School of Nursing & Midwifery

BSc Nursing (Hons) Programme

S. Name:

S. No:

Eye care Procedure Checklist

Essential equipment:
1. Gallipot
2. Swabs
3. Disposable towel
4. Gloves
5. Disposable bag
6. Sterile solution (normal saline)

# Steps A/P I/P N/P N/A Comments

1 Cleanse hands.
2 Explain the procedure to the patient.
3 Ensure privacy.
4 Prepare sterile equipment: gallipot, swabs and
disposable towel.
5 Nontouch technique: consider the possibility of
wearing gloves.
6 Pour prescribed solution into gallipot.
7 Prepare patient and environment.
8 Ask the patient to close the eyes.
9 Begin with the uninfected eye or the eye least
affected.
10 Moisten the swab in the solution.

11 Applying gentle pressure, swab from the inner

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Eye care
 School of Nursing & Midwifery
BSc Nursing (Hons) Programme

# Steps A/P I/P N/P N/A Comments

aspect of the eye (canthus) outwards, starting
with the lower eyelid.
12 Use one swab per sweep.
13 Continue procedure until debris is completely
removed from the lower eyelid, then repeat for
the upper eyelid.
14 On completion, ensure that the patient is
comfortable and that all used equipment is
disposed of properly.

Reference: A/P = Accurately Performed N/P = Not Performed

I/A = Inaccurately Performed N/A = Not Applicable

For Practice Use For OSPE use

the the the

Competent Need more practice Pass Fail

Evaluator Name: Title: Organization:

Signature: Date:

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Eye care