Critical Elements
S=Satisfactory NI= Needs Improvement
Procedure Steps
Prior to entering room
1. Review medical record
2. Gather supplies and equipment (inspect packages for integrity / expiration
dates)
Patient preparation
1. Hand hygiene (washes hands/uses sanitizer)
2. Introduce Self
3. Provide privacy and sanitize hands
4. Identification of patient using ALL patient identifiers
verifies wristband (patient will state their name and date of birth)
verify medical record (MR) number with chart
5. Verify allergies
6. Pain Assessment
Use pain scale (0-10)
Assess location, description and duration
Treat according to assessment findings
7. Assess patient to verify need for procedure
8. Explain procedure to patient
9. Position for optimal body mechanics (bed height, side rails)
During procedure
1. Follows standard precautions
2. Maintains sterility, if applicable
Post procedure
1.
2.
3.
4.
5.
6.
7.
8.
Assess response to procedure
Reassess for pain
Lowers the bed and bedside table (if used); raises the side rail
Call bell within reach
Disposes of supplies and materials in proper receptacles
Performs hand hygiene (washes hands/uses sanitizer)
Accurate documentation
Completes procedure in the allotted time frame
Recommendation: Pass_____ Needs more practice_____
Student:________________________________ Date:_____________
Instructor:______________________________ Date:_____________
Dressed appropriately:
Satisfactory
Unsatisfactory________
(S)
(NI)
Comments