<p> Philips MRX HeartStart™ Defibrillator Competency Verification Record University of Virginia Health System</p><p>Employee Name: Employee ID #: _____ Date: ______</p><p>Note: This Competency Verification Record is not a required part of the permanent personnel record. This form is to be used as a guide for competency check off only; the Annual Competency Record is used to document competency. (If competency validation occurs away from the unit, this form can be completed by the validator; the signed form can then be presented to the unit NEC or manager as evidence of competency. The Annual Competency Record is then signed indicating that the competency was validated).</p><p>Evaluator’s Demonstrated Skills: Initials SECTION ONE: USE OF MRX™ DEFIBRILLATOR A. Identifies device readiness (hourglass, cables, charging indicator, check expiration of monitoring electrodes and defib pads) B. Applies pads correctly C. Sets machine for AED D. Sets machine for manual defibrillation E. Disarms an energy load F. Sets machine for cardiac monitoring G. Demonstrates audio pause and all alarms pause H. Sets machine for cardioversion I. Sets machine for pacing ------J. *Demonstrates when and how to complete a weekly device check (nurses or other licensed staff with this responsibility only) K *Identifies capnography capable machine (yellow handle and luggage tag) L *Identifies capnograpy filter and demonstrates attaching to capnography port on MRx </p><p>SECTION TWO: STAFF WITH PEDIATRIC RESPONSIBILITY A. Locates pediatric pads B. Uses therapy cable connector with adaptor to attach pads for neonatal patients C. Adjusts MRx into pediatric mode D. Sets therapy knob to 1-10 joules and adjusts to desired joules SECTION THREE: STAFF WITH INTERNAL PADDLE RESPONSIBILITY A. Locates therapy cable port B. Plugs in internal paddles C. Verbalizes that paddles will only deliver 50 joules regardless of setting *TRAINING ONLY* SECTION FOUR: STAFF USING THE FRx™ AED FOR PATIENT TRANSPORT  Complete on-line CBL entitled “Philips Defibrillator AED Function Training – FRx and MRx”; no competency assessment needed</p><p>Competency Verified by:</p><p>Date: Evaluator’s Name (printed) Evaluator’s signature</p><p>Subject matter expert: Kostas Alibertis Page 1 of 1 Revised: 21 April 2015</p>