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Skills Assessment Report
Date:
Skill Assessment - 12-Lead Electrocardiogram (ECG, EKG) Acquisition
Student Name:
Credentials:
Date:
Location:
Laboratory Simulation
Clinical Environment
Device:
Select a Device
12 lead ECG / EKG machine
Other
Step
Pass
Unsatisfactory
Preparation
Clinical Standards for Procedures and Interventions
.
Gathers 12 lead ECG machine, electrodes, prep materials (razor, alcohol pads), and leads.
Assessment
Assesses
Vital Signs
.
Assesses indications (chest pain, arrhythmia) and checks for contraindications to adhesive placement (skin injury).
Implementation
Preps skin and places limb and precordial leads in standard positions.
Verifies lead quality and acquires 12 lead tracing; annotates clinical context.
Monitoring & Modifications
Monitors tolerance and device function; adjusts per response; discontinues and notifies provider if adverse reactions occur.
Post-Intervention
Post-Intervention Management Steps
.
References
Summary Performance Evaluation
PASS: Satisfactory performance
Student has demonstrated skill proficiency and may perform under supervision of clinical instructor or preceptor.
Student has demonstrated skill proficiency and may perform in clinical environment.
FAIL: Unsatisfactory performance
Remediation Required
Evaluator
Student Signature
Evaluator Signature
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