Clinical Skills Evaluation Sheets Packet 1: Vital Signs

Evaluator Name

First NameLast Name

Candidate Name

First NameLast Name

Testing Site Name

Date

Time

:HourMinutesAM/PM Option

AECA: CS1 Oral Temperature Competency Check

	Perform (YES)	Perform (NO)
1. Assemble equipment and supplies
2. Wash hands / Wear gloves (follow standard precautions)
3. Greet the patient
4. Identify yourself (name & designation)
5. Identify patient (full name & date of birth)
6. Explain procedure & inquire about activity , diet & medication
7. Ask the patient about recent activities
8. Remove thermometer from case
9. Inspect & disinfect the thermometer
10. Apply thermometer probe cover
11. Switch thermometer on
12. Check display window for “ready” signal
13. Insert sublingually
14. Wait for the thermometer to beep
15. Withdraw thermometer/read the results
16. Remove probe cover and discard in biohazard waste
17. Disinfect the thermometer
18. Remove gloves and discard
19. Wash hands
20. Record results in patient chart accurately

Select the steps that the candidate is:

Evaluator Comments (Reference: CS1 Oral Temperature Competency Check)

AECA: CS2 Pulse Rate Competency Check

	Perform (YES)	Perform (NO)
1. Assemble equipment and supplies (timer/stopwatch)
2. Wash hands (follow standard precautions)
3. Greet the patient
4. Identify yourself (name & designation)
5. Identify patient (full name & date of birth)
6.Explain procedure & inquire about activity,diet & medication
7. Position patient comfortably
8. Locate the pulse using proper finger placement
9. Palpate & describe the quality of the pulse
10. Count beats per minute
11. Record results in the patient chart
12. Wash hands

Select the steps that the candidate is:

Evaluator Comments (Reference: CS2 Pulse Rate Competency Check)

AECA: CS3 Respiration Competency Check

	Perform (YES)	Perform (NO)
1. Assemble equipment and supplies
2. Wash hands (follow standard precautions)
3. Greet the patient
4. Identify yourself ( name & designation )
5. Identify patient (full name & date of birth)
6. Ask the patient about recent activities influencing the respiratory rate
7. Position patient comfortably
8. Observe the rise and fall of the chest (inspiration and expiration) ‐this counts as one breath.
9. Assess & verbally describe the quality of the respiration
10. The respirations should be counted for a full minute in order tohave an accurate recording.
11. Record results in patient chart

Select the steps that the candidate is:

Evaluator Comments (Reference: CS3 Respiration Competency Check)

AECA: CS4 Blood Pressure Competency

	Perform (YES)	Perform (NO)
1. Assemble equipment and supplies
2. Disinfect earpieces and head of stethoscope
3. Wash hands ( follow standard precautions )
4. Greet the patient
5. Identify yourself ( name & designation )
6. Identify patient ( full name & date of birth )
7. Explain procedure & inquire about activity , diet & medication
8. Position patient comfortably
9. Squeeze all air from bladder cuff of the sphygmomanometer
10. Close valve of the sphygmomanometer
11. Expose patient’s arm and apply cuff at an appropriate location
12. Palpate/Locate brachial artery by using index & middle finger
13. Tap the head of the stethoscope for audible sound
14. Position stethoscope on the brachial artery
15. Inflate cuff as directed
16. Open valve slowly as directed to deflate the cuff
17. Note first sound heard in the earpieces of the stethoscope (systolic pressure)
18. Note last sound heard in the earpieces of the stethoscope (diastolic pressure)
19. Release remaining air
20. Remove stethoscope and cuff from patient’s arm ( fully deflate the cuff )
21. Clean equipment/ return to storage
22. Record results

Select the steps that the candidate is:

Evaluator Comments (Reference: CS4 Blood Pressure Competency Check)

Evaluator Signature

Clinical Skills Evaluation: Vital Signs (4 Skills)