ORAL HYGIENE INSTRUCTION PROFICIENCY PROCESS EVALUATION clinici¥5% am Of name: fetasher Ui he nwt Instructor: ACen rat ey Date:_)-7-IS Competency: Provide patient counseling A= Acceptable Competency: Promote dental health I=Needs Improvement Competency: Assess own performance U=Unacceptable * Failure of starred item/critical errors results in automatic failure of proficiency i. Professionalism A T U Time management Professional behavior Bass? FAIL Asepsis/infection control” PASS, FAIL Ul, Evaluates Patient Knowledge ‘Asks patient about current knowledge of dental disease/responds ay 0 appropriately Ill, Evaluate Patient General Condition Uses information from medical, dental and oral examination Se 4 0 Uses information from dental and periodontal chart © 0 IV Evaluates Current Periodontal Condition ‘Shows patient disease/health in patient's own mouth Q 4 0 Discloses plaque/completed plaque score os 4 0 Uses plaque score to evaluate and determine home care procedures 2) 4 0 \V. Determined Patient's Self Care Needs Allows patient to demo current brushing, flossing method in own mouth ty 1 0 Revises brushing/fiossing method as needediintro flossing if necessary 1 0 Recommends brushing method and establishes routine with patient 1 oO Recommends other home care needs and aids as necessary to patient 2) 1 0 Vi. Self-Assessment Criteria: = ‘Student completes self assessment™ PA FAIL Discusses assessment with instructor PAS! FAIL 202_ = Wy 20 Instructor comments: Revised 2013ORAL HYGIENE INSTRUCTION PROFICIENCY PROCESS EVALUATION wane hegSnecuithelaay eee OO MEN BAS oie rs Date: 21 1S Competency: Provide patient counseling —A = Acceptabl Competency: Promote dental health \oe leeds Improvement ‘Competency: Assess own performance gas U =Unacceptable * Failure of starred item/critical errors results in automatic failure of proficiency i 1. Professionalism TA i U ime management EE = Professional behavior G FAIL Asepsis/infection control "ASS “FAIL ___ll. Evaluates Patient Knowledge _ a ‘Asks patient about current knowledge of dental disease/responds @ 4 0 appropriate) Ill, Evaluate Patient General Condition Uses information from medical, dental and oral examination 7 {ses information from dental and periodontal chart * IV Evaluates Current Periodontal Condition _ Shows patient disease/health in patient's own mouth Discloses plaque/completed plaque score asec Uses plaque score to evaluate and determine home care procedures V. Determined Patient's Self Care Needs Pes | S Allows patient io demo current brushing, flossing method in own mouth 4 oO Revises brushing/fiossing method as needediintro flossing if necessary 1 0 Recommends brushing method and establishes routine with patient 1 0 Recommends other home gare needs and aids as necessary to patient 1 0 PV MOSS + Ms (aS VI. Self-Assessment Criteria: Student completes self assessment* FAIL Discusses assessment with instructor FAIL Zo_=100 % fds she a | SLOHS ooo Seca, Sa 20 sQleounnd- Some pe Fala risk caniss, Reviewed wren ‘structor comments Re cormoma Aen Yinse, ev Cunde tal osdker + Aylirslosed AS? ange 4 prs Lean trmpaovs. om Rose cade aye = ae Aveapa tee cate) mere 3 Revised 2013 px dorms Goede" oO ieeeBLOOD PRESSURE PROFICIENCY Clinic 1 () PROCESS EVALUATION Competency: Take vital si Competency: Assess own performance for quality and improvement Name: Instructor: Patient Nam Date: Clinic | 75% 2 Acceptable Clinic 1 85% 1 Needs Improvement 0 Unacceptable “Failure of starred items/critical errors _ results in automatic failure of proficiency. A 1 U 1. Cleans stethoscope, ear tips, diaphragm and 2 1 0 bell with alcohol pads. 2. Supports patient's extended arm at heart 72 7 0 level. 3. Palpates brachial artery. ai (2 aaaeee aae0 4, Places cuff snugly 2" above the elbow over o] 1 0 the brachial artery. 5. Properly places ear pieces of stethoscope in 2 1 0 ears. (Angled toward nose when in the ears). 6. Tasts the diaphragm of stethoscope by 2 1 0 tubing to insure audibility. 7. Places diaphragm over brachial artery and ‘2 i 0 holds in place with 2 fingers (not under cuff). 8. Closes valve of bulb. iz 2 i 0 9. Inflates cuff by squeezing bulb with minimal 2 1 0 tube motion to 180-200 mm Hg. 10. Gently opens valve and allows air to escape 2 1 0 slowly, noting the systolic and diastolic pressures. 11. Cleans stethoscope 2 1 12. Record BP in EHR 2 1 cate 13. Records blood pressure within 2 pts systolic 2 1 and 2 pts diastolic of instructor. fae 14. Complete above procedure in 10 minutes.* PASS [== 15. Self assessment completed.* __| PASS FEES % 30 Instructor Comments: Revised 2013