Adult Vital Signs Evaluation

Email(Required)

Employed by:(Required)

Equipment and Patient Preparation

1. Reviews patient chart for significant findings and data(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

2. Identifies and gathers the necessary equipment(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

Implementation of Procedure

1. Measures pulse using one of the following sites: radial artery, brachial artery, dorsalis pedis or popliteal. Making sure to use the index and middle finger and assesses pulse for one minute.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

2. Measures respiratory rate for one minute without informing patient, to ensure an accurate number.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

3. Assesses saturation using a pulse oximeter. Appropriately places device on finger or alternate measuring site. Compares measured rate with palpated rate to evaluate accuracy of the device.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

4. Assesses blood pressure using sphygmomanometer and a stethoscope. Inflates cuff to an appropriate level for patient. Releases pressure at a rate that allows for accurate measurement of systolic and diastolic pressure, but not to slow to provide patient discomfort.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

5. Evaluates or measures temperature as appropriate.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

6. Validates vital signs with respect to patient condition or repeats measurement to confirm patient results.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

Follow-up

1. Decontaminates hands with an alcohol-based hand rub or performs a 15 second hand wash.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

2. Records relevant data in patient chart and appropriate departmental records.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

3. Provides modifications to patient care plan as needed, and reports this to appropriate personnel.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

Demonstrates Knowledge of Fundamental Concepts

1. Identifies need for assessing parameters for one minute(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

2. Identifies reason for not using thumb during pulse assessment.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

3. Identifies normal ranges for each of the above parameters.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

4. Identifies potential causes for patient values outside of the normal range(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

Clinical Competency Performance Criteria

1. Displays rational judgment and is able to explain the relationship between theory and clinical practice(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

2. Performs procedure in a reasonable time frame and with attention to appropriate detail(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

3. Maintains aseptic technique and takes appropriate safety precautions.(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

4. Communicates clearly, and in a courteous manner(Required)

Satisfactory

Unsatisfactory

Not observed

Not applicable

Additional comments: include errors of oversight or sequence, strengths and weaknesses during procedure (i.e. knowledge, communication skills, and patient interaction skills)

Please use the following criteria and select the appropriate pop-up menu.
Satisfactory - ready for clinical application with minimal supervision. Performed procedure accurately, or was able to correct performance without injury to the patient or decreasing effect of therapy being given.

Summary Performance Evaluation:(Required)

Satisfactory

Minor - Unsatisfactory

Major - Unsatisfactory

References

1. CDC, Guideline for Hand Hygiene in Healthcare Settings. MMWR Oct. 25, 2002; vol. 51(No. RR-16)
2. Scanlan CL, Wilkins RL, Stoller JK "Egan's Fundamentals of Respiratory Care" Mosby 8th ed, 2003, Chapter 14, p 317-320

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