D.3 Ventilator Caregiver Checklist.docx
DOCX document 18 KB Posted
- Attached to
- Q201--FY26 Miami Home Oxygen Service
- Solicitation number
- 36C24825Q0568
About this file
The document is a Ventilator/Caregiver Competency Checklist that details a comprehensive training guide for operating a Trilogy ventilator. The checklist covers 12 key learning objectives, including understanding ventilator controls, connecting power sources, assembling patient circuits, navigating monitoring screens, managing alarms, and reviewing maintenance and emergency procedures. The document provides a detailed breakdown of front, rear, and side panel components, with specific instructions for clinicians to verify a caregiver's proficiency in ventilator operation and patient care.
This checklist appears related to the VA's Home Oxygen Services solicitation (Solicitation Number: 36C24825Q0568) for the Miami VA Healthcare System. The solicitation is a set-aside for Service Disabled Veterans Owned Small Businesses, covering home oxygen services in Broward, Dade, and Monroe Counties. The contract will be an Indefinite Delivery Contract with a base 12-month period and four 12-month option periods. The primary NAICS code is 621610 (Home Health Care Services), with a $19 million size standard. Key dates include a request for information deadline of 06/30/2025 and a quote submission deadline of 07/07/2025.
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Text version
1.0 VENTILATOR/CAREGIVER CHECKLIST
STATION NAME:
Vendor being surveyed: _______________________________
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 .