UNIVERSITY OF SOUTH ALABAMA
DEPARTMENT OF CARDIORESPIRATORY CARE
Clinical Competency Checklist
Medicated Aerosol Therapy via Hand Held Nebulizer (HHN)
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
______
2. Checks written physician order for drug and dosage and frequency of therapy
______
3. Washes hands
______
4. Assures patient identity
______
5. Completes patient assessment
______
6. Communicates with the patient, explaining the rationale for the therapy and
instructs the patient how to perform the therapy
______
7. Correctly assembles equipment for therapy
______
8. Places medication and diluents in the nebulizer
______
9. Adjusts flow to produce adequate mist (usually 6-10 lpm)
______
10. Administers treatment until medication is spent
______
11. Stores nebulizer or disposes of it appropriately
______
12. Records patient responses, data in chart to include medication, dosage,
treatment parameters, sputum characteristics, breath sounds, pulse,
and side effects, if any
______
13. Completes other documentation.
______
100% proficiency required to pass
Total = ________ out of 26
Score = _____ pass _____ fail
Instructor’s Signature: _________________________________________
Instructor's Name: ______________________________ Credential: ______
(Please print)
Student's Signature: ____________________________________________
Comments ________________________________________________________