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Name: __________________________________________ Date: _____________ Score: _____________
Competency Checklist
Procedure 39–7 Perform Spirometry Testing
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.2.d Perform pulmonary function testing
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: Evaluate patients suspected of having pulmonary insufficiency.
Supplies and Conditions: Spirometer and disposable mouthpieces, 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 20 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 39–7 Steps
Start Time: End Time: Total Time:
Steps
Possible
Points
First
Attempt
Second
Attempt
Third
Attempt
1. Obtain the spirometer machine; assemble the
necessary equipment and supplies; wash hands.
Incorporate critical thinking skills when performing
patient assessment and care.
15
2. 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
3. Be sure the patient is in a comfortable position and any
restrictive clothing (such as a tie or collar) is loosened
before initiating the procedure.
15
4. Instruct the patient to sit or stand as straight as
possible and not bend at the waist while blowing into
the disposable mouthpiece.
15
5. Instruct the patient to make a tight seal around the
mouthpiece with the lips.
15
6. After telling the patient to take deep breaths in
(inhalation), coach the patient to breathe all the air out
of the lungs until unable to exhale any longer, usually
about 15 seconds.
15
7. Allow the patient to have a practice run before
performing the actual test.
15
8. Support the patient during the test and have the patient
keep blowing into the mouthpiece until told to stop.
15
9. Document the procedure in the patient’s chart and
place the results in the chart for the provider’s review.
15
Points Awarded / Points Possible ____/
135
544