DreamStation CPAP, CPAP Pro and Auto CPAP

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DreamStation CPAP, CPAP Pro and Auto CPAP Homecare provider competency check-list

Just the essentials

Full-featured flexibility

Assessed:_____________________________________ Assessor:______________________________________ Date:___________ Goals Principles of operation

Date goals met

1. Describe the intended use of the device: n Designated patient populations n Describe appropriate delivery environments

2. Explain the purpose of each: n CPAP mode n SmartRamp n C-Flex n C-Flex+ n Auto mode n A-Flex

n Opti-Start n EZ-Start n CPAP-Check n Auto-Trial

Setup and operation

1. Identify the circuit components of the DreamStation system: n 6’ tubing n Power supply n Optional bacterial filter n Ultra-fine and pollen filters n Modular humidifier 2. Demonstrate assembly of device with filters, power supply, and patient circuit including the set-up and adjustment of the humidifier. 3. Demonstrate the steps to access and utilize the Provider Mode screen. n Power the device n Configure device to access the Provider Mode screen n Demonstrate mode selection n Demonstrate setting selections n Set a prescribed graduated ramp

Assessor

Goals The clinician will be able to:

Date goals met

Assessor

4. Demonstrate how to utilize the provider mode to verify compliance. Specifics:

n VIC n AHI n Phone-in n Days>4

n Blower hours n System leak n Periodic breathing

5. Demonstrate steps to adjust Patient settings. n Power the device n Set-up and change device settings n View patient information n Adjustment of flex settings n Adjust humidification 6. Describe the various methods of obtaining data from the device. 8. Describe the method and issues involved with adding supplemental oxygen. Alert conditions and troubleshooting

1. Demonstrate understanding of device alarms/alerts, including possible causes, and corrective action. Cleaning and care Specific alarms/alerts: n Service required n SD card n Modem n Patient reminder Cleaning and care

1. Demonstrate the method of cleaning the device, interface, and replacement of the filters. Assessed signature______________________________________Assessor signature ______________________________________

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CAUTION: US federal law restricts these devices to sale by or on the order of a physician. e-doc Clay Com TC 7/19/16 MCI 4107614

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