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    3+3+1 Accomplisment Requirements 3-Day Basic Intravenous Therapy Training Program For Nurses

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    jp_sure
    This document outlines the requirements for Janice S. Domingo's 3-day basic intravenous therapy training program. It includes tables documenting her initiation and maintenance of peripheral IV infusions on three patients, administration of intravenous drugs to three patients, and administration and maintenance of blood and blood components to one patient. All procedures were performed under the supervision of certified trainer Zenaida Riboroso and took place at Baguio General Hospital and Medical Center from December 3-5, 2011. The document was submitted by Janice S. Domingo on February 22, 2011 and received and approved by the named nurses.

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    3+3+1 Accomplisment Requirements 3-Day Basic Intravenous Therapy Training Program For Nurses

    Uploaded by

    jp_sure
    39 views3 pages
    This document outlines the requirements for Janice S. Domingo's 3-day basic intravenous therapy training program. It includes tables documenting her initiation and maintenance of peripheral IV infusions on three patients, administration of intravenous drugs to three patients, and administration and maintenance of blood and blood components to one patient. All procedures were performed under the supervision of certified trainer Zenaida Riboroso and took place at Baguio General Hospital and Medical Center from December 3-5, 2011. The document was submitted by Janice S. Domingo on February 22, 2011 and received and approved by the named nurses.

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    82436527-IVT-Form (1)

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    This document outlines the requirements for Janice S. Domingo's 3-day basic intravenous therapy training program. It includes tables documenting her initiation and maintenance of peripheral IV infusions on three patients, administration of intravenous drugs to three patients, and administration and maintenance of blood and blood components to one patient. All procedures were performed under the supervision of certified trainer Zenaida Riboroso and took place at Baguio General Hospital and Medical Center from December 3-5, 2011. The document was submitted by Janice S. Domingo on February 22, 2011 and received and approved by the named nurses.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    39 views3 pages

    3+3+1 Accomplisment Requirements 3-Day Basic Intravenous Therapy Training Program For Nurses

    Uploaded by

    jp_sure
    This document outlines the requirements for Janice S. Domingo's 3-day basic intravenous therapy training program. It includes tables documenting her initiation and maintenance of peripheral IV infusions on three patients, administration of intravenous drugs to three patients, and administration and maintenance of blood and blood components to one patient. All procedures were performed under the supervision of certified trainer Zenaida Riboroso and took place at Baguio General Hospital and Medical Center from December 3-5, 2011. The document was submitted by Janice S. Domingo on February 22, 2011 and received and approved by the named nurses.

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    IVT Form

    3+3+1 ACCOMPLISMENT REQUIREMENTS


    3-DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES
    Name of Registered Nurse: DOMINGO, 1ANICE S. PRC Number:
    0696478
    Name of Hospital Offering IV Training: BAGUIO GENERAL HOSPITAL and MEDICAL CENTER Provider No.: 028
    Date of IV Training Program Attended: December 3-5 2011 Venue: BGHMC Auditorium

    I. Initiating Maintaining Peripheral IV Infusion
    Patient
    No.
    Name of Patient Age Date Time
    Kind of
    Infusion
    Site
    Type of
    Cannula
    Dose Rate
    Signature over Printed name
    of Certified Trainer/Preceptor
    License
    No.
    55473 Torres,1esie 48 December 28, 2011 10am 0.9 Sodium
    Chloride
    Solution
    Left Metacarpal
    Vein
    Introcan G20 1LiterX
    16 Hours
    16 drops/minute Zenaida Riboroso RN,MAN 62560
    445235 Agpawan,Samuel 79 December 28, 2011 1pm Dextrose 5
    in Water
    Left Metacarpal
    Vein
    Introcan G22 500LiterX
    KVO
    10 drops/minute Zenaida Riboroso RN,MAN 62560
    043903 Banawan,Francis 54 December 28, 2011 5pm 0.9 Sodium
    Chloride
    Solution
    Left Metacarpal
    Vein
    Introcan G22 1LiterX
    KVO
    10 drops/minute Zenaida Riboroso RN,MAN 62560

    II. Administering Intravenous Drugs
    Patient
    No.
    Name of Patient
    Age Date Time
    Kind of
    Infusion
    Site
    Type of
    Cannula
    Dose Rate
    Signature over Printed name
    of Certified Trainer/Preceptor
    License
    No.
    327324 Tachado,Editha 68 December 28, 2011 8am Sulbactam-
    Ampicillin
    Left Metacarpal
    Vein
    Introcan G20 1.5gm/ml
    every 8
    hours
    20 drops/minute
    Zenaida Riboroso RN,MAN
    62560
    558412 Cirineo,Desiree 39 December 28, 2011 12pm Mannitol Right Metacarpal
    Vein
    Introcan G24 200ml every
    4 hours
    31 drops/minute
    Zenaida Riboroso RN,MAN
    62560
    593007 Hermenora,Petra 76 December 28, 2011 12pm Piperacillin+
    Tazobactam
    Right Metacarpal
    Vein
    Introcan G22 2.25gm/ml
    every 6
    hours
    20 drops/minute Zenaida Riboroso RN,MAN 62560
    III. Administering and Maintaining Blood and Blood Components
    Patient
    No.
    Name of Patient
    Age Date Time
    Kind of
    Infusion
    Site
    Type of
    Cannula
    Dose Rate
    Signature over Printed name
    of Certified Trainer/Preceptor
    License
    No.
    485857 Andres, Decela 27 December 28,2011 2pm Type ~O(+)
    Fresh Frozen
    Plasma
    Left Metacarpal
    Vein
    Introcan G18 250ml 30 drops/minute Zenaida Riboroso RN,MAN 62560
    Submitted by: DOMINGO,1ANICE S. Date Submitted: February 22, 2011 Received by: 1ovita E. Pajarillo RN, MAN Approved by: Elena Tampican RN,MAN
    IVT Form
    3+3+1 ACCOMPLISMENT REQUIREMENTS
    3-DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES
    Name of Registered Nurse: DOMINGO, 1ANICE S. PRC Number:0696478
    Name of Hospital Offering IV Training: BAGUIO GENERAL HOSPITAL and MEDICAL CENTER Provider No.: 028
    Date of IV Training Program Attended: December 3-5 2011 Venue: BGHMC Auditorium

    I. Initiating Maintaining Peripheral IV Infusion
    Patient
    No.
    Name of Patient Age Date Time
    Kind of
    Infusion
    Site
    Type of
    Cannula
    Dose Rate
    Signature over Printed name of Certified
    Trainer/Preceptor
    55473 Torres,1esie 48 December 28, 2011 10am 0.9 Sodium
    Chloride
    Solution
    Left Metacarpal
    Vein
    Introcan G20 1LiterX
    16 Hours
    16 drops/minute Zenaida Riboroso RN,MAN
    62560
    445235 Agpawan,Samuel 79 December 28, 2011 1pm Dextrose 5
    in Water
    Left Metacarpal
    Vein
    Introcan G22 500LiterX
    KVO
    10 drops/minute Zenaida Riboroso RN,MAN
    62560
    043903 Banawan,Francis 54 December 28, 2011 5pm 0.9 Sodium
    Chloride
    Solution
    Left Metacarpal
    Vein
    Introcan G22 1LiterX
    KVO
    10 drops/minute Zenaida Riboroso RN,MAN
    62560

    II. Administering Intravenous Drugs
    Patient
    No.
    Name of Patient
    Age Date Time
    Kind of
    Infusion
    Site
    Type of
    Cannula
    Dose Rate
    Signature over Printed name of Certified
    Trainer/Preceptor
    327324 Tachado,Editha 68 December 28, 2011 8am Sulbactam-
    Ampicillin
    Left Metacarpal
    Vein
    Introcan G20 1.5gm/ml
    every 8
    hours
    20 drops/minute
    Zenaida Riboroso RN,MAN
    62560
    558412 Cirineo,Desiree 39 December 28, 2011 12pm Mannitol Right Metacarpal
    Vein
    Introcan G24 200ml every
    4 hours
    31 drops/minute Zenaida Riboroso RN,MAN
    62560
    593007 Hermenora,Petra 76 December 28, 2011 12pm Piperacillin+
    Tazobactam
    Right Metacarpal
    Vein
    Introcan G22 2.25gm/ml
    every 6
    hours
    20 drops/minute Zenaida Riboroso RN,MAN
    62560
    III. Administering and Maintaining Blood and Blood Components
    Patient
    No.
    Name of Patient
    Age Date Time
    Kind of
    Infusion
    Site
    Type of
    Cannula
    Dose Rate
    Signature over Printed name of Certified
    Trainer/Preceptor
    485857 Andres, Decela 27 December 28,2011 2pm Type ~O(+)
    Fresh Frozen
    Plasma
    Left Metacarpal
    Vein
    Introcan G18 250ml 30 drops/minute Zenaida Riboroso RN,MAN
    62560
    Submitted by: DOMINGO,1ANICE S. Date Submitted: February 22, 2011 Received by: 1ovita E. Pajarillo RN, MAN Approved by: Elena Tampican RN,MAN

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