Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 0 = No Experience / Observed Only
  • 1 = Limited Experience / Rarely Done (<6 times/year)
  • 2 = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 3 = Experienced / Frequently Done (daily or weekly)
  • AGE OF PATIENTS CARED FOR
    Newborn/Neonate (birth to 30 days)
    Infant (31 days to 12 months)
    Toddler/Preschool (13 months to 5 years)
    School Age Child/adolescent (6 years to 18 years)
    Young Adults/Middle Adult (19 years to 64 years)
    Older Adults/Elderly (65+ years)
    GENERAL KNOWLEDGE
    Proper identification of patient using at least 2 identifiers
    Proper identification/labeling of all lab or specimen results
    Pre-procedural time-out process
    Demonstrate application of all monitoring devices
    Understanding of scope of practice and limitations as a certified anesthesia technician
    Prioritize tasks related to role and function
    Delegating responsibilities to other team members of anesthesia team
    Knowledge of professional standards to uphold patient rights and confidentiality
    Knowledge of "Do Not Use Abbreviations"
    Do you have charge/supervisor experience?
    Knowledge of current Joint Commission National Patient Safety Goals
    Knowledge/familiarity with HCAHPS scores
    Basic life support
    Purpose, use and care of physiological monitors relating to the administration of anesthesia
    Biologic hazards, infection control, and standard precautions
    Fire, electrical, laser and explosion hazards in the operating room and other anesthesia related areas
    Storage, use and safe handling of bulk and cylinder gases
    Structure, function and care of all components of anesthesia delivery systems
    Sterile technique and the principals of aseptic practice
    Usage of common anesthetic gases
    Type and indications for local, monitored anesthesia care (MAC), regional and general anesthesia
    Assists the licensed anesthesia providers in various settings
    Performs duties under the direct supervision of a licensed anesthesia provider and/or Registered Nurse (RN)
    Provides support for routine surgical cases by assisting in the preparation and maintenance of patient equipment and anesthesia delivery systems before, during and after anesthesia
    Performs first level maintenance on anesthesia equipment
    Cleans, sterilizes, disinfects, stocks, orders and maintains the routine anesthesia equipment and supplies
    Principles of purchasing and supply levels
    Communication skills
    Ability to troubleshoot delivery systems, monitors, and ancillary devices
    Participate in Quality Assurance
    Maintain quality control records for anesthesia department
    Use of electronic medical record charting
    Participate in continuing education development for the certified anesthesia technician
    Implement safety procedures and guidelines for fire safety and infection control
    IV Pumps
    Other IV Pumps: