Name: ________________________ Section: ______ Date: _____

Drug Incorporation into Soluset Checklist

Procedure CD ID
Countercheck with written doctor’s order and make medication card.
Observe “10 Rights” when preparing and administering medications.
Explain procedure to patient/SO.
Assess patient for any untoward S/S, check IV site, on-going IV fluid /
incorporations and verify skin test result of drug to be administered.
Wash hands before and after procedure.
Prepare the necessary materials needed.
(on IV tray- separate IV solution compatible with drug dilution, drug to be
incorporated in vial or ampule, soluset, needle, syringe, plaster, cotton
balls soaked in alcohol in covered container)
Note: Soluset is to be consumed in 6-8 hours, confirm with doctor if IV
fluid is to be used solely for drug administration and keep the whole set
sterile for succeeding doses.
(Spike soluset to new IVF container, prime the tubing, place an
appropriate needle to distal end of tubing, and connect to the IV main line
through the Y-injection port, secure with tape)
Aspirate prepared right drug with correct dose.
Close the clamp of the main line.
Add desired IVF diluents into soluset by opening the clamp from the bottle
then close the clamp after.
Disinfect rubber injection port of the soluset and incorporate the drug. Mix
gently.
Open the clamp of the airway at the soluset and regulate flow rate as
ordered or per manufacturer’s instruction.
Place IV label on soluset indicating drug incorporation.
When drug is consumed, add more 20 cc of IV fluid to soluset for flushing
to ensure complete administration of the drug.
Close the main line. Open soluset up to 30 mL then close the airway.
Regulate to according to physician’s order.
Observe patient for any adverse reaction
Regulate flow rate of main IV fluid
Discard all waste according to hospital policy
Document Accordingly
TOTAL
Perfect Score: 30 Passing Score: 24

______________________________________
Clinical Instructor’s Signature over printed name
 Pediatric Glasgow Coma Scale
Procedure CD ID
Preparation
Identify patient, introduce self and role.
Meet immediate needs of patient.
Explain plan.
Assessment Phase
Assess Eye Opening
4- Spontaneous
3- Respond to speech
2- Respond to pain
1- No Eye Opening
Assessment Score: _____
Assess Verbal Response
5- Coos and babbles
4- Irritable cries
3-Cries to pain
2- Moans to pain
1- No Response
Assessment Score:_____
Assess Motor:
6- Normal spontaneous movement
5- Withdraws to touch
4- Withdraws to pain
3- Abnormal flexion
2-Abnormal extension
1- No Response
Assessment Score:_____
Follow-up Phase
Tallying and Interpretation
Documentation
Perfect Score: 16 Passing Score: 13 Total:

______________________________________
Clinical Instructor’s signature over printed name