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Skills Assessment Report

Date:

Skill Assessment - Clinical Standards for Procedures and Interventions

Step Pass Unsatisfactory
Preparation
Verify, interpret, and evaluate the provider’s order or institutional protocol.
Review the patient chart for pertinent data, including diagnosis, medications, therapies, radiographic and laboratory results, and progress notes.
Perform Hand Hygiene.
Select, obtain, assemble equipment correctly, and verify functionality
Don Personal Protective Equipment (PPE); observe standard precautions and transmission-based isolation procedures as appropriate
Identify the patient and introduce yourself and your department.
Assessment
Explain the purpose of the procedure and confirm patient understanding.
Position the patient for the procedure.
Assess patient, including Vital Signs and ventilatory status.

Summary Performance Evaluation

Evaluator

Student Signature

Evaluator Signature