/depts/,/depts/uwhealth/,/depts/uwhealth/ambulatory-education/,/depts/uwhealth/ambulatory-education/ambulatory-orientation/,/depts/uwhealth/ambulatory-education/ambulatory-orientation/checklists/,/depts/uwhealth/ambulatory-education/ambulatory-orientation/checklists/resources/,

/depts/uwhealth/ambulatory-education/ambulatory-orientation/checklists/resources/DHC-Endoscopy-Tech-Checklist-182018.pdf

20180116

page

100

UWHC,UWMF,

Learning and Development,

Departments & Programs,UW Health,Ambulatory Education,Ambulatory Orientation,Checklists - Core and Department Specific,Resources

DHC Endoscopy Tech

DHC Endoscopy Tech - Departments & Programs, UW Health, Ambulatory Education, Ambulatory Orientation, Checklists - Core and Department Specific, Resources


Digestive Health Center
Endoscopy Tech Orientation Checklist Name: ________________________________________
Performance Criteria
Method of
Validation
(RD/V/NA)
Requires
assistance/
coaching
Performs w/
minimal
assist
Performs
independen
tly Comments & Examples
0 1 2 General
Completes Building Tour and Endoscopy
Scavenger Hunt
Reviews DHC Internal Disaster
Procedures: DHC Emergency Binder
Policy 4.09 Medical Emergency at DHC
Completes ProVation program computer
training within first week of orientation
Verbalizes knowledge of HIPAA &
consistently complies to ensure patient
confidentiality
Demonstrates ability to assist with
patient throughput during shift
(collaborative teamwork)
Demonstrates ability to assist with
opening & closing duties
Equipment & General Skills
Identifies location of emergency cart
Demonstrates knowledge of/ability to
stock patient rooms appropriately
Self Assessment
2 = Knowledgable/has
experience 1 = Limited
knowledge/experience 0 =
no knowledge/experience
RD = Return demonstration/Documentation
review V = Verbalizes understanding NA = Not
applicable
Validation of Competency - Trainer Initials/Date
Page 1 JLH/12-2016

Digestive Health Center
Endoscopy Tech Orientation Checklist Name: ________________________________________
Performance Criteria
Method of
Validation
(RD/V/NA)
Requires
assistance/
coaching
Performs w/
minimal
assist
Performs
independen
tly Comments & ExamplesSelf Assessment
Demonstrates ability to turn over patient
room & prepare for a new pt
Demonstrates correct application/use of
oxygen set ups, including nasal cannula,
face mask, NRB
Demonstrates ability to correctly apply
bedside monitoring equipment (skin prep
with lead placement, correct size BP cuff,
pulse oximeter)
Verbalizes knowledge of/demonstrates
correct use of isolation:
rooms/signs/equipment/PPE
Demonstrates ability to document
VS/data validate in HL
Demonstrates knowledge of/ability to
assess pain and document
Demonstrates knowledge of normal VS
and correct "when to call RN/MD"
parameters
Demonstrates knowledge of
interventions & patient positioning for
management of nausea/vomiting
Verbalizes understanding of various
bowel prep regimes, dietary restrictions,
NPO requirements
(PEG/SUPREP/Moviprep, etc)
Page 2 JLH/12-2016

Digestive Health Center
Endoscopy Tech Orientation Checklist Name: ________________________________________
Performance Criteria
Method of
Validation
(RD/V/NA)
Requires
assistance/
coaching
Performs w/
minimal
assist
Performs
independen
tly Comments & ExamplesSelf Assessment
Check in/Prep Phase of Care
Workflow
AM Daily pod checklist completed
Consistently greets patient/driver in
professional manner
Verifies patient identity with 2 patient
identifiers every time
Escort patient from waiting room.
Document in "events" that pt is in prep
Introduce self and role. Provides clear
instructions on changing clothes, closet,
plan of care expectations.
Record name and phone # of driver on
clipboard
Consistently identifies & confirms driver
for patient
Make sure labels on clipboard match
wristband using two pt identifiers
Check preferred language of patient
Label consent form and fill out
Offer use of bathroom before rooming &
beginning prep
Page 3 JLH/12-2016

Digestive Health Center
Endoscopy Tech Orientation Checklist Name: ________________________________________
Performance Criteria
Method of
Validation
(RD/V/NA)
Requires
assistance/
coaching
Performs w/
minimal
assist
Performs
independen
tly Comments & ExamplesSelf Assessment
Verify procedure & doctor. Notify patient
of any delays
Assist pt with changing into gown if
needed. Tell pt to open door when ready
Add self to Care Team/Visit Treatment
team
Chief complaint: Add specific GI
procedure
Check for history of pre-
diabetes/diabetes. IF present, obtain
glucometer & check blood glucose if
needed. Report result to RN.
Admit patient to GE bedside monitor
BEFORE attaching ECG leads &/or
getting VS
Obtain initial set of VS, ht/wt, pain level,
& temp (if propofol)
Complete Prep checklist
Assign PCP & referring MD in
communication management. Ask pt if
they would like additional MDs to receive
copy of the report
If an Interpreter is used, document in HL
Review allergies, medications and
medical history with patient
Page 4 JLH/12-2016

Digestive Health Center
Endoscopy Tech Orientation Checklist Name: ________________________________________
Performance Criteria
Method of
Validation
(RD/V/NA)
Requires
assistance/
coaching
Performs w/
minimal
assist
Performs
independen
tly Comments & ExamplesSelf Assessment
Callback review
Ensure that CPAP is readily available if
required (home device or DHC device)
Procedure Phase of Care
Demonstrates complete room set up
according to Procedure Room checklist
Ensures that room is stocked and all
safety equipment is in place
Demonstrates correct equipment set up
& testing for GI procedures:
colonoscopy, upper endoscopy, flexible
sigmoidoscopy; chromo
Demonstrates placing patient in proper
procedure room in Health Link
Retrieves paient from Prep room.
Connect PDM to GE monitor
Verify procedure consent has been
completed and signed appropriately
Obtain patient labels. Re-confirms right
patient/right procedure.
Enter patient information into Provation
system
Page 5 JLH/12-2016

Digestive Health Center
Endoscopy Tech Orientation Checklist Name: ________________________________________
Performance Criteria
Method of
Validation
(RD/V/NA)
Requires
assistance/
coaching
Performs w/
minimal
assist
Performs
independen
tly Comments & ExamplesSelf Assessment
Demonstrates & assists with correct
patient positioning for specific procedure
Don appropriate PPE for all procedures
every time
Notify Provider patient is ready
Participates in Time Out/Universal
Protocol with team for all procedures
Documents correctly in Provation which
scope is used for procedure
Demonstrates correct use of endoscopic
accessories to assist as needed (biopsy
forceps, balloon dilators, injections,
snares, etc)
Demonstrates knowledge of correct
media for specimens (formalin, viral
media, etc)
Demonstrates knowledge of correct
dilutions for flushable and submucosal
medications such as kenalog and botox
Demonstrate correct set up and use of
electrosurgical unit (ESU)
Page 6 JLH/12-2016

Digestive Health Center
Endoscopy Tech Orientation Checklist Name: ________________________________________
Performance Criteria
Method of
Validation
(RD/V/NA)
Requires
assistance/
coaching
Performs w/
minimal
assist
Performs
independen
tly Comments & ExamplesSelf Assessment
Prior to patient leaving the room : RN &
Tech independently verify actual
specimen in bottle; bottle and cap letter
correspond, and TWO pt identifiers on
bottle & wristband correspond with
order requisition. Procedure RN &
Procedure Tech initial the order
requisition, verifying completion of
independent checks
Ensures that NO specimens are left in
procedure room unattended. ( Joint
responsibility with RN)
Ensures that all lab specimens are
delivered to lab after 1430
Demonstrates proper handling/preparing
of used equipment, including pre-
cleaning of scope
Demonstrates complete & accurate
documentation of procedure
Demonstrates ability to complete room
"turn over" for next patient
Recovery
Meet patient in recovery room and
receive report from Procedure RN
Connect PDM to GE monitor. Obtain
initial set of VS.
Page 7 JLH/12-2016

Digestive Health Center
Endoscopy Tech Orientation Checklist Name: ________________________________________
Performance Criteria
Method of
Validation
(RD/V/NA)
Requires
assistance/
coaching
Performs w/
minimal
assist
Performs
independen
tly Comments & ExamplesSelf Assessment
If Diabetic or Pre-diabetic, check blood
glucose in Recovery. Report value to
recovery RN.
Demonstrates knowledge of 'usual'
recovery time for GI procedures
IF acceptable to patient, ask driver to
come to pt room or call for ride when
needed.
Demonstrates ability to safely escort
patient to car (wheelchair if needed or
ambulatory). Remove SC badge
wristband.
Demonstrates ability to complete "room
turnover". Caviwipes contact time = 3
minutes. Bleach wipes contact time for
iso = 5 minutes.
Competency will be reviewed during and at end of orientation in Endoscopy. Upon completion, sign/date form and return to manager.
Endo Tech Orientee: _________________________________________ Date: _____________
Endo Tech Trainer: ________________________________________ Date: _____________
CNS/Manager: ________________________________________________ Date: _____________
Page 8 JLH/12-2016