2   3   NA

               Equipment Maintenance Log                                         1   2   3   NA

Reference #8025 DME
ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - DME DRIVER/SERVICE
TECHNICIAN (continued)

               Delivery invoices                                                   1   2   3   NA

               Vehicle Files                                                       1   2   3   NA

       Demonstrates competency in the knowledge of the delivery of client care     1   2   3   NA
        in an environment that optimizes client safety and reduces the likelihood
        of medical/health care errors.

       Demonstrates the knowledge of proper identification and reporting of        1   2   3   NA
        medical/health care errors. Protects the client in the event of a
        medical/health care error and, as appropriate, assists in medical/health
        care error resolution.

       Company Environment - Able to locate and/or demonstrate knowledge of:

               Physician directory                                                 1   2   3   NA

               Company directory                                                   1   2   3   NA

               Home Health Agency directory                                        1   2   3   NA

               New orders to be completed each day                                 1   2   3   NA

               HME and respiratory equipment                                       1   2   3   NA

               Forms to be completed for each home visit                           1   2   3   NA

               Office Equipment:

                      Telephone system                                             1   2   3   NA

                      Beeper system                                                1   2   3   NA

                      Computer system                                              1   2   3   NA

                      Fax machine                                                  1   2   3   NA

                      Copy machine                                                 1   2   3   NA

                      Other                                                        1   2   3   NA

               Vehicles:

                      Safety checks                                                1   2   3   NA

                      Safety procedures                                            1   2   3   NA

                      Preventive maintenance                                       1   2   3   NA

                      Other                                                        1   2   3   NA


Reference #8025 DME
ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - DME DRIVER/SERVICE
TECHNICIAN (continued)

                       Demonstrates the ability to pack the delivery truck safely   1   2   3   NA
                        and efficiently.

               Fire Equipment:

                       Alarms                                                       1   2   3   NA

                       Fire extinguishers                                           1   2   3   NA

                       Exit doors                                                   1   2   3   NA

       Company Organization - Able to describe roles and functions of:

               Operations Manager                                                   1   2   3   NA

               Warehouse Supervisor                                                 1   2   3   NA

               Customer Service Supervisor/Representatives                          1   2   3   NA

               Receptionist                                                         1   2   3   NA

               Marketing Representative                                             1   2   3   NA

               Respiratory Care Supervisor                                          1   2   3   NA

               Billing Collection Coordinator                                       1   2   3   NA

       Company Resources - Able to locate and demonstrate the use of:

               Company Policy and Procedure Manual                                  1   2   3   NA

               Corporate Compliance Policy and Procedure Manual                     1   2   3   NA

               Safety Manual                                                        1   2   3   NA

               Fire/Emergency Management Manual                                     1   2   3   NA

               Material Safety Data Sheets (MSDS) Manual                            1   2   3   NA

               US Department of Transportation and Food and Drug                    1   2   3   NA
                Administration Regulations - Guidelines

               Specific Reference Materials                                         1   2   3   NA

               Client Teaching Manual                                               1   2   3   NA

               PI Documentation                                                     1   2   3   NA

               Other                                                                1   2   3   NA

       Routines - Able to describe, locate and/or demonstrate knowledge of:

Reference #8025 DME
ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - DME DRIVER/SERVICE
TECHNICIAN (continued)

               Communication System:

                      Bulletin boards                   1   2      3   NA

                      Logbooks                          1   2      3   NA

                      Delivery schedule                 1   2      3   NA

                      Meeting minutes                   1   2      3   NA

                      Ordering supplies                 1   2      3   NA

       Cultural Factors:

               Religion                                 1   2      3   NA

               Food preferences                         1   2      3   NA

               Family/community services                1   2      3   NA

               Healthcare attitudes/understanding       1   2      3   NA

               Trust/privacy needs                      1   2      3   NA

               Socioeconomic environment                1   2      3   NA




Reference #8025 DME
ANNUAL COMPETENCY CLINICAL SKILLS ASSESSMENT - DME DRIVER/SERVICE
TECHNICIAN (continued)

Total of Score #3s: __________
Total of Score #2s: __________
Total of Score #1s: __________

Identified Areas that Require Improvement:




Comments:




Name:                                        Title:


Date:




Signature of Supervisor:




Signature of Staff Member:




Reference #8025 DME

								
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