The University of the West Indies

Faculty of Medical Sciences

The UWI School of Nursing, Mona
Year IV Semester II
BScN

Checklist: Eye Irrigation

Student's Name:______________________________Student’s ID: ________________________________

Scores: Outstanding (3 points), Satisfactory (2 points), Needs Improvement (1 point), Omitted task
DATES Lab Clin Clin
TASKS ATTEMPTED 1st 2nd 3rd 4th 5th 6th 7th
S U S U S U S U S U S U S U
1. Check and verify physician’s order.
2. Identify the patient.
3. Explain procedure to patient.
4. Gather necessary equipment
5. Perform hand hygiene and put on
PPE, if indicated.
6. Position patient appropriately. Protect
the patient and bed with a waterproof
pad. Place curved basin at cheek on the
side of the affected eyeto receive
irrigating solution. Ask patient to support
the basin if they are able
7. Clean lids and lashes as necessary,
with moistened washcloth moistened
with the irrigating solution.Wipe from
inner to outer canthus. Usea different
corner of washcloth with each wipe
8. Fill syringe with irrigation solution. If
an irrigating container is used, prime the
tubing.
9. Expose lower conjunctival sac and
hold upper lid openwith your
nondominant hand.
10. Holdirrigation syringe about 2.5 cm
(1 inch) from eye. Directflow of solution
from inner to outer canthus
alongconjunctival sac andavoid touching
any part ofthe eye with the irrigating tip.

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Eye Irrigation
DATES Lab Clin Clin
TASKS ATTEMPTED 1st 2nd 3rd 4th 5th 6th 7th
S U S U S U S U S U S U S U
11. Irrigate until the solution is clear or
all the solution hasbeen used.Dry
periorbital area after irrigation with
gauze sponge.
12. Remove gloves. Assist the patient to
a comfortable position.
13. Remove additional PPE, if used.
Perform hand hygiene.
14. Document the administration of the
medication immediately after
administration.

15. Evaluate the patient’s response to the

procedure and the patient’s response to
medication within appropriate time
frame.

Evaluators’ Comments:
1stDate :_________________
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__________________________________________________________________Name &Signature
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2ndDate:________________
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____________________________________________________________________Name &Signature
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Eye Irrigation
3rdDate:_________________
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_____________________________________________________________________Name & Signature
_______________________________

4th Date:_____________
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______________________________________________________________________Name &Signature
______________________________

5th Date:_____________
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______________________________________________________________________Name &Signature
______________________________

6th Date :___________

____________________________________________________________________________________________
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____________________________________________________________________________________________
______________________________________________________________________Name & Signature
______________________________

7th Date:___________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
_____________________________________________Name & Signature _______________________________

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Eye Irrigation
Student’s Signature: _________________________________

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Eye Irrigation