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Skills Assessment Report

Date:

Skill Assessment - Securing Artificial Airway

Step Pass Unsatisfactory
Knowledge
States Contraindications and Relative Contraindications of procedure.
Preparation
Clinical Standards for Procedures and Interventions.
Confirms airway placement, depth, and sizing before securing.
Identifies and gathers required equipment: commercial ETT holder or tape, protective barrier, bite block (if indicated), skin prep.
Assessment
Assesses Vital Signs.
Assesses skin breakdown risk, tube position/markings, and need for repositioning.
Implementation
Maintains tube position while loosening old securement; applies new device/tape per manufacturer instructions.
Verifies and documents tube depth/position, skin integrity, and bite block placement if used.
Monitoring & Modifications
Monitors patient tolerance, work of breathing, and oxygenation/ventilation response during the intervention.
Adjusts technique/device settings per patient response; discontinues treatment and notifies provider if adverse reactions occur.
Encourages cough and assesses secretion clearance as indicated.
Post-Intervention
Post-Intervention Management Steps.

Summary Performance Evaluation

Evaluator

Student Signature

Evaluator Signature