POCT Competency Assessment
 UA DIP (Multistix)

, Score: 0%, must retake test. Scroll down for missed test question numbers

Name:  

Date:

Emp ID:

Clinic / Unit:
TSM Name:

Preceptor(s):

CERT EXPIRES: 

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

Competency Assessment:
      1.  Read entire Policy/Procedure
     2.  Complete and pass written test (Passing criteria is 100%)
     3.  Direct observation by preceptor (return demonstration, complete )

TEST SCORE 0

Test taken on: 6/19/2013

 CRITICAL POINTS FROM POLICY AND PROCEDURE

 OPERATOR INITIALS BELOW

a. Sample Application:  Mix specimen 10 times by inversion if allowed to settle; dip and remove immediately from container; blot excess urine.

 

b. Interpretation of Results:  Match reagent pads to appropriate areas on key - handle side up; begin reading after 60 seconds have elapsed; leukocytes may be read up to 120 seconds.

 

c. Quality Control: Two levels of quality control are performed and documented weekly.

 

d. Storage Requirements: UA strip vials must remain closed until ready to use; urine must be examined within 1 hour of collection.

 

SAMPLE # _______           RESULTS: (check appropriate boxes) 

Specific Gravity

   □             □             □             □             □             □             □
1.000        1.005        1.010        1.015        1.020        1.025        1.030

pH

   □             □             □             □             □  
   5               6              7              8              9

Leukocytes

   □             □             □             □       
   Neg       Trace          +             ++

Nitrite

   □             □      
   Neg       Pos

Protein

   □             □             □             □             □       
   Neg         Trace         +             ++          +++
                                   30            100           500 mg/dL

Glucose

   □             □             □             □             □             □         
  Norm         50            100           250           500         1000 mg/dL

Ketones

   □             □             □             □          
  Neg            +             ++            +++
                 small          mod          large

Urobininogen

   □             □             □             □             □          
 Norm           1              4              8             12 mg/dL

Bilirubin

   □             □             □             □        
  Neg            +             ++            +++ 

Blood

   □             □             □             □          
  Neg          trace       about 50    about 250 Ery/uL

 

 

o Pass o Fail 
Validator:_______________
 
If your Score is NOT 100%, missed test question numbers follow: 1, 2, 3, 4, 5,

Please Print this page and bring to check offs. Passing Score is 100%

To Online Tests  

    To POCT Homepage

This application requires INTERNET EXPLORER. Application will not work properly with NETSCAPE.

  Online Test Application designed and developed by D. R. DeHoyos BSMT (ASCP)
at the University of Texas Medical Branch