Competency Assessment Form
2 Pages
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Page 1
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Name:
Ward:
Date:
Hospital/Department: Having completed this assessment, users will be able to demonstrate competency with the equipment to ensure correct application. Performance Criteria
Attained
Deferred Date
Describe clinical application for the equipment Identify key components: ON/OFF switch Volume Control Headphone Socket Battery Low Indicator Probe Battery Compartment Speaker LCD Display Demonstrate and perform: Removal/Storage of Probe Remove and replace battery Using the headphones (Option) Demonstrate how to determine best probe position with increasing gestational age Demonstrate how to apply gel to the patient/probe Demonstrate how to hold the probe on the skin and adjust for optimum signal Demonstrate different sounds which maybe detected: Umbilical cord flow sounds Fetal heart sounds Placental sounds Maternal
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Signature of Assessor
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Performance Criteria
Attained
Deferred Date
Signature of Assessor
Demonstrate understanding of displayed FHR Demonstrate understanding of potential for false/invalid FHR rates Demonstrate how best to avoid false / invalid rates Indicate why the unit may switch off automatically When used continuously When left on Show how the unit should be cleaned and stored after use Indicate the most fragile part of the probe and why it should not be dropped
Signature of Assessor:
Date:
Signature of Participant:
Date:
Sept 2010 Issue 1
Re-assessment Date:
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