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Skills Assessment Report

Date:

Skill Assessment - PFT Spirometry

Notes
  • Delay therapy for at least 1 hour after eating to reduce the risk of nausea or vomiting during forced exhalation or coughing maneuvers.
  • If caffeine has been consumed within 12 hours of testing or therapy, the clinician should verify with the ordering provider or supervising physician before proceeding.
Step Pass Unsatisfactory
Knowledge
States Contraindications and Relative Contraindications of procedure.
Preparation
Clinical Standards for Procedures and Interventions.
Identifies and gathers required equipment: calibrated spirometer, disposable mouthpiece, nose clip, bacterial/viral filter, disinfecting supplies, calibration syringe per policy.
Assessment
Assesses Vital Signs.
Screens for acute illness, recent surgery, or contraindications to forced exhalation; obtains height, weight, age, sex, and race for predicted values.
Implementation
Performs daily calibration and verification according to ATS/ERS standards before testing.
Coaches patient through acceptable maneuvers: maximal inhalation, forceful rapid exhalation for at least 6 seconds (or until plateau), meeting repeatability criteria.
Documents acceptability grade and reports FEV1, FVC, and FEV1/FVC with LLN and predicted values.
Monitoring & Modifications
Monitors patient tolerance, work of breathing, and oxygenation or ventilation response during the intervention.
Adjusts technique or device settings per patient response; discontinues testing 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