UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF ALLIED HEALTH PROFESSIONS
DEPARTMENT OF CARDIORESPIRATORY CARE
Clinical Competency Checklist
Vibratory PEP Therapy (Flutter Valve, Acapella)
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. Verifies written physician’s order for therapy
______
3. Washes hands
______
4. Assures patient identity
______
5. Completes patient assessment
______
6. Assembles device for use
______
7. Instructs patient
______
8. Assures that patient adheres to proper technique to include,
a. taking a deep breath
b. exhaling through the device to FRC actively,
but not forcefully, for 3-4 seconds
c. make adjustments, if necessary (Acapella)
d. repeat for requisite number of times
______
9. Encourages coughing with expectoration (if necessary)
______
10. Performs necessary charting to include: parameters of treatment,
sputum characteristics (if obtained), breath sounds, patient’s reaction,
and side effects, if any
______
11. Completes necessary charting and other documentation
______
90% proficiency required to pass
Total = ________ out of 22
Score = _____ pass _____ fail
Instructor’s Signature: _________________________________________
Instructor's Name: ______________________________ Credential: ______
(Please print)
Student's Signature: ____________________________________________
Comments ________________________________________________________