Providence Everett Medical Center

GWINNETT HOSPITAL SYSTEM ABBOTT PXP GLUCOSE METER Initial Direct Observation (DO) Competency Assessment

Objective: The employee will use appropriate equipment and follow written policies and procedures to perform a point of care (POC) patient glucose test meeting all behaviors listed below with 100% compliance.  Blood Glucose Monitoring CBL in Netlearning is required to be done annually  One successful DO POC patient glucose test is required for initial competency  Observed by trained Laboratory Staff or Unit Validator

PERFORMS INDEPENDENTLY (INITIALS) Verbalizes location of, and has reviewed the point of care policy, 701-007, Precision Glucose System Performs patient test :  Demonstrates proper standard precautions  Scans badge for operator ID  Scans patient ID from armband  Properly identifies patient  Knowledgeable about True ID  Performs proper finger stick technique  Demonstrates proper dosing of glucose test strip  Demonstrates keeping meter flat during patient testing  Records result on patients flow sheet/chart Demonstrates proper cleaning technique of meter with hospital approved wipe Demonstrates docking the meter

Blood Glucose Monitoring CBL Completion Date: ______

This verifies that:

(Name) ______EMP ID# ___DEPT ______has correctly performed a patient WB glucose test meeting all critical behaviors according to written policy

Initials and Signature of Validator: ______Date:______

File this form in the employee’s personnel file

Original Date: May 21, 2009 Revision Date: 0 2/10; 03/10, 4/10, 2/13, 2/14

FAX 678-312-3371