UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF ALLIED HEALTH PROFESSIONS
DEPARTMENT OF CARDIORESPIRATORY CARE
Clinical Competency Checklist
Daily Oxygen and Aerosol Rounds
NOTE: One check list may be submitted for each device (nasal cannula, jet nebulizer, venturi mask, nonrebreathing mask, etc.).
Student Name _____________________________________Date _____________________
Attempt # _________ DEVICE:_________________________
Rating Scale: 0 = inappropriate, incorrect, or omitted
1 = needs additional study and practice
2 = completed appropriately and correct
N/A = not applicable
ITEM
1.
Checks physician's order for current settings
RATING
______
2.
Washes ______
3.
Confirms
4.
Confirms O
2
flow and/or FiO
2
______
5.
Changes the delivery device (if indicated) ______
6.
Changes humidifier or nebulizer (if indicated)
7.
Checks for proper functioning of the device
______
______
8.
Assures patient comfort
9.
Performs necessary charting and other documentation.
______
______
100% proficiency required to pass Total = ________ out of 18 fail
Instructor’s Signature: _________________________________________
Instructor's Name: ______________________________ Credential: ______
(Please print)
Student's Signature: ____________________________________________
Comments ________________________________________________________