Phenazine Ph Training Competency - Mass General Hospital
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1
2Accutest® pH Training and Competency Assessment Record¹
Learning Assessment/Test
Individual Information
Skills Training and Evaluation
(At the completion of training session, the trainee should be able
1. After you apply the specimen to the paper, how long
to complete these tasks and successfully conduct Nitrazine pH
should you wait to read the color change?
testing)
Name: ______________________________
a)
Immediately
Met*
Unmet
Employee ID#: _______________________
1. Describes purpose of test
b)
1-2 minutes
c)
3-5 minutes
2. Demonstrates hand hygiene protocol
Care Unit: ______________________
d)
at least 10 minutes
and wears gloves
3. Describes proper sample collection and
Accutest®
Date of Training:
2.
paper pH is used to definitively diagnose
application procedure
______________________
4. Examines the Accutest® paper for color
bacterial vaginosis.
change as soon as sample is applied.
5. Describes normal/abnormal and
True
False
Midwife
negative/positive results for vaginal fluid
Nurse Practitioner
and amniotic fluid, respectively.
Accutest®
MD
3.
paper can be touched to the vaginal wall
6. Understands proper reagent storage.
RN
(dispenser stays in box)
to obtain the sample.
7. Records the results in the appropriate
log or record.
True
False
Other: __________________________
8. States institution policy for running
Quality Control.
4. Quality Control must be run:
Training Status:
9. Successfully performs Quality Control
using the appropriate buffer solutions.
a)
when a new roll is opened
10. Documents Quality Control results
New/Initial
b)
once per week
along with lot numbers, expiration
c)
if the provider questions the results
dates, initials, for all reagents.
Recertification
d)
Both A and C
* All skills parameters must be “met” in order to become an
authorized user of this product.
Accutest®
5.
testing is highly sensitive but not very
specific.
True
False
___________________________
Trainer Signature
Accutest®
(
Trainer signature indicates trainee has successfully
6.
paper has no expiration date and can be
completed the program and scored 80% or better on
used indefinitely, unless it gets wet.
the quiz)
False
True
1
Retain as part of permanent record
SCORE: _______________________________
(Passing = 80% or higher)
Title (with LTR): Phenazine pH Test Training and Competency Assessment Record (LTR21358)
Revised: 11/21/2014 4:05:52 PM
1
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