Intravenous Bolus Medication Administration
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:
Hour
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Minutes
What class is the student in?
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A
B
C
Evening
A Shift
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Please Select
Brown
Crown
Downs
Friedman
Fuentes
Gonzales
Gosnell
Lombardi
Mccolgan
Patterson
Robinson
Stidham
B Shift
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Please Select
Chimenian
Clark
Collins
Cooper
Fowler
Lally
Pauley
Pavelka
Staub
Stoddard
Sword
C Shift
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Please Select
Begosh
Decker
Eckroade
Keeney
Kough
Leonard
Peterson
Santucci
Shaffer
Swann
Wigmore
Evening Class
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Please Select
Ale
Dana
Decamp
Flanary
Gunawardana
Hunt
Kaffi
Knoyer
Lopez-Puentes
Manon
Mejias
Olson
Sahadzic
Sakaria
Who is the Evaluator?
*
Instructor
A Shift Student Evaluator
B Shift Student Evaluator
C Shift Student Evaluator
Evening Class Student Evaluator
Instructor
*
Please Select
Burkhammer, Michele
Cleveland, Susan
Cordero, Jennifer
Cousins, Robert
Dugan, Pete
Gorodetsky, Nelly
Hayunga, Joe
Herman, Geoffrey
Hutchinson, David
Kauffman, Mike
Kinna, Donald
Le Renard, Yann
Leigh, Michael
Lipp, Troy
Lofland, Larry
Luger, Brian
Newman, David
Ney, Kirk
Nosbisch, Nick
Oliveira, Rae
Ruff, Greg
Scott, Tony
Shawl, Jon
Singer, Arye
Stottlemyer, Ty
Strudwick, Rosni
Sweder-Gold, David
Touzeau, Chris
Turcotte, Jeremy
Weinstock, Sam
Wooden, Andrew
Zea, Alejandro
A Shift Student Evaluator
*
Please Select
Brown
Crown
Downs
Friedman
Fuentes
Gonzales
Gosnell
Lombardi
Mccolgan
Patterson
Robinson
Stidham
B Shift Student Evaluator
*
Please Select
Chimenian
Clark
Collins
Cooper
Fowler
Lally
Pauley
Pavelka
Staub
Stoddard
Sword
C Shift Student Evaluator
*
Please Select
Begosh
Decker
Eckroade
Keeney
Kough
Leonard
Peterson
Santucci
Shaffer
Swann
Wigmore
Evening Class Student Evaluator
*
Please Select
Ale
Dana
Decamp
Flanary
Gunawardana
Hunt
Kaffi
Knoyer
Lopez-Puentes
Manon
Mejias
Olson
Sahadzic
Sakaria
Selects, checks, assembles equipment
IV medication
Sharps container
Alcohol swabs
Administers Medication
Takes or verbalizes appropriate PPE precautions
Confirms medication order
Asks patient for known allergies
Explains procedure to patient
Check medication for: Right patient
Check medication for: Right medication
Check medication for: Right dosage/concentration
Check medication for: Right rate
Check medication for: Right route
Check medication for: Expiration date
Assembles prefilled syringe correctly and dispels air
Identifies and cleanses most proximal injection site(Y-port or hub)
Reconfirms medication
Stops IV flow
Administers correct dose at proper push rate
Disposes/verbalizes proper disposal of syringe and other material in proper container
Turns IV on and adjusts drip rate to TKO/KVO
Verbalizes need to observe patient for desired effect and adverse side effects
Affective
Accepts evaluation and criticism professionally
Shows willingness to learn
Interacts with simulated patient and other personnel in professional manner
Critical Criteria
Failure to take or verbalize appropriate PPE precautions
Contaminates equipment or site without appropriately correcting situation
Failure to adequately dispel air resulting in the potential for air embolism
Injects improper medication or dosage (wrong medication, incorrect amount, administers at an inappropriate rate)
Recaps needle or failure to dispose/verbalize disposal of syringe and other material in proper container
Failure to turn on IV after administering medication
Failure to manage the patient as a competent EMT
Exhibits unacceptable affect with patient or other personnel
Uses or orders a dangerous or inappropriate intervention
Evaluator Comments
Was the student successful or unsuccessful in this skill?
*
Successful
Unsuccessful
Signature
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