SkillSheetChecklists 8

NAME: BATCH #
SKILLS EVALUATION SHEET CHECKLISTS
OTHERS
SKILL SHEET
NO. SKILL 1ST TAKE REMARKS 2ND TAKE REMARKS
#
53 Delivering the Baby A
54 Newborn B
55 Treating Shock C
56 Applying a Pneumatic Antishock Garment (PASG) D
57 Administering PX MEDS E
58 Administering NO PX MEDS F
59 Drawing up Meds G
60 IVT Access H
8
61 IV Medications I
62 Administering SQ, IM, AND ET Medication J
63 Adult IO K
64 Pedia IO L
TRIAGE
MASS CASUALTY INCIDENT
GAINING ACCESS
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Page 1 of 21
SKILLS EVALUATION NO. 8 - A - EMERGENCY CHILDBIRTH
OBJECTIVE: The participants shall be able to correctly perform Emergency Childbirth POINTS
DETERMINE PROPER BSI
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
1 Takes appropriate body substance isolation precautions
SCENE SAFETY
1
2 Assess scene safety
1
3 Determine Nature of Illness
1
4 Determine Mechanism of Injury
1
5 Determine number of Patients
1
6 Assess need for additional help
1
7 Take cervical spine precautions as necessary
EMERGENCY CHILDBIRTH
Obtains the following information during patient history:

Due date?
Last menstrual period?
Bleeding or discharge?
Has the bag of waters broken, and was it stained water?
8 How many times have you been pregnant and how many times have you given birth? 1
Drug use within 12 hours?
Are you expecting twins?
Pain or Contraction?
How long are the contractions? and how far apart are they?
Do you feel a need to push or move your bowels?
9 Explains the necessity of examining the patient for crowning. 1
10 If time allows, drapes the patient for examination. 1
11 Allow patient to choose position for delivery. 1
12 Observes for crowning or any presenting part. 1
13 Places a hand on the infant's head, without depressing the fontanels, to prevent explosive delivery. 1
14 Checks to see if cord is around the infant's neck when the head presents. Slips cord over head if necessary. 1
15 Clears the infant's airway by suctioning mouth and then the nose with a bulb syringe or other appropriate device. (Expels air from the syringe prior to insertion.) 1
16 Holds baby securely supporting the head and body. 1
17 Keeps infant level with vagina until cord is clamped. 1
18 After cord pulsations cease, clamps the cord at approximately 7 inches from the infant and places another clamp at approximately 10 inches from the infant. 1
19 Cuts the cord between the clamps. 1
20 Dries infant and wraps in clean, dry, warm blanket, ensuring that head is covered. 1
21 Provides additional tactile stimulation if infant is blue, limp, or not breathing. 1
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Page 2 of 21
Evaluates respirations, heart rate, and color:
a. If HR is greater than 100 and baby is pink, gives supportive care.
22 b. If HR is greater than 100 and baby is not pink centrally, gives oxygen. 1
c. If apneic or heart rate is less than 100, provides bag-valve-mask ventilations with supplemental oxygen.
d. If heart rate is less than 60, provides chest compressions and bag-valve-mask ventilations with supplemental oxygen.
23 For infants not requiring life support interventions, assesses an APGAR score at one minute and five minutes post-delivery. 1
24 Continues to maintain the infant’s body temperature. 1
25 Places the infant on the mother’s abdomen or gives the baby to the assistant. 1
26 Does not perform uterine massage prior to delivery of the placenta. 1
27 Delivers the placenta without pulling the cord. Transports all placental tissue with the mother and baby. 1
Massages the abdomen over the mother's uterus until it shrinks to a firm, hard consistency, or assists the mother with uterine massage. The mother should be
28 1
encouraged to attempt to breastfeed at this time.
29 Applies OB pad and instructs mother to hold her legs together. Provides assistance to the mother as needed. 1
30 Records time of delivery and APGAR scores. 1
POSSI- 2ND
CRITICAL CRITERIA GIVEN
BLE TAKE
1
1 Take or verbalize BSI precautions
1
2 Evaluate the need for Scene Size Up
1
3 Immediately direct initiation / resumption of CPR at appropriate times
FAILED - SCORES BELOW 25 PASSED - SCORES 25 AND ABOVE SCORE 33
REMARKS P/F
PARTICIPANTS COMMENTS: _______________________________________________________________________

_____________________________________________________________________________________________
EVALUATOR’S COMMENTS: ________________________________________________________________________
_____________________________________________________________________________________________
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Page 3 of 21
SKILLS EVALUATION NO. 8 - B - NEWBORN ASSESSMENT
OBJECTIVE: The participants shall be able to correctly perform Newborn Assessment POINTS
# POSSI- GIVEN 2ND

STEPS
BLE TAKE
1
SCENE SAFETY
1
1
1
1
1
1
NEWBORN ASSESSMENT
1
8 Clears the mouth and nose and suctions with a bulb syringe or other appropriate device if needed.
1
9 Dries infant and wraps in clean, dry, warm blanket, ensuring that head is covered.
1
10 Provides additional tactile stimulation if infant is blue, limp, or not breathing.
Evaluates respirations, heart rate and color: 1

a. If HR is greater than 100 and baby is pink, gives supportive care.
11 b. If HR is greater than 100 and baby is not pink centrally, gives oxygen.
c. If apneic or heart rate is less than 100, provides bag-valve-mask ventilations with supplemental oxygen.
d. If heart rate is less than 60, provides chest compressions and bag-valve-mask ventilations with supplemental oxygen.
1
12 For infants not requiring life support interventions, assesses an APGAR score at one minute and five minutes post-delivery.
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Page 4 of 21
1
13 Continues to maintain the infant’s body temperature.
POSSI- 2ND
BLE TAKE
1
1
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
SKILLS EVALUATION NO. 8 - C - BASIC SHOCK TREATMENT

OBJECTIVE: The participants shall be able to correctly perform Basic Shock treatment POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
1
1
1
1
BASIC SHOCK TREATMENT
1
8 Verbalizes consideration of standard precautions and takes standard precautions when indicated.
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Page 5 of 21
1
9 Places the patient in a supine position.
1
10 Controls external bleeding if indicated.
1
11 Initiates oxygen flow at 10 - 15 liters per minute via a non-rebreather mask.
1
12 Elevates the patient’s legs 8-12 inches.
1
13 Maintains the patient’s body temperature.
1
14 Communicates with and reassures the patient.
1
15 Obtains BP, pulse, and respiratory rate.
1
16 Evaluates the level of consciousness.
1
17 Verbalizes consideration of application of PASG.
1
18 Determines if the need for rapid transport exists.
POSSI- 2ND
BLE TAKE
1
1
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
SKILLS EVALUATION NO. 8 - D - PNEUMATIC ANTI SHOCK GARMENT

OBJECTIVE: The participants shall be able to correctly perform Use of PASG POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
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Page 6 of 21
1
1
1
1
1
PASG
1
8 Considers stabilization of the patient’s cervical spine, if indicated, and maintains stabilization through application of the PASG.
1
9 Explains the procedure to the patient.
1
10 Evaluates lung sounds.
1
11 Removes or verbalizes removal of patient’s clothing from the waist down, including shoes.
1
12 Unfolds and positions the PASG.
1
13 Positions garment correctly with the top of the garment just below lateral rib margin.
1
14 Wraps and secures the leg sections.
1
15 Wraps and secures the abdominal section.
1
16 Attaches the pump to all three stopcocks. Closes the abdominal stopcock and opens stopcocks to legs.
Inflates the leg sections until: 1

a. Velcro closures start to slip or
17
b. pop-off valves release, or
c. garment is easily dented by finger pressure.
1
18 Closes leg stopcocks.
1
19 Assesses BP and lung sounds. If systolic BP is less than 90 mmHg, proceed to step 14. If systolic BP is greater than or equal to 90 mmHg, go to step 17.
Opens the abdominal stopcock and inflates the abdominal section until: 1
a. Velcro closures start to slip, or
20
b. pop-off valves release, or
c. garment is easily dented by finger pressure.
1
21 Closes abdominal stopcock.
1
22 Checks the patient's vital signs and lung sounds.
1
23 Assures all stopcocks are closed.
When asked, states the conditions which must exist prior to deflation and the procedures for deflation: 1
a. Patient is in a medical facility with at least one large bore IV in place; and
24
b. Deflate compartments one at a time, starting with the abdomen, stopping deflation if BP drops more than 10 mmHg or pulse increases by more than
10/minute.
NOTE: Some pneumatic anti-shock devices do not have pop-off valves. Do not exceed 100 mm Hg inflation pressure
--- --- ---
within the garment. Monitor closely during transport and adjust as necessary.
POSSI- 2ND
BLE TAKE
1
1
1
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Page 7 of 21
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
⍟
Page 8 of 21
SKILLS EVALUATION NO. 8 - E - ASSISTING WITH PRESCRIBED MEDICATION
OBJECTIVE: The participants shall be able to correctly perform Assistance with prescribed medication POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
1
1
1
1
ASSISTING WITH PRESCRIBED MEDICATION
1
8 Obtains the patient’s prescribed medication.
1
9 Contacts medical direction for authorization if administration is not covered in standing orders.
1
10 Assures the medication is prescribed and indicated for the patient.
1
11 Determines if the patient has taken any prescribed dose(s).
1
12 Checks the medication for expiration date.
SPECIFIC MEDICATIONS
--- ---
--- NITROGLYCERIN METERED DOSE INHALER EPINEPHRINE AUTO INJECTOR
1
13 Ensures systolic BP is at least 100 mm Hg. Assesses breathing and listens to lung sounds. Obtains the patient’s auto injector.
Ask if the patient is taking a phosphodiesterase in- 1

hibitor (medications such as Viagra®, Levitra®, or
14 Cialis®, commonly prescribed for erectile dysfunc- Directs the patient to exhale completely. Checks medication for clarity.
tion). If so, contact medical control before adminis-
tering nitroglycerin.
Places the mouthpiece of the inhaler into the pa- 1

Places a tablet or sprays single dose under the
15 tient’s mouth between closed lips, depresses canister Removes safety cap from injector.
tongue.
while the patient inhales deeply.
Directs patient to hold breath for as long as comfort- Pushes injector firmly against lateral thigh and 1
16 Re-assesses BP.
able. holds for 10 seconds.
If pain persists administers 1 dose, every 3-5 min-

17 utes, to a maximum of 3 doses, if systolic BP remains Re-assesses patient's breathing and lung sounds. Discards auto-injector in sharps container. 1
above 100 mmHg.
1
18 ----- Administers up to maximum dose. -----
19 Re-assesses patient for desired effect and possible side effects. 1
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Page 9 of 21
POSSI- 2ND
BLE TAKE
1
1
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
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Page 10 of 21
SKILLS EVALUATION NO. 8 - F - ASSISTING WITH NON PRESCRIBED MEDICATIONS
OBJECTIVE: The participants shall be able to correctly assist with non prescribed medication POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
1
1
1
1
ASSISTING WITH NON PRESCRIBED MEDICATIONS
1
8 Verbalizes consideration of standard precautions and takes standard precautions when indicated. *
1
9 Assures the medication is indicated for the patient.
1
10 Selects the appropriate medication.
1
11 Contacts medical direction for authorization if administration is not covered in standing orders.
1
12 Checks the medication for expiration date.
1
13 Establishes that the patient is not allergic to the drug.
SPECIFIC MEDICATIONS
1
--- ORAL GLUCOSE ACTIVATED CHARCOAL ASPIRIN
1
14 Ensures the patient is alert enough to swallow. Ensures the patient is alert enough to swallow. Ensures the patient is alert enough to swallow.
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Page 11 of 21
Administers the entire tube of glucose by placing the 1
Mixes one gram of activated charcoal per kilogram
glucose on a tongue depressor and inserting it be-
15 of body weight into water or other liquid if not pre- Checks for contraindications.
tween the cheek and gum or by allowing the patient
mixed.
to squeeze the tube into his or her mouth.
Has the patient drink the activated charcoal suspen- 1

16 ---- Has the patient chew 160 to 325 mg of aspirin.
sion.
1
17 Re-assesses the patient for desired effect and possible side effects.
POSSI- 2ND
BLE TAKE
1
1
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
SKILLS EVALUATION NO. 8 - G - DRAWING UP MEDICATIONS

OBJECTIVE: The participants shall be able to correctly perform proper drawing up of medications POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
1
1
1
1
DRAWING UP MEDICATIONS
1
8 Assembles necessary equipment.
1
9 Checks medication for expiration date.
1
10 Checks medication for clarity.
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Page 12 of 21
1
11 Checks the name and concentration of the medication.
1
12 Confirms the correct dose.
CPR
1
13 PRELOADED SYRINGE VIAL AMPULE
Opens vial, maintaining sterility of the top or 1

14 Assembles prefilled syringe and expels air. Ensures all medication is at bottom of ampule.
cleanses top with alcohol prep if vial already open.
b) Some preload systems require the needle cover b) Uses syringe size that allows filling with more 1
b) Wraps ampule in gauze or uses commercially-
15 be removed or the needle depressed before air than the dose so that dose will be correct when air
available ampule tool and breaks off top of ampule.
can be expelled. is expelled.
Injects same amount of air into vial as fluid to be c) Attaches a filter straw or filter needle to the sy- 1
16 ----
drawn out ringe.
1
17 ---- d) Draws up desired dose plus 10%. EMTs may choose to flip ampule upside down.
1
18 ---- Expels air from syringe and sets to desired dose. e) Draws up desired dose plus 10%.
Removes filter needle and disposes of it in sharps 1

19 ---- ----
container.
g) Attaches appropriate needle or needleless 1

20 ---- ----
adapter to syringe.
h) Expels air from syringe and sets to desired 1

21 ---- ----
dose.
POSSI- 2ND
BLE TAKE
1
1
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
SKILLS EVALUATION NO. 8 - H - INTRAVENOUS ACCESS

OBJECTIVE: The participants shall be able to correctly perform IV access POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
1
1
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Page 13 of 21
1
1
INTRAVENOUS ACCESS
1
8 Explains the procedure to the patient.
1
1
10 Selects proper solution, checks color, clarity, and expiration date.
1
11 Selects proper administration set.
1
12 Connects IV tubing to bag.
1
13 Partially fills drip chamber and flushes IV tubing.
1
14 Prepares tape or securing device.
1
15 Applies tourniquet.
1
16 Selects an appropriate vein.
1
17 Cleanses puncture site using aseptic technique.
1
18 Correctly performs venipuncture.
1
19 Notes blood return.
1
20 Advances catheter.
1
21 Tamponades the vein.
1
22 Removes needle and engages sharp-protective safety device.
1
23 (Optional) Obtains blood sample using aseptic technique. Properly labels blood tubes.
1
24 Removes tourniquet.
1
25 Attaches IV tubing to IV catheter.
1
26 Ensures that IV is flowing freely without signs of infiltration.
1
27 Adjusts drip rate to TKO.
1
28 Adequately secures IV.
1
29 Disposes of sharps appropriately.
POSSI- 2ND
BLE TAKE
1
1
1
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Page 14 of 21
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
⍟
Page 15 of 21
SKILLS EVALUATION NO. 8 - I - ADMINISTERING IV MEDS
OBJECTIVE: The participants shall be able to correctly perform IV Meds administration POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
1
1
1
1
ADMINISTERING IV MEDS
1
8 Assures medication is indicated for the patient.
1
9 Assembles necessary equipment and draws up medication (see Drawing Up Medications skill sheet for details).
1
10 Determines patient is not allergic to medication.
1
11 Cleanses injection port with alcohol prep.
1
12 Reaffirms correct medication and dose.
1
13 Pinches or clamps IV tubing above the injection port.
1
14 Ensures that IV is patent.
1
15 Administers correct dose at proper push rate.
1
16 Flushes tubing.
1
17 Readjusts drip rate to previous flow rate
1
18 Disposes of syringe and needle in sharps container.
1
19 Re-assesses patient for desired effect and possible adverse effects.
POSSI- 2ND
BLE TAKE
1
1
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Page 16 of 21
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
SKILLS EVALUATION NO. 8 - J - ADMINISTRATION OF SUBCUTANEOUS, INTRAMUSCULAR AND ENDOTRA -

CHEAL MEDICATIONS
OBJECTIVE: The participants shall be able to correctly perform Administration of meds in SQ, IM and ET medications POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
1
1
1
1
ADMINISTRATION OF SQ, IM AND ET MEDICATIONS
1
8 Assures medication is indicated for the patient.
1
1
10 Determines patient is not allergic to medication.
1
11 Checks medication for expiration date.
SQ, IM AND ET MEDICATION ADMINISTRATION
SUBCUTANEOUS INTRAMUSCULAR ENDOTRACHEAL
Ensures proper tube placement and adequate oxy- 1

12 Selects 25g 1/2 or 5/8" needle and 1 ml syringe Selects 19-21g 1 needle and up to 5 ml syringe.
genation and ventilation
Prepares medication by selecting 2-2.5 times the IV 1

13 b) Identifies injection site. b) Identifies injection site. dose and dilutes into 10 ml or prepares a 10 ml
flush
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Page 17 of 21
1
14 Cleanses puncture site using aseptic technique Cleanses puncture site using aseptic technique c) Pre-oxygenates the patient.
1
15 d) Elevates SQ tissue by pinching skin d) Holds skin taut at injection site d) Removes BVM and injects medication into tube
1
16 e) Inserts needle at 45 angle in one quick motion e) Inserts needle at 90 angle in one quick motion e) Follows drug with flush if not diluted
f) Aspirates for blood return. If no blood return, f) Aspirates for blood return. If no blood return, 1
smoothly and gently injects medications. If blood re- smoothly and gently injects medications. If blood
17 f) Reattaches BVM.
turns, withdraws needle, discard, and starts over at returns, withdraws needle, discard, and starts over
another site at another site
Resumes ventilation with several large breaths be- 1

18 g) Withdraws needle and massage site. g) Withdraws needle.
fore returning to normal rate and resuming CPR.
1
19 Disposes of all sharps in a sharps container.
1
20 Re-assesses patient for desired effect and possible adverse effects.
POSSI- 2ND
BLE TAKE
1
1
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
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Page 18 of 21
SKILLS EVALUATION NO. 8 - K - ADULT INTRAOSSEUS INFUSION
OBJECTIVE: The participants shall be able to correctly perform IO Infusion POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
1
1
1
1
ADULT INTRAOSSEUS INFUSION
1
8 Explains the procedure to the patient, if conscious.
1
9 Assembles equipment and fills syringe with appropriate fluid.
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Page 19 of 21
1
10 Exposes and selects proper anatomical site for IO infusion.
1
11 Cleans IO site using aseptic technique.
1
12 Inserts device at a 90 degree angle according to manufacturer’s instructions.
1
13 Manually stabilizes device.
1
14 Removes sharp and places in sharps container.
1
15 Attaches syringe according to manufacturer’s instructions and aspirates bone marrow if indicated.
1
16 Slowly pushes fluid and observes site for infiltration.
1
17 Attaches IV administration set and administers proper fluid.
1
18 Secures device.
1
19 Checks administration rate and IO site for infiltration.
POSSI- 2ND
BLE TAKE
1
1
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
SKILLS EVALUATION NO. 8 - L - PEDIATRIC INTRAOSSEUS INFUSION

OBJECTIVE: The participants shall be able to correctly perform CPR POINTS
# POSSI- 2ND
STEPS GIVEN
BLE TAKE
1
SCENE SAFETY
1
1
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Page 20 of 21
1
1
1
1
PEDIATRIC INTRAOSSEUS INFUSION
1
8 Explains the procedure to the patient’s parent or guardian, if present.
1
9 Assembles equipment and fills syringe with appropriate fluid.
1
10 Exposes and elects proper anatomical site for IO infusion (see manufacture’s recommendations).
1
11 Cleans IO site using aseptic technique.
1
12 Inserts device at a 90° angle and away from epiphysial plate.
Insert the device. Bone marrow aspiration needle penetrates the bone with firm pressure and a rotary ("screwdriver") motion. A "pop" and sudden lack of resis - 1
13
tance signaling entry into the marrow cavity Bone Injection Gun ® (BIG) E-Z IO ®
1
14 Manually stabilizes device.
1
15 Removes stylet (if applicable) and places in sharps container.
1
16 Attaches syringe and aspirates for marrow contents (if appropriate for device).
1
17 Flushes the device and observes site for infiltration.
1
18 Attaches IV administration set and administers proper fluid.
1
19 Secures device.
1
20 Checks administration rate and IO site for infiltration.
POSSI- 2ND
BLE TAKE
1
1
1
REMARKS P/F

_____________________________________________________________________________________________
_____________________________________________________________________________________________
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Page 21 of 21

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NAME: BATCH #

SKILLS EVALUATION SHEET CHECKLISTS

53 Delivering the Baby A

56 Applying a Pneumatic Antishock Garment (PASG) D

62 Administering SQ, IM, AND ET Medication J

MASS CASUALTY INCIDENT

DETERMINE PROPER BSI

Obtains the following information during patient history:

9 Explains the necessity of examining the patient for crowning. 1

10 If time allows, drapes the patient for examination. 1

11 Allow patient to choose position for delivery. 1

12 Observes for crowning or any presenting part. 1

16 Holds baby securely supporting the head and body. 1

17 Keeps infant level with vagina until cord is clamped. 1

19 Cuts the cord between the clamps. 1

21 Provides additional tactile stimulation if infant is blue, limp, or not breathing. 1

24 Continues to maintain the infant’s body temperature. 1

26 Does not perform uterine massage prior to delivery of the placenta. 1

30 Records time of delivery and APGAR scores. 1

FAILED - SCORES BELOW 25 PASSED - SCORES 25 AND ABOVE SCORE 33

PARTICIPANTS COMMENTS: _______________________________________________________________________

DETERMINE PROPER BSI

# POSSI- GIVEN 2ND

Evaluates respirations, heart rate and color: 1

FAILED - SCORES BELOW 12 PASSED - SCORES 12 AND ABOVE SCORE 16

PARTICIPANTS COMMENTS: _______________________________________________________________________

SKILLS EVALUATION NO. 8 - C - BASIC SHOCK TREATMENT

DETERMINE PROPER BSI

BASIC SHOCK TREATMENT

FAILED - SCORES BELOW 16 PASSED - SCORES 16 AND ABOVE SCORE 21

PARTICIPANTS COMMENTS: _______________________________________________________________________

SKILLS EVALUATION NO. 8 - D - PNEUMATIC ANTI SHOCK GARMENT

DETERMINE PROPER BSI

Inflates the leg sections until: 1

PARTICIPANTS COMMENTS: _______________________________________________________________________

DETERMINE PROPER BSI

ASSISTING WITH PRESCRIBED MEDICATION

Ask if the patient is taking a phosphodiesterase in- 1

Places the mouthpiece of the inhaler into the pa- 1

If pain persists administers 1 dose, every 3-5 min-

19 Re-assesses patient for desired effect and possible side effects. 1

FAILED - SCORES BELOW 17 PASSED - SCORES 17 AND ABOVE SCORE 22

PARTICIPANTS COMMENTS: _______________________________________________________________________

DETERMINE PROPER BSI

ASSISTING WITH NON PRESCRIBED MEDICATIONS

Has the patient drink the activated charcoal suspen- 1

FAILED - SCORES BELOW 15 PASSED - SCORES 15 AND ABOVE SCORE 20

PARTICIPANTS COMMENTS: _______________________________________________________________________

SKILLS EVALUATION NO. 8 - G - DRAWING UP MEDICATIONS

DETERMINE PROPER BSI

Opens vial, maintaining sterility of the top or 1

Removes filter needle and disposes of it in sharps 1

g) Attaches appropriate needle or needleless 1

h) Expels air from syringe and sets to desired 1

FAILED - SCORES BELOW 14 PASSED - SCORES 14 AND ABOVE SCORE 24

PARTICIPANTS COMMENTS: _______________________________________________________________________

SKILLS EVALUATION NO. 8 - H - INTRAVENOUS ACCESS

DETERMINE PROPER BSI

PARTICIPANTS COMMENTS: _______________________________________________________________________

DETERMINE PROPER BSI

FAILED - SCORES BELOW 17 PASSED - SCORES 17 AND ABOVE SCORE 22

PARTICIPANTS COMMENTS: _______________________________________________________________________

SKILLS EVALUATION NO. 8 - J - ADMINISTRATION OF SUBCUTANEOUS, INTRAMUSCULAR AND ENDOTRA -