ACT (Activated Clotting Time)
Instrument name: Hemochron Response     Tubes: FTCA510, P210

 AFTER TAKING ONLINE TEST AND READING THE POLICY, EMPLOYEE PERFORMS A TEST AND  MARKS RESULTS BELOW.  THE PRECEPTOR OR TSM GRADES RESULTS FOR ACCURACY. 

1. Has read entire Policy/Procedure prior to competency check-off.
2. Has scored 100% on written (below) or online competency test
3. Direct observation by preceptor (return demonstration, complete. Results documented below)

 TEST SCORE 0
Test taken on: 5/23/2013

CRITICAL POINTS

OPERATOR INITIALS

Understands specimen collection  (indwelling venous,  central venous, arterial blood line, pre-oxygenator port, AV Fistula, PTEE graft) and handling of whole blood. 

States reasons for sample rejection as in contamination with

·         Tissue thromboplastin

·         IV solutions

·         Alcohol

·         Visible clots

Interfering substances:

·         Aprotinin

Familiar with handling and storage of tubes and liquid controls

States purpose of performing QC, the requirements (when to run QC) and procedure to run QC (include both electronic and liquid controls).

Performs patient test correctly.

Demonstrates proficiency in reading results.

Knows action required for critical values per test site protocol.

Reports and documents results appropriately.

Describes maintenance & cleaning (incl. documentation) and temperature verification.

9. Documentation of ACT test result : Patient Comparison    Liquid QC
                                                                     (circle one)

ACT result:
Target:             
%  difference =

o Pass o Fail 

Validator:___________