ARMED FORCES OF THE PHILIPPINES MEDICAL CENTER ARMED FORCES OF THE PHILIPPINES MEDICAL SERVICE SCHOOL V.

Luna Road, Quezon City Competency Performance Checklist Providing Tracheostomy Care Student: _______________________________________ Element 1. 2. 3. 4. 5. 6. Introduced self and verified clients identity. Explained procedure to client and discussed how results will be used. Gathered appropriate equipment. Performed hand hygiene and observed other appropriate infection control. Provided for client privacy. Prepared client and equipment. a. Assisted client to semi-Fowlers or Fowlers position to promote lung expansion. b. Suctioned tracheostomy tube, if needed. c. If suctioning was required, allowed client to rest and restore oxygenation. d. Opened tracheostomy kit or sterile basins. e. Established sterile field. f. Opened other sterile supplies as needed. g. Poured soaking solution and sterile normal saline into separate containers. h. Applied clean gloves. i. Removed oxygen source. j. Unlocked inner cannula and removed it by gently pulling it outward toward self in line with its curvature. Placed inner cannula in soaking solution. k. Removed soiled tracheostomy dressing. Placed soiled dressing in gloved hand and peeled glove off so that it turned inside out over dressing. Removed and discarded gloves and dressing. Performed hand hygiene. l. Applied sterile gloves. Kept dominant hand sterile during procedure. 7. Remove and soaked inner cannula in hydrogen peroxide 8. Cleaned incision site and tube flange. a. Used sterile applicators or gauze dressings moistened with normal saline and cleaned incision site. b. Cleaned flange of tube. c. Thoroughly dried clients skin and tube flanges with dry gauze squares. 9. Applied sterile dressing. a. Used a commercially prepared tracheostomy dressing or opened and refolded a nonraveling 4 x 4 gauze dressing into a V shape. b. Placed dressing under flange of tracheostomy tube. c. Ensured that tracheostomy tube is securely supported while applying dressing. 10. Cleaned inner cannula. a. Removed inner cannula from soaking solution. b. Cleaned lumen and entire inner cannula thoroughly using brush or pipe cleaners moistened with sterile normal saline. Inspected cannula for cleanliness. Date: _______________ Competency Demonstrated? Yes No

c. Rinsed inner cannula thoroughly in sterile normal saline. d. After rinsing, gently tapped cannula against inside edge of sterile saline container. Used pipe cleaner folded in half to dry only inside of cannula. 11. Replaced inner cannula and secured it in place. a. Inserted inner cannula by grasping outer flange and inserting cannula in direction of its curvature. b. Locked cannula in place by turning lock into position to secure flange of inner cannula to outer cannula. 12. Changed tracheostomy ties. a. Changed as needed to keep skin clean and dry. 13. Removed and discarded sterile gloves. Performed hand hygiene. ___ Used effective body mechanics throughout procedure. ___ Communicated appropriately with the client. ___ Documented all relevant information. Comments: ______________________________________________________________________________ ______________________________________________________________________________ Overall Performance: Satisfactory Unsatisfactory Evaluator: _______________________________