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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3852_Библиотеки_им_академика_М_И_Перельмана
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282
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APPENDIX C Competency Checklists
COMPETENCY CHECKLIST
Hand Washing
Performance Standard
Properly wash hands using the aseptic technique.
Maximum time to complete assignment: 5 minutes.
Name ____________________________________
Date _____________
Materials and Equipment
• Sinkwithrunningwater
Instructions
1. Properly demonstrate aseptic hand-washing
• Soapdispenser
• Papertowels
technique.
2. Demonstrate competency by performing the
procedure of hand washing satisfactorily for the
instructor. All steps must be completed as listed
on the Competency Checklist.
Procedure
Record in the comments section any problems encountered while performing
the procedure.
S 5 Satisfactory
U 5 Unsatisfactory
You Must: S U Comments
1. Remove all hand and wrist jewelry, including rings.
2. Wet your hands with warm water.
3. Apply soap to your hands.
4. Rub your hands together vigorously, working up a lather.
5. Scrub palms, between fingers, under nails, and the back of hands for at least
15 seconds.
6. Rinse in a downward position.
7. Dry your hands thoroughly with paper towels.
8. Turn off the faucet with paper towels.
9. Discard paper towels.
Performance Standard Met Comments
________ Yes
________ No
Evaluator________ Date _____
282
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COMPETENCY CHECKLIST
Donning and Removing Personal
Protective Equipment
Performance Standard
Properly apply and remove personal protective
equipment in the correct order. Maximum time to
complete assignment: 8 minutes.
Name ____________________________________
Date __________
Materials and Equipment
• Hand-washingequipment
Instructions
1. Properly demonstrate how to put on and take
offpersonalprotectiveequipment.
2. Demonstrate competency by demonstrating the
• Gownorlabcoat
• Goggles,mask,orfaceshield
• Gloves
• Biohazardwastecontainer
correctorderofputtingpersonalprotectiveequipment on andthe appropriate order of removing
and discarding it. All steps must be completed as
listed on the Competency Checklist.
Procedure
Record in the comments section any problems encountered while performing the procedure.
S 5 Satisfactory
U 5 Unsatisfactory
You Must: S U Comments
Apply Personal Protective Equipment
1. Wash your hands.
2. Put on a lab coat or gown and fasten buttons or ties appropriately.
3. Apply goggles, face mask, or face shield. If applying a mask, tie the mask at the top and then
at the bottom.
4. Apply gloves over the cuffs of the lab coat or gown.
Remove Personal Protective Equipment
1. Untie and remove gown.
2. Remove gloves as you finish peeling off gown
3. Dispose of the gloves and gown in a biohazard waste container.
4. Remove the face mask, goggles, or face shield. If wearing a mask, untie the top ties and
then the bottom ties, and discard the mask in a biohazard waste container.
5. Wash your hands.
Performance Standard Met Comments
________ Yes
________ No
Evaluator ________ Date _____
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APPEN DI X C Competency Checklists http://evolve.elsevier.com/Warekois/phlebotomy
COMPETENCY CHECKLIST
Venipuncture (Evacuated Tube
Method)
Name ____________________________________
Date __________
Materials and Equipment
• Hand-washingequipment
• Personalprotectiveequipment
• Tourniquet
• Alcoholwipe
• Safetyneedle
• Disposableadapter
Instructions
1. Performavenipunctureusingtheevacuatedtube
method.
2. Demonstrate competency by demonstrating the
procedureforperformingavenipuncturesatisfac-
• Collectiontubes
• Sharpscontainer
• 232gauzepad
• Bandage
• Biohazardwastecontainer
torily for the instructor. All steps must be completed as listed on the Competency Checklist.
Performance Standard
Successfully and properly perform a venipuncture
usingtheevacuatedtubemethod.Maximumtimeto
complete assignment: 10 minutes.
Procedure
Record in the comments section any problems encountered while performing the procedure.
You Must: S U Comments
1. Greet and identify the patient. Ask the patient to state his or her name. Use two identifiers
to verify patient identity.
2. Introduce yourself and explain the procedure to the patient.
3. Verify the lab tests ordered against the requisition.
4. Position and prepare the patient.
5. Wash your hands and don personal protective equipment.
6. Apply the tourniquet.
7. Select vein by palpating the vein.
8. Cleanse the site with an alcohol wipe and allow to air dry. Remove the tourniquet.
9. Assemble the equipment.
10. Reapply the tourniquet (if necessary).
11. Examine the safety needle.
12. Anchor the vein.
13. Insert the needle into the vein at the appropriate angle.
14. Advance and change tubes in the appropriate order of draw.
15. Remove the tourniquet.
16. Mix anticoagulated tubes as they are removed from the adapter.
17. Remove the last tube from the adapter before removing the needle. Activate the safety device.
18. Remove the needle and discard it in a sharps container.
19. Apply pressure to the site with gauze.
20. Label tubes with appropriate information.
21. Check the site and apply a bandage.
22. Thank the patient.
23. Dispose of used supplies and materials.
24. Remove personal protective equipment and wash your hands.
25. Deliver specimens to appropriate departments.
S 5 Satisfactory
U 5 Unsatisfactory
Performance Standard Met Comments
________Yes
_________No
Evaluator_________ Date _____
Copyright2016,2011,2007,2002bySaunders,animprintofElsevierInc.Allrightsreserved.
http://evolve.elsevier.com/Warekois/phlebotomy APP ENDIX C Competency Checklists
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285
COMPETENCY CHECKLIST
Venipuncture (Syringe Method)
Name ____________________________________
Date __________
Materials and Equipment
• Hand-washingequipment
• Personalprotectiveequipment
• Tourniquet
• Alcoholwipe
• Syringe
Instructions
1. Perform a venipuncture using the syringe
method.
2. Demonstrate competency by demonstrating the
procedureforperformingavenipuncturesatisfactorily for the instructor. All steps must be completed as listed on the Competency Checklist.
• Safetyneedle
• 232gauzepad
• Collectiontubes
• Syringetransferdevice
• Sharpscontainer
• Bandage
• Biohazardwastecontainer
Performance Standard
Successfully and properly perform a venipuncture
using the syringe method. Maximum time to complete assignment: 10 minutes.
Procedure
Record in the comments section any problems encountered while performing
the procedure.
S 5 Satisfactory
U 5 Unsatisfactory
You Must: S U Comments
1. Greet and identify the patient. Ask the patient to state his or her name. Use two
identifiers to verify patient identity.
2. Introduce yourself and explain the procedure to the patient.
3. Verify the lab tests ordered against the requisition.
4. Position and prepare the patient.
5. Wash your hands and don personal protective equipment.
6. Apply the tourniquet.
7. Palpate the vein.
8. Cleanse the site with an alcohol wipe and allow to air dry. Remove the tourniquet.
9. Assemble the equipment.
10. Reapply the tourniquet.
11. Check the syringe plunger to verify free movement.
12. Examine the safety needle.
13. Anchor the vein.
14. Insert the needle into the vein at the appropriate angle.
15. Pull back the plunger evenly to withdraw blood.
16. Remove the tourniquet.
Continued
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APPEN DI X C Competency Checklists http://evolve.elsevier.com/Warekois/phlebotomy
Procedure
Record in the comments section any problems encountered while performing
the procedure.
—cont’d
S 5 Satisfactory
U 5 Unsatisfactory
You Must: S U Comments
17. Remove the needle and activate the safety device.
18. Apply pressure to the site with gauze.
19. Transfer blood to evacuated tubes in the correct order of draw using the
syringe transfer device.
20. Mix any anticoagulated tubes as needed.
21. Discard the syringe and needle in a sharps container.
22. Label tubes with appropriate information.
23. Check the site and apply a bandage.
24. Thank the patient.
25. Dispose of used supplies and materials.
26. Remove personal protective equipment and wash your hands.
27. Deliver specimens to the appropriate departments.
Performance Standard Met Comments
________ Yes
________ No
Evaluator ________ Date _____
Copyright2016,2011,2007,2002bySaunders,animprintofElsevierInc.Allrightsreserved.
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287
COMPETENCY CHECKLIST
Capillary Puncture (Finger Stick)
Name ____________________________________
Date __________
Materials and Equipment
• Hand-washingequipment
• Personalprotectiveequipment
• Alcoholwipe
• Skinpuncturedevice
• Collection tubes (microtainers or capillary
Instructions
1. Perform a capillary puncture.
2. Demonstrate competency by demonstrating the
procedure for performing a capillary puncture
satisfactorily for the instructor. All steps must be
completed as listed on the Competency Checklist.
pipettes)
• Sealingcapsorclay
• 232gauzepad
• Bandage
• Sharpscontainer
• Biohazardwastecontainer
Performance Standard
Successfully and properly perform a capillary
puncture. Maximum time to complete assignment:
10 minutes.
Procedure
Record in the comments section any problems encountered while performing
the procedure.
You Must: S U Comments
1. Greet and identify the patient. Ask the patient to state his or her name. Use two
identifiers to verify patient identity.
2. Introduce yourself and explain the procedure.
3. Verify the lab tests ordered against the requisition.
4. Wash your hands and don personal protective equipment.
5. Assemble the equipment.
6. Select the puncture site (and warm if necessary). Cleanse with alcohol and
allow to air dry.
7. Position and hold the finger and make the puncture in the appropriate area
and position.
8. Wipe away the first drop of blood.
9. Collect the specimen in the appropriate containers, without air bubbles.
10. Seal the specimen containers.
11. Mix specimens with anticoagulant to prevent clot formation.
12. Apply pressure to the puncture site with gauze.
13. Bandage the puncture site appropriately based on the patient’s age.
14. Label the specimens.
15. Thank the patient.
16. Dispose of used supplies and materials appropriately.
17. Remove personal protective equipment and wash your hands.
S 5 Satisfactory
U 5 Unsatisfactory
Performance Standard Met Comments
________ Yes
________ No
Evaluator ________ Date _____
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APPEN DI X C Competency Checklists http://evolve.elsevier.com/Warekois/phlebotomy
COMPETENCY CHECKLIST
Bleeding Time
Name ____________________________________
Date __________
Instructions
1. Successfullyperformthebleedingtimetest.
2. Demonstrate competency by demonstrating the
procedure for bleeding time satisfactorily for the
instructor. All steps must be completed as listed
on the Competency Checklist.
Materials and Equipment
• Hand-washingequipment
• Personalprotectiveequipment
• Alcoholwipe
• Bloodpressurecuff
• Automatedbleedingtimepuncturedevice
• Stopwatchortimerwithsecondhand
• Filterpaper
• Butterybandage
• Sharpscontainer
• Biohazardwastecontainer
Performance Standard
Determineplatelet function, aswell as thesignicance of the test result. Maximum time to complete
assignment: 15 minutes.
Procedure
Record in the comments section any problems encountered while performing
the procedure.
You Must: S U Comments
1. Greet and identify the patient. Ask the patient to state his or her name.
Use two identifiers to verify patient identity.
2. Identify yourself and explain the procedure.
3. Verify the lab tests ordered against the requisition.
4. Wash your hands and don personal protective equipment.
5. Assemble the equipment.
6. Position the patient’s arm on a flat, steady surface.
7. Select and cleanse the incision site with alcohol and allow to air dry.
8. Apply the blood pressure cuff on the arm and inflate to 40 mm Hg.
9. Position the incision device.
10. Make the incision and start the timer.
11. Wick blood onto the filter paper every 30 seconds after the timer starts.
12. Stop the timer when blood is no longer absorbed by the filter paper and record
the time.
13. Deflate and remove the blood pressure cuff.
14. Cleanse the puncture site and apply a butterfly bandage.
15. Instruct the patient on puncture site and bandage care.
16. Correctly dispose of used supplies and materials.
17. Thank the patient.
18. Remove personal protective equipment and wash your hands.
S 5 Satisfactory
U 5 Unsatisfactory
Performance Standard Met Comments
________ Yes
_________ No
Evaluator _________ Date _____
Copyright2016,2011,2007,2002bySaunders,animprintofElsevierInc.Allrightsreserved.
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289
COMPETENCY CHECKLIST
Venipuncture (Winged Infusion
Method)
Name ____________________________________
Date __________
Materials and Equipment
• Hand-washingequipment
• Personalprotectiveequipment
• Tourniquet
• Alcoholwipe
• Wingedinfusionset
• Evacuatedtubesorsyringe
Instructions
1. Perform a venipuncture using the winged infu-
sion method.
2. Demonstrate competency by demonstrating the
• 232gauzepad
• Sharpscontainer
• Bandage
• Biohazardwastecontainer
procedureforperformingavenipuncturesatisfac-
torily for the instructor. All steps must be completed as listed on the Competency Checklist.
Performance Standard
Successfully and properly perform a venipuncture
using the winged infusion method. Maximum time
to complete assignment: 10 minutes.
Procedure
Record in the comments section any problems encountered while performing
the procedure.
S 5 Satisfactory
U 5 Unsatisfactory
You Must: S U Comments
1. Greet and identify the patient. Ask the patient to state his or her name. Use two
identifiers to verify patient identity.
2. Introduce yourself and explain the procedure to the patient.
3. Verify the lab tests ordered against the requisition.
4. Wash your hands and don personal protective equipment.
5. Position the patient’s hand and apply the tourniquet around the wrist.
6. Choose the puncture site and palpate the vein.
7. Cleanse the site with an alcohol wipe and allow it to air dry. Release the tourniquet.
8. Assemble the equipment.
9. Reapply the tourniquet (if necessary).
10. Anchor the vein.
11. Holding the butterfly wings, insert the needle into the vein at the appropriate angle.
12. Advance the needle and hold it in place by one wing with the thumb of the
opposite hand.
13. Collect the sample in accordance with the method being used (evacuated tubes
or syringe).
Continued
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APPEN DI X C Competency Checklists http://evolve.elsevier.com/Warekois/phlebotomy
Procedure
Record in the comments section any problems encountered while performing
the procedure.
—cont’d
S 5 Satisfactory
U 5 Unsatisfactory
You Must: S U Comments
14. Release the tourniquet, remove the needle, and activate the safety device.
15. Apply pressure to the site with gauze.
16. Mix anticoagulated tubes if applicable.
17. If using a syringe, transfer blood to evacuated tubes. Use a syringe transfer device.
18. Discard the needle and tubing in a sharps container.
19. Label tubes with appropriate information.
20. Check the site and apply a bandage.
21. Thank the patient.
22. Dispose of used supplies and materials.
23. Remove personal protective equipment and wash your hands.
24. Deliver specimens to appropriate departments.
Performance Standard Met Comments
________ Yes
_________ No
Evaluator _________ Date _____
Copyright2016,2011,2007,2002bySaunders,animprintofElsevierInc.Allrightsreserved.
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291
COMPETENCY CHECKLIST
Modified Allen Test
Name ____________________________________
Performance Standard
Determine the presence of collateral circulation, as
wellasthesignicanceofthetestresult.Maximum
time to complete assignment: 5 minutes.
Date __________
Materials and Equipment
Instructions
1. ProperlyperformthemodiedAllentest.
2. Demonstrate competency by demonstrating the
procedure for determining collateral circulation
satisfactorily for the instructor. All steps must be
completed as listed on the Competency Checklist.
Procedure
Record in the comments section any problems encountered while performing
the procedure.
You Must: S U Comments
1. Extend the patient’s wrist over a towel and position the hand palm up.
2. Locate the radial and ulnar pulse sites by palpating with the appropriate fingers.
3. Ask the patient to make a fist.
4. Compress both arteries.
5. Ask the patient to open and close the fist until the palm blanches.
6. Release pressure on the ulnar artery and observe the color of the patient’s palm.
7. State and record a positive or negative result.
8. Explain the significance and appropriate action to take for the test result.
• Towel
S 5 Satisfactory
U 5 Unsatisfactory
Performance Standard Met Comments
________ Yes
________ No
Evaluator ________ Date _____
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