CPR STUDENT CLINICAL SITE Perform CPR Demonstrate the proper techniques utilized for CPR Provided preceptor with a copy of current CPR certification card *Not * If a competency is initialed as Not, it MUST be repeated to pass competency. Evaluator Signature: Date: Appendix D: On ground Option Competency Evaluation Form & Criteria
VITAL SIGNS STUDENT CLINICAL SITE *Not Obtain a respiration rate Demonstrate the proper technique for obtaining and recording a respiration rate Measure a patient s respiration by observing the patient s chest or abdomen for a 60- second period Record the number of respirations per minute Count obtained is. Is this within a normal range? YES NO Obtain a pulse rate Demonstrate the proper technique for obtaining and recording a respiration rate Measure a patient s pulse rate at the radial artery near the wrist for 60-second period Record the patient s pulse rate per minute Count obtained is. Is this within a normal range? YES NO Obtain a blood pressure Demonstrate the proper technique for obtaining and recording a blood pressure Obtain a sphygmomanometer and stethoscope Place the cuff of the sphygmomanometer on the patient s upper arm midway between the elbow and shoulder Inflate the cuff above the systolic pressure to stop blood flow to the arm With the stethoscope in place over the brachial artery in the antecubital fossa of the elbow, slowly release the cuff of the sphygmomanometer and listen for pulse tones Record the systolic reading Record the blood pressure obtained using proper nomenclature Is this within normal range? YES NO Record the diastolic reading * If a competency is initialed as Not, it MUST be repeated to pass competency. Evaluator Signature: Date: Student Signature: Date:
STERILE & ASEPTIC TECHNIQUE Open a sterile package onto a table Demonstrate the proper technique for opening a sterile package onto a table Place package on table with top flap of wrapper set to open away from yourself Open top flap and lay flat on far surface of table (by reaching around, not over) Use right hand to open right-side flap, and left hand to open left-side flap and lay flat Open fourth flap by using turned-down corner and lay flat Open a sterile package in air and deposit onto sterile field Demonstrate the proper technique for opening a sterile package and deposit content onto sterile field Hold package with top flat of wrapper set to open towards yourself Peel top flap back and drop contents onto sterile field without contamination Donning sterile gloves (open method) Demonstrate the proper technique for donning sterile gloves Open outer dust cover and open sterile packaging Open sterile flaps using proper technique Don first glove using proper sterile technique to maintain glove sterility Don second glove using proper sterile technique to maintain glove sterility Sterile gowning (self-gowning) *Not Demonstrate proper technique for sterile self-gowning Properly pick up gown by its folded edges Grasp gown at its neckband, hold at arms length, and unfold it While facing inside of gown, properly insert arms into both sleeves Direct an assistant to help you with spin technique or faster back of gown Don sterile gloves without contamination * If a competency is initialed as Not, it MUST be repeated to pass competency.
VENIPUNCTURE *Not Perform venipuncture Demonstrate the proper techniques utilized for venipuncture Assemble all needed supplies Introduce yourself to the patient Check the patient s identification and explain the procedure Apply tourniquet above the site suing sufficient tension to impede blood flow Use techniques to distend veins, if necessary Perform hand hygiene and put on disposable gloves Choose appropriate site for venipuncture and cleanse with an alcohol pad using a circular motion, starting in the center and moving out Stabilize vein Hold needle by pinching wings, bevel upward, at a 10-15 degree angle and gently advance into vein; blood "flash" indicates needle is correctly positioned Remove tourniquet Secure the needle with tape without covering the site Carefully remove the needle while applying pressure to the site with gauze Dispose of equipment properly and wash hands Document information (time, date, site, gauge) * If a competency is initialed as Not, it MUST be repeated to pass competency.
TRANSFER OF PATIENT Perform a wheelchair transfer Demonstrate the steps required for a wheelchair transfer Introduce yourself to the patient Check the patient s identification and explain the procedure Place wheelchair next to table Lock wheels Lift footrests Stand with one foot between the patient s feet Maintain good posture while helping patient up Once standing, turn and pivot patient to the table Support patient s shoulders while raising legs Ease patient to supine position Perform a gurney with sheet transfer Demonstrate the steps required for a gurney with sheet transfer Introduce yourself Check patient ID Place sheet under patient using log-roll technique Place gurney next to bed and lock wheels One person pulls the patient from the gurney side Unlock wheels and place side-rails up for transport Maintain good posture while sliding patient over Perform a two/three person lift wheelchair transfer Demonstrate the steps required for a two/three person lift wheelchair transfer Introduce yourself Check patient ID Lock wheels Lift footrests Primary stands behind patient, arms through axillae Secondary kneels cradling thighs and legs (Inst.) Primary gives lift instruction; both lift together Patient placed gently on table * If a competency is initialed as Not, it MUST be repeated to pass competency. *Not
CARE OF PATIENT MEDICAL EQUIPMENT Proper use of oxygen delivery devices Demonstrate proper use of oxygen delivery devices Obtain required equipment Explain the procedure to the patient Adjust device to ordered level Correctly apply device to patient Confirm oxygen level as appropriate Peripheral venous lines Demonstrate proper technique for handling a central venous while performing an examination Demonstrate proper placement of IV line on IV pole Demonstrate how you would manipulate an IV line to perform an upright chest radiograph * If a competency is initialed as Not, it MUST be repeated to pass competency. *Not