SKILLS CHECKLIST

Name_________________________________ Performance Expectations Met______ Date_ ___________ Signed___________________

SKILL 18.2: Performing a Dry Dressing Change

Procedure Performed Comments

Yes No
1. Checked physician’s order. Gathered equipment and supplies. Introduced self,
explained what procedure was to be done and why. Performed hand hygiene
following infection control measures and verified client’s identity. Provided privacy.
Provided comfort and safety for client and self, including raising bed to appropriate
height for procedure.
2. Exposed only the wound area, using a bath blanket to cover the client, if necessary.
3. Applied a face mask if needed.
4. Removed outer dressings.
a. Applied clean gloves.
b. If adhesive tape was used, removed it by holding down the skin and pulling the
tape gently but firmly toward the wound.
c. Used a solvent to loosen tape, if required.
d. Lifted the dressing so that the underside was away from the client’s face.
5. Disposed of soiled dressings.
a. Placed the soiled dressing in the moisture-proof bag without touching the
outside of the bag.
b. Removed and disposed of gloves, performed hand hygiene.
6. Removed inner dressings
a. Opened the sterile dressing set, using aseptic technique.
b. Placed the sterile drape beside the wound or on the bedside table to form a
sterile field. Opened individual sterile equipment and placed on the field.
Donned sterile gloves if needed.
7. Assessed incision area for erythema, edema, or drainage. Assessed location, type,
and odor of wound drainage, and the number of gauzes saturated or diameter of
drainage collected on the dressings. Assessed overall appearance of wound and
measured its size.
8. Discarded soiled dressings in moisture-proof bag.
9. If sterile gloves were applied, removed and discarded. Performed hand hygiene.
Donned clean gloves.
10. Cleansed wound if indicated.
a. Used new forceps, clean gloves, moistened swabs. Kept forceps tips lower than
handles at all times
b. Cleaned from top to bottom, from center to outside.
OR
Cleaned outward from the wound using circular motion.
c. Repeated cleaning process until all drainage removed.
d. Used separate swab for each stroke, discarding after use.
11. Removed gloves and discarded. Performed hand hygiene. Donned fresh gloves.
12. Applied sterile dressings one at a time over the wound.
13. Secured the dressing with tape, tie tapes, or a binder.
a. Placed tape so that dressing could not be folded back to expose wound. Placed
strips at ends of dressing and spaced tapes evenly in middle.
b. Ensured that tape was long and wide enough to adhere to skin.
c. Placed tape in opposite direction from body action.
14. Returned bed to lowest height. Removed gloves and discarded. Performed
hand hygiene.
15. Documented procedure, assessments, and client’s response.

Clinical Nursing Skills: A Concept-Based Approach to Learning, Volume III, 2e   Copyright © 2015 by Pearson Education, Inc. All rights reserved.