NAME: ____________________________________ DATE: _____________________

YEAR & SECTION: ___________________________ SCORE: _______________/13

CLINICAL PERFORMANCE EVALUATION CHECKLIST

MONITORING OXYGEN SATURATION (NCM 109 SL)
Legend: Done Student performs consistently in an effective and efficient manner
Not Done No progress in performance has been demonstrated and/or
Performance is consistently ineffective and inefficient

EQUIPMENT Done Not done REMARKS

Prepare all necessary equipment and materials,
which includes the pulse oximeter, sensor probe,
alcohol pads, and in some cases, nail polish remover.
PROCEDURE
1. Explained the purpose and process of the
procedure to the patient.
2. Perform hand hygiene
3. Select a finger (or any other site possible when
the finger is not accessible) to place the probe,
making sure existing nail polish or fake
fingernail are removed from the test site.
4. Attach the probe on the finger, ensuring that the
light beam and sensor are positioned opposite
each other.
5. Make sure the patient’s hand is positioned at
heart level.
6. Turn on the device and watch out for a beep
sound followed by the device’s display.

7. Wait for the reading, which usually displays after

four to six heartbeats.
8. Remove the probe from the patient’s finger.
9. Perform hand hygiene
10. Clean the probe between patients. When using a
disposable probe, discard as needed.
11. Record the reading.

STUDENT’S SIGNATURE: CLINICAL INSTRUCTOR’S

SIGNATURE:
____________________ _______________________________