interdisciplinary procedure manual for health workers of
TRANSCRIPT
Interdisciplinary Procedure Manual for Health Workers of Liberia Student Log Book
Name of student: ______________________________
Name of school: ______________________________
This log book was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The Rebuilding Basic Health Services (RBHS) Project is implemented by JSI Research and Training Institute, Inc., in collaboration with the Johns Hopkins Center for Communications Programs (JHUCCP), Jhpiego, and Management Sciences for Health (MSH).The contents are the responsibility of the RBHS Project and do not necessarily reflect the views of USAID or the United States Government. © 2013 by Jhpiego Corporation, an affiliate of The Johns Hopkins University. All rights reserved. Published by: Jhpiego Brown’s Wharf 1615 Thames Street Baltimore, Maryland 21231, USA www.jhpiego.org
INTRODUCTION
Hands-on and experiential learning to ensure competency for health providers is very important. That is why the Liberia Interdisciplinary Procedure Manual (IPM) was developed. The checklists, protocols, and job aids in the manual are designed to assist students in practicing and preparing to become competent health care providers. This log book is a supplement to the newly developed IPM. As such, it is meant to increase students’ awareness of the most important skill they need to be competent in before graduation. The log book is to be used as an educational guide for the students and an assessment guide for the faculty. Please note that, while the log book documents procedures with specific checklists that have been validated in the IPM, these are not the only procedures or skills that students need to be competent in before graduation. Faculty are responsible for assigning other procedures in the IPM (such as 5: Basic Hospital Procedures—Bed Making, Oral Care, Bed Bath, Hair and Body Care, and Patient’s Positions of Comfort or 19.1 and 19.2: Management of the sick child or 24: Management of Pre-Eclampsia/Eclampsia) to ensure student competency before graduation. Having a written log book from the beginning of clinical education not only can help the student learn better, it also allows the learner to record his/her learning practices. The log book can be used as a tool for continuous assessment, to record ongoing interaction between the instructor and student, and to provide a feedback loop for evaluating learning activities. This log book can be used to document evidence of competency in the procedures necessary for quality patient care. Proper documentation in the log book provides proof to the institution that a student has completed the procedure accurately as outlined in the IPM and required for graduation. This log book is required for validating the procedural experience at the advanced training level and reduces the repetition of trials between the basic and advanced training levels.
HOW TO USE THE LOG BOOK
Each student will be given a personal log book when training begins. The student is to save the book and record the dates of clinical practice: when the procedure was first performed with the instructor/clinical preceptor, the student’s first trial with the instructor/clinical preceptor observing, and, if necessary, repeat trials. The instructor/clinical preceptor is to document feedback and sign for each procedure/trial. The log book will be checked at the beginning, midterm, and end of each semester. Faculty are encouraged to assist students in seeking and carrying out required procedures as well as completing all procedures before graduation.
Student Log Book Table of Contents
Checklist 1: Admission .............................................................................. 1 Checklist 2: Admission of a Woman in Labor ............................................ 2 Checklist 3: Physical Examination of a Pregnant Woman ......................... 3
Checklist 3.1: Antenatal History Taking .................................................... 4 Checklist 6: Bimanual Compression ......................................................... 5 Checklist 7: Bladder Irrigation ................................................................... 6 Checklist 8: Blood Transfusion .................................................................. 7
Checklist 9.1: Supporting Successful Breastfeeding Checklist ......................... 8 10: Cardiopulmonary Resuscitation .......................................................... 9
Checklist 11.1: Catheterization (Female) ................................................ 10
Checklist 11.2: Catheterization (Male) .................................................... 11 Checklist 12: Cervical Laceration Repair ................................................ 12
Checklist 14.1: Breech Delivery .............................................................. 13
Checklist 14.2: Conducting Delivery of Face Presentation (Mento-Anterior) .................................................... 14
Checklist 14.3: The Management of Woman in Labor with Baby in Occiput Posterior Position.......................................................... 15
Checklist 14.4: Monitoring Labor Progress Using the Partograph .......... 16
Checklist 14.5: Normal Delivery and Active Management of Third Stage of Labor ............................................................................... 17
Checklist 14.6: Twin Delivery .................................................................. 18
Checklist 15: Enema Administration ....................................................... 19 Checklist 16: Episiotomy Repair ............................................................. 20 Checklist 17: Family Planning Counseling .............................................. 21
Checklist 17.2: COC— Assessment and Counseling for Combined Oral Contraceptive Use ...... 22
Checklist 17.4: Condoms—Condom Use (Male) and Disposal Checklist .................................................................................. 23
17.5: DMPA—DMPA Provision ............................................................... 24
Checklist 17.6: EC—Emergency Contraception Provision ...................... 25
Checklist 17.7: IUD—Loading Copper T IUD in a Sterile Package ......... 26
Checklist 17.8: IUD—IUD Insertion and Removal ................................... 27
Checklist 17.8.1: IUD—IUD Insertion ...................................................... 28
Checklist 17.9: Jadelle—Jadelle® Insertion and Removal ...................... 29
Checklist 17.11: POP—Assessment and Counseling for Progestin-Only Pill Contraceptive Use .................................................... 30 Checklist 18: Gastric Lavage .................................................................. 31
Checklist 20.2: Decontamination and Cleaning of Gloves, Instruments, and Equipment ................................................................... 32
Checklist 20.3: Hand Hygiene ................................................................. 33
Checklist 20.4: High-Level Disinfection—Boiling..................................... 34
Checklist 20.5: High-Level Disinfection—Steaming ................................ 35 Checklist 22: Kangaroo Mother Care ...................................................... 36 Checklist 23: Malaria Rapid Diagnostic Test ........................................... 37 Checklist 25: Management of Prolapsed Cord ........................................ 38 Checklist 26: Management of Shock ....................................................... 39 Checklist 28: Manual Removal of Placenta ............................................. 40 Checklist 29: Manual Vacuum Aspiration ................................................ 41 Checklist 30: Measuring Upper Arm Circumference (MUAC) ................. 42
Checklist 31.1: Administering an Intramuscular Injection ........................ 43
Checklist 31.2: Administering Nasal Installation ..................................... 44
Checklist 31.3: Administering Oral Medications ...................................... 45
Checklist 31.4: Establishing a Peripheral Intravenous Line .................... 46
Checklist 31.5: Establishing Two IV Lines .............................................. 47
Checklist 31.7: Ophthalmic Medication Administration ........................... 48
Checklist 31.8: Otic Medication Administration ....................................... 49
Checklist 31.9: Rectal Medication Administration ................................... 50
Checklist 31.10: Respiratory Medication Administration ......................... 51
Checklist 31.11: Transdermal Medication Administration ....................... 52 Checklist 33: Nasogastric Tube Insertion ................................................ 53
Checklist 33.1: Nasogastric (NG) Tube Gavage ..................................... 54
Checklist 33.2: Nasogastric (NG) Tube Gavage (For Babies and Children) ....................................................................... 55
Checklist 35.1: Bathing an Infant ............................................................ 56
Checklist 35.2: Newborn Eye Care ......................................................... 57
Checklist 35.3: Newborn Examination .................................................... 58
Checklist 35.3.1: Measuring Infant Body Temperature ........................... 59
Checklist 35.4: Newborn Resuscitation ................................................... 60 Checklist 37: Oxygen Administration ...................................................... 61 Checklist 37.1: Applying a Nasal Cannula .............................................. 62
Checklist 38: Physical Examination Checklist ......................................................... 63
38.1: Abdominal Examination ................................................................. 64
Checklist 38.2: Breast Examination ........................................................ 65
Checklist 38.3: Cardiac Examination ...................................................... 66
Checklist 38.6: Iliopsoas Sign ................................................................. 67
Checklist 38.7: Measuring Blood Pressure ............................................. 68
Checklist 38.9: Musculoskeletal Examination ......................................... 69
Checklist 38.10: Neuro Check ................................................................. 70
Checklist 38.11: Oral Examination/Examination of the Pharynx ............. 71
Checklist 38.12: Rectal Examination ....................................................... 72
Checklist 38.13: Respiratory Examination .............................................. 73
Checklist 38.14: Taking Axillary Temperature with Mercury Thermometer ..................................................................... 74
Checklist 38.15: Taking an Apical Pulse ................................................. 75
Checklist 38.16 Taking a Radial Pulse .................................................... 76
Checklist 38.17 Taking Respirations ....................................................... 77
Checklist 38.18.1: Swallow Test ............................................................. 78
Checklist 39: Postnatal Discharge Instructions— Newborn Danger Signs ........................................................................... 79
Checklist 39.1: Pre-Discharge Postpartum Interview and Physical Examination ............................................................................................ 80
Checklist 40.1: Putting on and Removing Sterile Gloves ........................ 81
Checklist 40.2: Setting Up a Sterile Field ................................................ 82
Checklist 41: Sputum Specimen Collection ............................................ 83
Checklist 42.1: Stool Specimen Collection .............................................. 84
Checklist 42.2: Urine Specimen Collection ............................................. 85 Checklist 44: Suture Removal ................................................................. 86
Checklist 45.1: Conducting a Vaccine Shake Test ................................. 87
Checklist 45.2: Loading a Cold Box for Use in Outreach Procedure ....... 88
Checklist 45.3: Loading a Vaccine Refrigerator ...................................... 89
Checklist 45.4: Reconstituting Measles Vaccine ..................................... 90
Checklist 45.5: Vaccination Education and Administration ..................... 91
Checklist 46: Venipuncture Blood Collection .......................................... 92
Checklist 47.1: Cleaning and Dressing a Wound with a Dry, Sterile Dressing .................................................................................................. 93
Checklist 47.2: Dressing a Simple Wound .............................................. 94
Checklist 47.3: Incision and Drainage ..................................................... 95
Checklist 47.4: Irrigating Wounds ........................................................... 96
Checklist 47.6: Sterile Dressing Change ................................................. 97
1: Admission
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
1
2: Admission of a Woman in Labor
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
2
3: Physical Examination of a Pregnant Woman Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
3
3.1: Antenatal History Taking
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
4
6: Bimanual Compression Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
5
7: Bladder Irrigation Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
6
8: Blood Transfusion
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
7
9.1: Supporting Successful Breastfeeding
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
8
10: Cardiopulmonary ResuscitationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
9
11.1: Catherization (Female)Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
10
11.2: Catherization (Male)Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
11
12: Cervical Laceration RepairDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
12
14.1: Breech DeliveryDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
13
14.2: Conducting Delivery of Face Presentation (Mento-Anterior)Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
14
14.3: The Management of Woman in Labor with Baby in Occiput Posterior PositionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
15
14.4: Monitoring Labor Progress Using the Partograph
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
16
14.5: Normal Delivery and Active Management of Third Stage of LaborDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
17
14.6: Twin DeliveryDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
18
15: Enema AdministrationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
19
16: Episiotomy RepairDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
20
17: Family Planning CounselingDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
21
17.2: COC—Assessment and Counseling for Combined Oral Contraceptive UseDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
22
17.4: Condoms—Condom Use (Male) and DisposalDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
23
17.5: DMPA—DMPA ProvisionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
24
17.6: EC—Emergency Contraception ProvisionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
25
17.7: IUD—Loading Copper T IUD in a Sterile Package
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
26
17.8: IUD—IUD Insertion and RemovalDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
27
17.8.1: IUD—IUD InsertionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
28
17.9: Jadelle—Jadelle® Insertion and RemovalDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
29
17.11: POP—Assessment and Counseling for Progestin-Only Pill Contraceptive UseDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
30
18: Gastric LavageDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
31
20.2: Decontamination and Cleaning of Gloves, Instruments, and EquipmentDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
32
20.3: Hand HygieneDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
33
20.4: High-Level Disinfection—BoilingDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
34
20.5: High-Level Disinfection—SteamingDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
35
22: Kangaroo Mother CareDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
36
23: Malaria Rapid Diagnostic TestDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
37
25: Management of Prolapsed CordDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
38
26: Management of ShockDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
39
28: Manual Removal of PlacentaDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
40
29: Manual Vacuum AspirationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
41
30: Measuring Upper Arm Circumference (MUAC)Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
42
31.1: Administering an Intramuscular InjectionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
43
31.2: Administering Nasal InstallationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
44
31.3: Administering Oral MedicationsDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
45
31.4: Establishing a Peripheral Intravenous LineDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
46
31.5: Establishing Two IV LinesDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
47
31.7: Ophthalmic Medication AdministrationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
48
31.8: Otic Medication AdministrationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
49
31.9: Rectal Medication AdministrationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
50
31.10: Respiratory Medication AdministrationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
51
31.11: Transdermal Medication AdministrationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
52
33: Nasogastric Tube InsertionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
53
33.1: Nasogastric (NG) Tube GavageDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
54
33.2: Nasogastric (NG) Tube Gavage (For Babies and Children)Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
55
35.1: Bathing an InfantDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
56
35.2: Newborn Eye CareDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
57
35.3: Newborn ExaminationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
58
35.3.1: Measuring Infant Body TemperatureDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
59
35.4: Newborn ResuscitationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
60
37: Oxygen Administration Checklist: Applying a Nasal CannulaDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
61
37.1: Applying a Nasal Cannula
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
62
38: Physical Examination ChecklistDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
63
38.1: Abdominal ExaminationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
64
38.2: Breast ExaminationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
65
38.3: Cardiac ExaminationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
66
38.6: Iliopsoas SignDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
67
38.7: Measuring Blood PressureDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
68
38.9: Musculoskeletal ExaminationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
69
38.10: Neuro CheckDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
70
38.11: Oral Examination/Examination of the Pharynx
Date of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
71
38.12: Rectal ExaminationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
72
38.13: Respiratory ExaminationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
73
38.14: Taking Axillary Temperature with Mercury ThermometerDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
74
38.15: Taking an Apical PulseDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
75
38.16: Taking a Radial PulseDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
76
38.17: Taking RespirationsDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
77
38.18.1: Swallow TestDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
78
39: Postnatal Discharge Instructions—Newborn Danger SignsDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
79
39.1: Pre-Discharge Postpartum Interview and Physical ExaminationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
80
40.1: Putting on and Removing Sterile GlovesDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
81
40.2: Setting Up a Sterile FieldDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
82
41: Sputum Specimen CollectionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
83
42.1: Stool Specimen CollectionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
84
42.2: Urine Specimen CollectionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
85
44: Suture RemovalDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
86
45.1: Conducting a Vaccine Shake TestDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
87
45.2: Loading a Cold Box For Use in Outreach ProcedureDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
88
45.3: Loading a Vaccine RefrigeratorDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
89
45.4: Reconstituting Measles VaccineDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
90
45.5: Vaccination Education and AdministrationDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
91
46: Venipuncture Blood CollectionDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
92
47.1: Cleaning and Dressing aWound with a Dry, Sterile DressingDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
93
47.2: Dressing a Simple WoundDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
94
47.3: Incision and DrainageDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
95
47.4: Irrigating WoundsDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
96
47.6: Sterile Dressing ChangeDate of first performance:
Comments of faculty/clinical preceptor:
Signature of faculty/clinical preceptor:
Date of 2nd trial: Satisfactory: Yes No
Comments:
Signature of faculty/clinical preceptor:
Date of 3rd trial: Competent: Yes No
Comments:
Signature of faculty/clinical preceptor:
97
