Professional Documents
Culture Documents
Tracheostomy Care
Tracheostomy Care
Name Date
TracheostomyCare
Setting:
Lab
Clinical
Evaluator:
Peer
Instructor
Conditions(describe):________________________________________________________________________
_______________________________________________________________________________________________
EquipmentUsed
_______________________________________________________________________________________________ _______________________________________________________________________________________________
S A T I S F A C T O R Y
U N S A T I S F A C T O R Y
N O T O B S E R V E D
N O T A P P L I C A B L E
EquipmentandPatientPreparation NOTE:Tracheostomypatientsshouldalwayshaveareplacementtracheostomytubeatthe bedsideincaseanemergencyreplacementbecomesnecessary 1.Selects,gathers,andassemblesthenecessaryequipment 2.Washeshandsandappliesstandardprecautionsandtransmissionbasedisolationproceduresas appropriate 3.Identifiespatient,introducesselfanddepartment 4.Explainspurposeoftheprocedureandconfirmspatientunderstanding AssessmentandImplementation 5.Assessespatient 6.Positionspatient 7.Suctionsthoroughly 8.Removestheolddressinganddiscardsproperly 9.Removestheinnercannulaandreplaceswiththespareredtopcannulaifanondisposable cannulaisinplace 10.Opensthetracheostomycarekitandfillsonebasinwithhydrogenperoxideandtheotherwith sterilesaline 11.Scrubsthecannulawithperoxideandrinseswithsterilesaline 12.Replacesthepermanentcannula 13.Ifadisposablecannulaisused,removesthedirtycannula,disposesofitproperly,andreplaces itwithaclean,disposablecannula 14.Cleansthestomasiteandexteriorportionsoftubeusingperoxide,cottontippedapplicators, andpipecleaners 15.Replacesthedressingusingaprecut4x4gauzepad 16.Removestheoldtiesortubesecuringdeviceandreplaceswithcleanones 17.Ensuresthatthetubeissecuredinproperpositionandreassessesthepatient Followup 18.Maintains/processesequipment 19.Disposesofinfectiouswasteandwasheshands 20.Recordspertinentdatainchartanddepartmentalrecords 21.Notifiesappropriatepersonnelandmakesanynecessaryrecommendationsormodifications tothepatientcareplan SignatureofEvaluator SignatureofStudent
TracheostomyCare.docx
PERFORMANCE RATINGSCALE
PERFORMANCECRITERIA
5 5 5 5 5 5 5 5 5 5
SCALE
4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1
1.DISPLAYSKNOWLEDGEOFESSENTIALCONCEPTS 2.DEMONSTRATESTHERELATIONSHIPBETWEENTHEORY ANDCLINICALPRACTICE 3.FOLLOWSDIRECTIONS,EXHIBITSSOUNDJUDGEMENT,AND DEMONSTRATESATTENTIONTOSAFETYANDDETAIL 4.EXHIBITSTHEREQUIREDMANUALDEXTERITY 5.PERFORMSPROCEDUREINAREASONABLETIMEFRAME 6.MAINTAINSSTERILEORASEPTICTECHNIQUE 7.INITIATESUNAMBIGUOUSGOALDIRECTEDCOMMUNICATION 8.PROVIDESFORADEQUATECAREANDMAINTENANCEOF EQUIPMENTANDSUPPLIES 9.EXHIBITSCOURTEOUSANDPLEASANTDEMEANOR 10.MAINTAINSCONCISEANDACCURATERECORDS
ADDITIONALCOMMENTS:INCLUDEERRORSOFOMISSIONORCOMMISSION, COMMUNICATIVESKILLS,ANDEFFECTIVENESSOFPATIENTINTERACTION:
SUMMARYPERFORMANCEEVALUATIONANDRECOMMENDATIONS SATISFACTORYPERFORMANCEPerformedwithouterrororprompting,orabletoselfcorrect,nocriticalerrors.
LABORATORYEVALUATION.SKILLSMAYBEAPPLIED/OBSERVEDINTHECLINICALSETTING.
CLINICALEVALUATION.STUDENTREADYFORMINIMALLYSUPERVISEDAPPLICATIONANDREFINEMENT.
UNSATISFACTORYPERFORMANCEPromptingrequired;performedwithcriticalerrors,potentiallyharmful.
STUDENTREQUIRESADDITIONALLABORATORYPRACTICE.
STUDENTREQUIRESADDITIONALSUPERVISEDCLINICALPRACTICE. SIGNATURES
STUDENT: DATE:
TracheostomyCare.docx
EVALUATOR: DATE: