Operating Room Checklist

CU-QMS-NURSING-0013 CAPITOL UNIVERSITY COLLEGE OF NURSING

EVALUATION OF CLINICAL PERFORMANCE IN THE OPERATING ROOM Name:______________________________________ Date of Assignment:_________________________

Year: _______________________ Final Rating:_________________

I:

Knowledge and Understanding ----------------------------------------------------------------------35% At the end of 4 weeks, the student is expected to: 1. Explain the important scientific principles in the nursing care plan Pre-operative and post operative patients in O.R. --------------------------------------- 5% 2. Explain intelligently the Pathophysiology of the disease condition of the patients ----------------------------------------------------------------------10% 3. Identify correctly signs and symptoms of impending complications referable to the disease condition of the pre-operative patients ----------------5% 4. State the action, contraindications, usual dosage, and side effects if Anesthetic agents and other drugs are used by the patient -----------------------------5% 5. State the correct surgical aseptic techniques in the performance of nursing procedure in the O.R. -----------------------------------------------------------10%

II:

Skills and Activities --------------------------------------------------------------------------------40% 1. Implements planned nursing care inside the O.R. by a. preparing the patient physical and emotional -------------------------------------5% b. preparing the necessary instruments and articles needed for the operation ---------------------------------------------------------------------5% 2. Perform effectively the duties and responsibilities of the scrub nurse ------------------------------------------------------------------------------5% 3. Perform effectively the duties and responsibilities of the circulating nurse -----------------------------------------------------------------------------------------5% 4. Carries out physician’s order accurately ----------------------------------------------5% 5. Writes accurate, concise and legible recording -----------------------------------5% 6. Communicates effectively with the operative team regarding Patients condition in the O.R. ---------------------------------------------------------5% 7. Anticipates the needs of the operative team before, during and after course of the operation ---------------------------------------------------------5%

III:

Professional and personal Assets -----------------------------------------------25% 1. Attitudes, appreciation’s and interest a. Accept nursing service responsibilities with interest and eagerness to work and to use learning opportunities ---------------------5% b. Accept constructive criticism and profit form it --------------------------5% c. Establishes good relationship with the patient, Family and other health team members --------------------------------------5% d. Finishes work load and submits report on time ---------------------------5% 2.

Personal Habits a. Neat clean in appearance, and mindful of personal hygiene -------------------b. Honest courteous and respectful --------------------------------------------------Total

2% 3% 100%

Instructor. Head nurse remark

_________________________ Student Signature

_____________________________ Instructor/Head nurse’s signature

Issue: 05 April 2006

Revision Code: 003