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Checkoff Topic: Activity O2 Check - #A.02 - Oxygen Check

School Name: Demo Testing SandBox Community College - STANDARD



Section 1: Equipment and Patient Preparation

ONLY check NO in this section if the student does not complete a step, and please COMMENT on the reason for the missed step, if appropriate.

TASK (* = must score at least 4 out of 5 points to pass)

Equipment Used

Verifies, interprets and evaluates physician's order

  N/A

  No

  Yes

Identifies patient, self, and department

  N/A

  No

  Yes

Explains procedure and confirms patient understanding

  N/A

  No

  Yes

Selects, gathers, and assembles appropriate equipment; Washes hands and applies gloves

  No

  Yes

Section 2: PEF Activity #A.02 - O2 Check - Oxygen Check

ONLY check NO in this section if the student does not complete a step, and please COMMENT on the reason for the missed step, if appropriate.

Obtains an H and E cylinder and appropriate regulators from storage areas

  No

  None

  Yes

Maneuvers the cylinder onto cart

  No

  None

  Yes

Secures the cylinder to the cart with the safety chain

  No

  None

  Yes

Tilts the cart upright

  No

  None

  Yes

Removes the cylinder valve cap and gives an audible warning of the impending noise

  No

  None

  Yes

Cracks the cylinder with safe hand and valve positions

  No

  None

  Yes

Selects the correct reducing valve/regulator for intended use

  No

  None

  Yes

Secures the reducing valve/regulator to the cylinder

  No

  None

  Yes

Checks for and corrects any leaks

  No

  None

  Yes

Calculates the amount of time before the cylinder must be changed at a liter flow designated by the instructor

  No

  None

  Yes

Demonstrates proper “bleeding” of the regulator prior to removing and properly removes regulator

  No

  None

  Yes

Uses safe handling procedures and demonstrates a clear understanding of the proper transporting and securing of O2 tanks

  No

  None

  Yes

Section 3: Follow-up Assessment

ONLY check NO in this section if the student does not complete a step, and please COMMENT on the reason for the missed step, if appropriate.

Reassures and resettles patient; Discards gloves and washes hands

  N/A

  No

  Yes

Records pertinent data in chart and departmental records

  N/A

  No

  Yes

Notifies appropriate personnel

  N/A

  No

  Yes

Maintains proper equipment function

  N/A

  No

  Yes

Section 4: Comments and Suggestions or Missed Steps Above

Comments and suggestions or steps missed above

(Note ANY and ALL dangerous actions; note advanced skills/knowledge.)

Section 5: Performance Evaluation and Supervision Recommendation

MOTOR SKILLS:

   A. Score 100 - 93 (5) | Good in dexterity and coordination

   B. Score 92 - 88 (4) | Slow and deliberate without significant errors

   C. Score 87 - 75 (3) | Awkward poor in coordination or equipment manipulation

   D. Score 74 - 63 (2) | Overtly careless with little attention to detail

KNOWLEDGE:

   A. Score 100 - 93 (5) | Understanding of basic concepts beyond the average student

   B. Score 92 - 88 (4) | Adequate knowledge of essential elements (basically safe)

   C. Score 87 - 75 (3) | Limited understanding of basic elements (requires supervision)

   D. Score 74 - 63 (2) | Inadequate understanding of basic concepts (maybe hazardous)

PROMPTING REQUIRED WAS:

   A. Score 100 - 93 (5) | Performs correctly with minimal prompts

   B. Score 92 - 88 (4) | Moderate (basically safe)

   C. Score 87 - 75 (3) | Unable to complete task without frequent hinting

   D. Score 74 - 63 (2) | Unable to complete task without direct instruction

SUPERVISION REQUIRED FOR NEXT PERFORMANCE:

   A. NONE 100 - 93 (5) | CI need only be available on floor

   B. MINIMAL 92 - 88 (4) | CI need only be available on specific care unit

   C. MODERATE 87 - 75 (3) | Requires CI presence

   D. CLOSE 74 - 63 (2) | Requires CI presence and instruction

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