Self-Evaluation

Wound Irrigation and Packing – Skills Checklist

0617338 Nov 5/19
Student
Student Name:
Number Date:

Evaluator Name:

Scoring Key: 0 = Totally Wrong/Step Omitted

1 = Performance Partially Wrong
2 = Accurate/Precise Performance

SKILL PEER
SELF SELFComments:
INSTR.

Introduce self, confirm client identity, explain 0 1 2 0 1 2

1 0 1 2
procedure

2 Hand hygiene, provide privacy 0 1 2 0 1 2 0 1 2

3 Position client in appropriate position 0 1 2 0 1 2 0 1 2

Don clean gloves, remove dressing and verbalize 0 1 2 0 1 2

4 0 1 2
wound assessment
- Turned back to sterile
5 Hand hygiene 0 1 2 0 1 2 0 1 2
field
0 1 2
- Forgot
0 1 2
to dry wound
Open the dressing tray maintaining surgical 0 1 2
6 edges before applying top
asepsis

0 1 2
dressing
0 1 2
Add required materials and irrigant (NS) to tray 0 1 2
7 - Did not use hand hygiene
maintaining surgical asepsis
after removing sterile
8 Don sterile gloves maintaining surgical asepsis 0 1 2 0 1 2 0 1 2
gloves but would have
9 Prepare gauze/irrigant and packing 0 1 2 when
0 1 I 2exited
0 1the2patient
room
Cleanse peri wound edges maintain surgical 0 1 2 0 1 2
10 0 1 2
asepsis

11 Irrigate the wound maintaining surgical asepsis 0 1 2 0 1 2 0 1 2

12 Pack the wound maintaining surgical asepsis 0 1 2 0 1 2 0 1 2

13 Dry wound edges and apply top dressing 0 1 2 0 1 2 0 1 2

14 Remove gloves/hand hygiene/reposition client 0 1 2 0 1 2 0 1 2

Verbalize documentation: Wound location and size (width, depth and

length) condition of wound bed and peri- wound edges, drainage (colour,
15
odour and amount.) Materials used to pack and dress the wound, patient 0 1 2 0 1 2 0 1 2
response.

TOTAL SCORE: 25