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Skills Assessment Report
Date:
Skill Assessment - Sputum Collection
Student Name:
Credentials:
Date:
Location:
Laboratory Simulation
Clinical Environment
Device:
Select a Device
Sterile Collection Container
Other
Step
Pass
Unsatisfactory
Knowledge
States
Contraindications
and
Relative Contraindications
of procedure.
Preparation
Clinical Standards for Procedures and Interventions
.
Gathers sterile specimen cup (sputum trap if using inline suction), label, requisition, biohazard bag.
Assessment
Assesses
Vital Signs
.
Assesses ability to produce sputum and need for induction.
Implementation
Labels specimen at bedside and verifies identifiers.
Instructs patient to cough deeply and expectorate into sterile container (or collect via inline trap).
Sends specimen to lab promptly per policy; notes antibiotic timing.
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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