PERFORMANCE EVALUATION:
DPI Administration

Lab Date:   Clinical Date: Agency Date:
Student Name:
Instructor Name:
Number of Times Observed in Clinical:
Number of Times Practiced in Clinical:
PASSING CRITERIA: Obtain 90% or better on the procedure. Tasks indicated by * must receive at least 1 point, or the evaluation# is terminated. Procedure must be performed within the designated time, or the performance receives a failing grade.
 
SCORING: 2 points -- Task performed satisfactorily without prompting.
1 point -- Task performed satisfactorily with self-initiated correction.
0 points -- Task performed incorrectly or with prompting required.
NA -- Task not applicable to the patient care situation.
 

Tasks:

Peer Lab Clinical
  1.

Verifies the physician's order

* 2.

Observes universal precautions, including washing hands

* 3.

Obtains the DPI

* 4.

Identifies the patient and introduces self

* 5.

Gives thorough and complete instructions

* 6.

Monitors the patient

     
   

a. Heart rate

   

b. Respiratory rate

   

c. Breath sounds

   

d. Peak expiratory flow

* 7.

Administers the DPI

* 8.

Monitors the patient following aerosol administration

     
    a. Heart rate
   

b. Respiratory rate

   

c. Breath sounds

   

d. Peak expiratory flow

  9.

Cleans up after the procedure

*

10.

Records the procedure in the patient's chart

           
  Score: Peer points of possible 28; %        
    Lab points of possible 28; %        
    Clinical points of possible 28; %        
             
  Time: out of possible 15 minutes        

STUDENT SIGNATURES INSTRUCTOR SIGNATURES
PEER: LAB:
STUDENT: CLINICAL: