Attachment 4 - Ventilator_Caregiver Checklist.docx
DOCX document 18 KB Posted
- Attached to
- 6515--VACHCS Home Oxygen Delivery Federal contract opportunity
- Solicitation number
- 36C24822R0033
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24822R0033 0003.docx | DOCX document | |
| 36C24822R0033 0002.docx | DOCX document | |
| Attachment 1 - PAST PERFORMANCE QUESTIONNAIRE (Orlando).docx | DOCX document | |
| 36C24822R0033 0001.docx | DOCX document | |
| 36C24822R0033_Revised.pdf | ||
| 36C24822R0033.pdf | ||
| Attachment 1 - PAST PERFORMANCE QUESTIONNAIRE.docx | DOCX document | |
| Attachment 3 - PATIENT SATISFACTION SURVEY.docx | DOCX document | |
| Attachment 2 - PATIENT RIGHTS AND RESPONSIBILITIES.docx | DOCX document | |
| Attachment 5 -Quality Assurance Surveillance Plan.docx | DOCX document |
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Text version
1.0 VENTILATOR/CAREGIVER CHECKLIST
STATION NAME:
Vendor being surveyed: _______________________________
TRILOGY 100 VENTILATOR/CAREGIVER COMPETENCY CHECKLIST
CLINICIAN/INSTRUCTOR:
| VETERANS NAME (LAST 4 SSN) |
| CAREGIVER NAME: |
GOALS
DATE GOALS
MET
The caregiver will be able to:
1. Understand basic instructions for ventilator usage
2. Explain the buttons, indicators, and/or connectors on the front, rear, and side panels of Trilogy.
Front Panel:
| Start/stop button |
| Audio pause button |
| Up, down button |
| Left, right button |
| A/C power LED |
| Backlight LED |
| Red Alarm LED |
| Yellow Alarm LED |
Rear and Side Panel:
| A/C power inlet |
| Breathing circuit connection |
| Exhalation port |
| SD data card slot |
| Serial connector |
| Remote alarm |
| Ethernet connector |
| External battery connector |
| O2 connector |
| Air inlet and filter |
| Detachable battery slot |
| Cord retainer |
3. Connect to A/C power.
4. Attach 02 source and discuss 02 safety
5. Assemble and Connect
Patient circuit
Filter
Exhalation device
Tubing
Patient connector (swirl or flex)
Humidifier (if ordered)
6. Turn ventilator on and off.
7. Access monitoring screens
Describe view off
Top monitor panel
Middle date/time panel
Bottom status panel
Detailed View
Top monitor panel
Middle measured settings panel
Bottom status panel
8. Navigate the Menu Screens
Switch to secondary settings
Safely remove the SD card
My Settings
Options
Alarm log
Information
9. Locate and explain alarm messages and alarm indicators (audio and visual).
Explain the Audio Pause feature
Understands what to do when an alarm occurs
10. Connect to D/C power and explain power source indicators.
External battery
Detachable battery pack
Internal battery
11. Review care, cleaning, and maintenance of ventilator and accessories.
12. Review emergency procedures.
| Caregiver Signature - |
| Clinician Signature - |
File details come from the government source that posted it. Updated .