Competency State-
ment
(Neo Puff)
High Risk Device – STOP!
Do not use this item unless you are competent to do so
Surname Forename(s)
Title (Mr/Mrs/Miss/Dr etc) Personal Number
Job Title/Designation
Dept/Directorate & Ward/Unit Extension:
Self-verification of competence is undertaken by assessment against the following statements:
These statements are designed to indicate competence to use this device. Responsibility for use remains with the user, so if you are
in any doubt regarding your competence to use the device, you should seek education to bring about improvement. Various methods
including self directed learning, coaching & formal training my be initiated (Consider local resources, product operation manual, the In -
tranet [Link] & discussion with colleagues or the Medical Devices
Trainer)
Carry out an initial assessment. You must be able to answer all the questions correctly before considering yourself to be competent.
If you are not competent, instigate learning & then repeat self verification.
Following completion of this assessment the participant will be able to demonstrate competence of both clinical and theoretical know-
ledge regarding the use of the NEO PUFF.
Performance Criteria Evaluation Method Date Assessors Signa-
Discussion/Demon- ture
stration
1. State the Clinical applications of the Discussion
Neo Puff
2. Identify the items required to set up Discussion / Observa-
the system tion
[Link] Calibration label sealed, and Direct observation
then demonstrate the ability to attach
the Neo Puff to gas supply and test its
function using test lung and recommen-
ded O2 flow
4. Demonstrate correct technique for Discussion/ direct ob-
setting both PIP and PEEP servation
[Link] correct technique for at- Direct observation
taching mask / ETT to Neo puff T piece,
for use in the clinical setting
6. Demonstrate cleaning and storage Direct observation
Statement: Having answered all the questions above correctly and taken into account my per-
sonal assessment of my competence with the product, I declare that:
I am competent to use this product without further training
Signed: Print Name: Date:
OR I require further training before I can use this product in a competent manner
Signed: Print Name: Date:
Melanie McAteer Clinical Development Nurse 2010
1
Indicate how you plan to meet your learning needs:
Keep this form in your personal portfolio or training record. Ensure that your manager has seen the form and
entered details of your competence in their records
Melanie McAteer Clinical Development Nurse 2010
1