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Name: __________________________________________ Date: _____________ Score: _____________
Competency Checklist
Procedure 39–4 Screen Visual Acuity with a Snellen Chart
ABHES Curriculum
MA.A.1.4.a Follow documentation guidelines
MA.A.1.9.a Practice standard precautions and perform disinfection/sterilization techniques
MA.A.1.9.e Perform specialty procedures
CAAHEP Core Curriculum
I.P.8 Instruct and prepare a patient for a procedure or a treatment
I.A.1 Incorporate critical thinking skills when performing patient assessment
I.A.2 Incorporate critical thinking skills when performing patient care
I.A.3 Show awareness of a patient’s concerns related to the procedure being performed
V.A.4 Explain to a patient the rationale for performance of a procedure
X.P.3 Document patient care accurately in the medical record
Task: To measure the distant visual acuity of a patient.
Supplies and Conditions: Snellen chart, pointer, ocular eye occluder, patient chart/ EHR, and a pen.
Standards: A maximum of three attempts may be used to complete the task. The time limit for each attempt
is 10 minutes, with a minimum score of 70 percent. Scoring: Determine student’s score by
dividing points awarded by total points possible and multiplying results by 100.
EVALUATION
Evaluator Signature: Date:
Evaluator Comments:
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© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Name: __________________________________________ Date: _____________ Score: _____________
Procedure 39–4 Steps
Start Time: End Time: Total Time:
Steps
Possible
Points
First
Attempt
Second
Attempt
Third
Attempt
1. Identify the patient, introduce yourself, and explain
the rationale for performance of the procedure. Show
awareness of the patient’s concerns related to the
procedure being performed.
15
2. Ask the patient to read the chart with both eyes (OU)
first, standing 20 feet from the chart. Incorporate
critical thinking skills when performing patient
assessment and care.
15
3. To test acuity of the right eye, have the patient cover
the left eye with an occluder.
15
4. Record the smallest line the patient can read without
making a mistake.
15
5. Have the patient cover his or her right eye and test
acuity of the left, following the same procedure.
15
6. Record the number of the smallest line the patient can
read.
15
Points Awarded / Points Possible ____/
90
538