UNIVERSITY OF SOUTH ALABAMA
DEPARTMENT OF CARDIORESPIRATORY CARE
Clinical Competency Checklist
Jet Nebulizer Setup (Bland Aerosol)
Student Name ________________________________ Date ___________ Attempt # ________
Rating Scale: 0 = inappropriate, incorrect, or omitted
1 = needs additional study and practice
2 = completed appropriately and correct
N/A = not applicable
ITEM
RATING
1. Gathers necessary equipment for jet nebulizer
________
2. Verifies written physician’s order for aerosol and FiO2
________
3. Washes hands
________
4. Assures patient identity
________
5. Installs flowmeter in appropriate outlet
________
6. Attaches nebulizer to flowmeter
________
7. Applies heater (if applicable)
________
8. Assembles tubing with drain midway in tubing
________
9. Attaches aerosol tubing to nebulizer
________
10. Sets FiO2
________
11. Attaches appropriate delivery device
________
12. Adjusts flow to deliver adequate mist to meet peak inspiratory demand.
________
13. Snugly attaches delivery device to the patient. Allows time to reach baseline,
then checks SpO2
________
14. Posts no smoking sign (if applicable)
________
15. Records data in chart or other facility records (e.g. computer) to include SpO2,
date, time, aerosol device, and FIO2
________
16. Completes other departmental record keeping.
________
100% proficiency required to pass
Total = _____ out of 32
Score = _____ pass _____ fail
Instructor’s Signature: __________________________________________
Instructor's Name: ______________________________ Credential: ________
(Please print)
Student's Signature: ____________________________________________
Comments _______________________________________________________________________