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University of Ottawa/Algonquin College NSG 3305 Practicum-Med-Surg
LAB EVALUATION GRADING RUBRIC
IV PRIMARY INFUSION
DATE:
Start time: End time:
□ 1st evaluation
□ Retake
□ Video
□ Satisfactory
□ Satisfactory with
remediation
□ Non-Satisfactory
STUDENT NAME (Last name first):
STUDENT N O^ : LAB TEACHER :
EVALUATOR:
In case of any error or omission, the student must verbalize in real time that an error took place and must explain how to rectify the situation. If the error or omission is not verbalized by the student in real time, then the student will be marked in accordance with the rubric. Any error/omission identified and corrected may still result in a non-Satisfactory mark (NS).
IV PRIMARY INFUSION
Clinical Scenario: Lesley is 12 hours post-op from a cholecystectomy. She has an infusion of Lactated Ringer’s running which has now completed.
Lesley now requires a change of IV solution/tubing and the new setting needs to be programmed in the electronic infusion pump.
Identification No.: 7-958-
Mai, Lesley
DOB: 09/01/
Allergies: NKDA
Medical order: -IV 0.9% NaCl at increased rate if signs of dehydration or decreased urine output. -IV D5W if the patient is stable but remains NPO -IV 0.9% NaCl for fluid maintenance until discharge criteria are met.
Indicate scenario selected here:
IV solution:
Rate in ml/hr:
2
INTRODUCTION COMMENTS/STUDENT ANSWER
□ Review Medical Chart, Orders and MAR Order is complete, dated and signed by MD MAR is properly transcribed from doctor’s orders (if necessary) □ Hand hygiene □ Introduce self (name and designation) □ Patient verification: Compare bracelet with chart/MAR. Use 2 identifiers: Name and DOB □ Assess patient’s history of allergies □ Inform client of goal/purpose of interaction; obtain consent
IV SITE ASSESSMENT
IV Site Assessment for signs and symptoms of phlebitis or infection. □ Check that the IV transparent dressing is dry and intact. □ Check for fluid leaking □ Redness, Pain, Swelling (Edema) □ Hand hygiene
IV Site Patency
□ Purge air from prefilled normal saline 0.9% syringe. □ Apply gloves and cleanse saline lock with alcohol swab (30 sec) and let dry for 30 seconds □ Check for blood return by pulling back on plunger of syringe □ Flush saline lock with a minimum of 3ml N/S using a pulsatile technique (stop- start) while observing for signs of swelling or pain.
INTERVENTION / TECHNIQUE and VERIFICATIONS
INITIATING AND REGULATING INTRAVENOUS INFUSIONS
Pre-Administration Verifications
Gather Equipment: □ Retrieve IV Primary Administration tubing set □ Retrieve correct bag of IV solution □ Inspection of the IV solution: □ Check solution’s expiration date □ Check solution for presence of precipitate or discoloration □ Retrieve IV tubing label □ Retrieve IV pole □ Retrieve volumetric pump □ Adjust height of IV pole to allow at least 72.6cm (30 inches) above IV site
Calculating the IV flow rate: □ Compare the IV solution bag against the med profile (MAR) making sure to do the “6 rights” □ Determine the flow rate (mL/hr) according to the medical order
Maintained sterility throughout the whole IV fluid administration process.
4
Connecting Primary Administration Set for administration □ Cleanse saline lock with alcohol swab (30 sec) and let dry for 30 seconds □ Remove the cap on the distal end of the primary tubing and carefully insert in saline lock □ Programs the pump according to the desired rate and volume to be infused (VTBI) □ Ensure roller clamp of primary tubing is open □ Ensure IV solution is infusing before leaving room □ Perform hand hygiene and leave the patient’s room
Documentation □ In the MAR (time and sign off)
Total volume to be infused verbalized by student______ ml
IV rate set by student: _ _ _ _ ml/h
CLIENT TEACHING / EFFECTIVE COMMUNICATOR
Subject: IV solution □ Discussed purpose and action of IV solution □ Allowed patient to ask questions □ Encourage patient to notify the health care provider if IV site becomes red, painful, or swollen, or if patient notices any adverse effects from the infusion □ Information was relevant, adequate, and specific
OVERALL PERFORMANCE AND PROFESSIONALISM
□ Student demonstrated an organized and well-structured assessment/intervention and were agile with equipment
□ Student completes proper steps and sequencing as per the rubric
□ The patient is not displaced/repositioned unnecessarily
□ Student adheres to dress code (scrubs, name tag, proper footwear, hair tied)
□ Student communicates with facilitator respectfully
5
RESULTS RECOMMENDATIONS
Satisfactory - competent: Meets expected competencies
Recommendation: □ None
Satisfactory – needs extra practice:
Meets expected competencies
Recommendation : □ Additional practice required to receive satisfactory
Non-Satisfactory: Does not meet expected competencies
Recommendation : □ Additional practice required □ Retake evaluation: to take place in the lab setting with a lab facilitator or in the clinical setting depending on available opportunity with the clinical instructor □ Last attempt video submission: to take place upon a non-successful retake
CRITICAL ELEMENTS:
Summarize the issues:
CAUTIONS:
Summarize the issues:
