RETURN DEMONSTRATION

VENIPUNCTURE- Syringe Method

ASSESSMENT CRITERIA FOR GRADING

Name: __________________________________ Date: ____________

2 3 4 5
1
CRITICAL BEGINNER COMPETENT PROFICIENT EXEMPLARY SCOR
REFER
DIMENSIONS (LIMITED (ADEQUATE (REMARKABLE (PROFESSIONAL E
(NO CONTENT)
CONTENT) CONTENT) CONTENT) CONTENT)

PRE-ANALYTICAL PHASE
PPE (lab gown, No PPE is worn. Only 1-2 out of Only 3 out of 5 Only 4 out of 5 Complete PPEs
mask, gloves, hair 5 PPEs are PPEs are worn. PPEs are worn. are worn.
cap & goggles) worn.
Materials No materials. 1 out of 4 2 out of 4 3 out of 4 Complete
materials is materials are materials are materials.
available. available. available.
Cleaning of work Did not clean Did not clean Neither clean Cleaned but did Cleaned and
area the working the working nor disinfect the not disinfect the disinfect the
area before area before working area working area working area
starting. starting. before starting. before starting. before starting.
Patient Identification Did not ask Did not ask Did ask patient’s Did ask and verify Did ask and
& Preparation patient’s full name patient’s full name full name but din patient’s full name verify patient’s
and did not verify and did not verify not verify on the , explained diet full name
on the request, on the request but request & diet restriction & the
,explained diet
neither the diet explained diet restriction but procedure but
restriction & restriction & the explained the incomplete detail restriction & the
explanation of procedure procedure procedure
procedure
Equipment and other Equipment and Materials are Equipment and Few materials are Equipment and
materials other materials found on the other materials found in the other materials are
that will not be working area. Did are found neither working area. properly stored in
used are located not perform hand on the working Perform hand the designated
above the table. hygiene area nor the hygiene area.
Did not perform designated area. Perform hand
hand hygiene hygiene

ANALYTICAL PHASE
Venipuncture Did not perform Performed Incomplete Followed all the
Preparation improperly execution steps indicated
in the procedure.
Abiding by the Did not perform Performed Incomplete Followed all the
procedures indicated improperly execution steps indicated
in the procedure.
Collection of the Failure to collect Blood only Withdrawn Withdrawn the
desired amount of blood enters the hub incomplete desired amount
blood amount of blood of blood

POST-ANALYTICAL PHASE
Aliquoting blood Did not perform Performed Incomplete Followed all the Followed all the
samples improperly execution steps indicated steps indicated
in the in the procedure.
procedure but
forget to mix
Cleaning of work Left the working Disposed the Disposed the Disposed all the Properly cleaned
area area dirty. waste in an wastes in an waste in proper and disinfect the
inappropriate inappropriate container, did working area.
container,
container, did not disinfect the
disinfect the
not disinfect. working area. working area.

TOTAL: /50

Evaluated by: ____________________________

Instructor