PHASE 2a - INITIAL ASSESSMENT OF CLINICAL SKILLS IN SIMULATION (IACSS)

Transcription

1 THE MEDICAL SCHOOL PHASE 2a - INITIAL ASSESSMENT OF CLINICAL SKILLS IN SIMULATION (IACSS) February 2017 Guidance notes and assessment criteria Index Instructions for the student pages 1 to 3 Instructions for the patient pages 4 to 7 Instructions for the examiner pages 8 to 13 IACSS mark sheets pages 14 to 20

2 PHASE 2a: INITIAL ASSESSMENT OF CLINICAL SKILLS IN SIMULATION (IACSS) CLINICAL SCENARIO = ABDOMINAL PAIN TIME = 48 minutes for assessment + 6 minutes for verbal feedback + 6 minutes to reset the station between candidates (1 hour per student) INSTRUCTIONS FOR THE STUDENT (3 pages) Your patient has been admitted to the urology ward with acute pyelonephritis (kidney infection). They are feeling hot, sweaty and generally unwell. You are not required to take a history or perform a physical examination on the patient. You should communicate with the patient as you would in a normal consultation. You have 48 minutes to consent the patient and perform the following clinical skills procedures in the order specified below. 1. Handwashing 2. Measuring vital signs 3. Venepuncture and managing blood samples 4. Intravenous cannulation 5. Preparing a drug for parenteral administration 6. Setting up an infusion It is recommended that you break these down into approximately 12 minute blocks as follows: First 12 minute period: Wash your hands thoroughly with soap and water Measure the patient s tympanic temperature, pulse rate, respiratory rate, blood pressure (using a manual sphygmomanometer) and oxygen saturation. (N.B. For the purposes of this assessment, you are only required to count the pulse rate and respiratory rate for 15 seconds each and multiply each by 4. Please note: The use of electronic stethoscopes is allowed if required by the student. Phase 2a IACSS 2017 Page 1

3 Record these measurements accurately on a standard observation chart and pass the completed chart to the examiner. Second 12 minute period: Apply a tourniquet and identify a suitable vein for venepuncture on the patient. Indicate your preferred site to the examiner then remove the tourniquet. Perform venepuncture on the manikin arm, obtaining blood samples for microbiological culture (one each of aerobic and anaerobic), measurement of urea and electrolytes and full blood count. (Approx 1ml blood in each tube will suffice). Label your blood sample bottles fully and legibly. Complete a laboratory request form for a full blood count for this patient (the examiner will inspect your labelled samples and laboratory request form when complete). Third 12 minute period: Apply a tourniquet and identify a suitable vein for cannulation on the patient arm. Indicate this to the examiner then remove the tourniquet. Insert a venous cannula (Venflon TM or alternative) into the manikin arm (N.B. If you fail to cannulate the manikin arm successfully, the assessment will be terminated at this stage). If needed you can replace the cannula with a new one and try again. Final 12 minute period: Prepare an intravenous injection of 1.5g cefuroxime (placebo) in 4ml sterile water and inject this via the cannula. (Although you would normally administer this slowly over a period of minutes, for the purposes of this assessment, administer it over approximately 15 seconds inform the examiner what you would actually do in clinical practice). Do not inject the solution in the manikin arm as the placebo can clog the arm. A cannulation Phase 2a IACSS 2017 Page 2

4 pad will be provided for you to inject the prepared solution. Set-up an infusion of 0.9% sodium chloride and administer this via the cannula at a rate of 500ml/hour. (Determine the rate by counting drips). Every 12 minutes there will be a verbal prompt. This is for guidance only and you may progress through the assessment at your own pace. At the end of 48 minutes the assessment will be end and any incomplete procedures will be awarded a fail. Note: You should communicate with the patient as you would in a normal consultation. The patient will respond accordingly to all your pre-assessment questions regarding vital signs and cannulation (see page 13). You are required to perform all non-invasive tests (e.g. pulse rate) on the patient. After identifying a suitable vein on the patient, you are required to perform venepuncture and cannulation on the manikin arm but need to communicate with the patient whilst doing so. You are supposed to wear gloves and don an apron for all invasive procedures. Following consent from the patient for venepuncture, you should don an apron and the right sized gloves. You do not have to change the gloves for each skill. If you feel that the gloves are either not the right size or if they get damaged at any stage then kindly change them. Students who fail to cannulate the vein of the manikin arm will not proceed to perform the remaining parts of the assessment (i.e. preparation and administration of the intravenous antibiotic and intravenous fluid administration). The examination will be terminated at this point and a resit arranged. You may replace the cannula with a new one and try again. If you feel that there may be problem with manikin then let the examiner know. Students who successfully cannulate the vein, but who are to be awarded a fail for cannulation due to inadequate or unsafe practice (e.g. not disposing of sharps in the sharps bin), will be allowed to undertake the remaining parts of the assessment and return to resit cannulation at a later date. Phase 2a IACSS 2017 Page 3

5 PHASE 2a: INITIAL ASSESSMENT OF CLINICAL SKILLS IN SIMULATION (IACSS) INSTRUCTIONS FOR THE PATIENT (4 pages) (MALE/FEMALE WITH NO CONTRAINDICATIONS TO BLOOD PRESSURE CUFF APPLICATION ON EITHER ARM) You will need to wear a short-sleeved T-shirt, with loosely fitting sleeves that can be rolled up if needed. Please wear an old T-shirt in case any red food colouring is accidentally spilled on it (see cannulation below). Please avoid wearing nail polish or false nails (or remove the false nail and/or nail polish from your right index finger). The background is that you are a patient who has been admitted to the urology ward with an infection in your right kidney. You have been feeling hot, sweaty and generally unwell. You do not have any allergies. The purpose of the assessment is to assess the student s ability to perform practical skills, rather than to hold a consultation with a patient who is acutely unwell. You are therefore not required to act as though you are ill for this assessment and can behave normally. You are able to sit up straight and can follow the student s instructions appropriately. The student will communicate with you throughout the assessment. Please respond appropriately to any questions that the student asks, but do not initiate any further conversation. For example, when the student has explained each procedure, they may ask if you have any questions: You do not. When asked, you consent to all procedures being performed. Introduction and identification The student should wash their hands with soap and water and dry them properly. They will then ask your name and date of birth and also ask to check your wristband. Phase 2a IACSS 2017 Page 4

6 Please use your own name and date of birth. The examiner will have written these on your wrist band together with a hospital number, ward and consultant. Temperature, pulse and blood pressure The student will check your temperature by inserting a probe into your ear. They will also count your pulse rate and rate of breathing and measure your blood pressure using a blood pressure cuff and stethoscope. If asked, you have never had any of these tests done before. Try and relax and not think about your breathing rate so that you do not subconsciously alter it e.g. by holding your breath, or breathing very rapidly or slowly. If asked, you have never had any significant injuries to your arms, nor have you had any operations on your arms, armpits or breast/chest area. You do not have any broken skin or rashes on your arms. You do not have a dialysis fistula. Also, if asked, you have not eaten a large meal or drunk a hot or cold drink, had a hot bath, smoked a cigarette or undertaken vigorous exercise within the last 30 minutes. You do not have an ear infection or any other problem affecting your ears. Oxygen saturation The student will explain to you that they need to measure the amount of oxygen in your blood by attaching a probe onto the end of your finger. This is painless and will produce a reading within a few seconds. Nail polish and false nails interfere with this process and the student should look for these when applying the probe. The student should also ensure that the blood pressure cuff is not still applied to your arm and that your sleeve or jewellery are not tight as they may restrict blood flow to your finger. Please keep your finger as still as possible while the machine produces its reading. Phase 2a IACSS 2017 Page 5

7 Venepuncture If asked, you have never had a blood test before. The student will explain the procedure to you and ask your permission to perform the procedure. The student will then apply a tourniquet to your arm and will identify a suitable vein for obtaining the blood sample (usually in the front of your arm at the bend of your elbow). Having indicated their choice of vein to the examiner, they should immediately release the tourniquet and turn their attentions to the manikin arm. If the student does not release the tourniquet after identifying a suitable vein, please ask them to do so. The student will carry out the procedure on the manikin arm, but will communicate with you throughout the procedure. Cannulation If asked, you have never had a cannula ( drip ) inserted before. The student will explain the procedure to you and ask your permission to perform the procedure. The student will carry out the procedure on the manikin arm, but will communicate with you throughout the procedure. The student will initially apply a tourniquet to your arm and will identify a suitable vein for cannula insertion (usually in the back of your hand). Having indicated their choice of vein to the examiner, they should immediately release the tourniquet and turn their attentions to the manikin arm. If the student does not release the tourniquet after identifying a suitable vein, please ask them to do so. The student will carry out the procedure on the manikin arm and will communicate with you throughout the procedure. Phase 2a IACSS 2017 Page 6

8 Administration of intravenous antibiotics The student will ask you again at this stage if you have any allergies. You should state that you do not. The student will then flush the cannula with a small amount of saline before administering the antibiotic. They should ask you if you experience any discomfort whilst they do this. You do not. The student will then prepare a syringe of antibiotic solution (placebo will be used in place of real antibiotics) and administer this through the cannula. They should also ask you to let them know if you experience any shortness of breath, wheeze, itching, flushing of the skin or swelling of the tongue, lips or throat during this time. You do not experience these. Following administration of the antibiotic, the student will flush the cannula again with saline to ensure that all no antibiotic remains in the cannula. Administration of intravenous fluids The student will then connect a drip bag to the cannula and start the infusion. They may ask you again whether you experience any discomfort or swelling whilst the infusion is running. You should state that you do not. The assessment will take 48 minutes in total. At the end of this period, the examiner will give the student feedback on their performance. Phase 2a IACSS 2017 Page 7

9 PHASE 2a: INITIAL ASSESSMENT OF CLINICAL SKILLS IN SIMULATION (IACSS) CLINICAL SCENARIO = ABDOMINAL PAIN INSTRUCTIONS FOR THE EXAMINER (6 pages) TIME = 48 minutes for assessment + 6 minutes for verbal feedback + 6 minutes to reset the station between candidates (1 hour per student) Before the examination starts, familiarise yourself fully with the instructions to students and patients. Please write the patient s real name and date of birth on their wrist band, plus a fictitious hospital number (e.g. A123456), Ward (e.g. Ward 2) and Consultant (e.g. Dr Smith). Ensure that the patient s details are written correctly on a prescription chart and that the intravenous antibiotics and fluids (see below) are correctly prescribed. Ensure that the placebo has been labelled as Cefuroxime 1.5g and that it has a suitable expiry date on it. If you need any assistance please inform a member of the clinical skills team. The patient s details need to be filled in on the laboratory request form before the assessment starts, but all other details (e.g. clinical details, test required, student s name and signature, date, time) should be completed by the student during the assessment. At the start: Greet the student and give them the written instructions. Please write the student s name on all of the mark sheets. Please put the date on all mark sheets. The student is required to perform the tasks in order, during the 48-minute assessment period. The student can progress through the assessment at their own rate however there will be verbal prompt every 12 minutes to give the student guidance as to how much time has elapsed. Suggested approximate timings are: Phase 2a IACSS 2017 Page 8

10 First 12 minutes: Wash hands thoroughly with soap and water Measure the patient s tympanic temperature, pulse rate, respiratory rate, blood pressure (using a manual sphygmomanometer) and oxygen saturation. (N.B. For the purposes of this assessment, they are only required to count the pulse rate and respiratory rate for 15 seconds each and multiply each by 4). Record these measurements accurately on a standard observation chart and pass this to you once complete. (Please check that it has been completed correctly. If not done, ask the student to do so before moving to the next skill). Second 12 minute period: Please Note Students are supposed to wear gloves and don an apron for invasive procedures. Once they have consented the patient for a venepuncture, they should don an apron and the right sized gloves. In case the student has forgotten to do so, remind them to put on gloves and an apron before they initiate venepuncture. They do not have to change the gloves or the apron for each subsequent skill. If they feel that the gloves are either not the right size or if they get damaged during the IACSS at any stage then these can be changed as desired. Second 12 minute period: Apply a tourniquet and identify a suitable vein for venepuncture on the patient. Indicate this to the examiner then remove the tourniquet. Perform venepuncture on the manikin arm, obtaining blood samples for microbiological culture (aerobic and anaerobic), urea and electrolytes and full blood count. (Approx 1ml blood in each tube will suffice). Label the blood samples fully and legibly. Complete a laboratory request form for a full blood count (The examiner needs Phase 2a IACSS 2017 Page 9

11 to check that the samples and form have been filled in legibly, completely and correctly). Third 12-minute period: Apply a tourniquet and identify a suitable vein for cannulation on the patient. Indicate this to the examiner then remove the tourniquet. Insert a venous cannula (Venflon TM or alternative) into the manikin. Fourth 12 minute period: Prepare an IV injection of 1.5g cefuroxime (placebo) in 4ml sterile water (to be confirmed) and inject this via the cannula. Do not let the student inject the solution in the manikin arm as the placebo can clog the arm. A cannulation pad will be provided for them to inject the prepared solution. Kindly indicate this to the student Set-up an infusion of 0.9% sodium chloride and administer this at a rate of 500ml/hour (Determine the rate by counting drips). Every 12 minutes there will be a verbal prompt. This is for guidance only and the student may progress through the assessment at their own pace. At the end of the 48 minutes, the examination is immediately terminated and any incomplete procedures are classed as a fail. You are required to assess the student s competence in performing the above procedures in simulation. For the purposes of this assessment, a competent student is one who approaches the task in a professional manner, and performs it safely and effectively, in accordance with the assessment criteria, demonstrating good understanding of the task and good decision-making skills. Please note that you are required to indicate whether the student performed each procedure competently in simulation at the time of the assessment, and in doing so, Phase 2a IACSS 2017 Page 10

12 you are making a judgement as to whether they are now ready to practice each procedure under appropriate supervision with patients in the clinical setting. You are not making a judgement as to whether the student is ready to perform a procedure unsupervised. You need to award a pass or fail for each clinical skill, using the definition of competence above and the assessment criteria on the marksheets. Decide whether a student has performed the skill competently, or requires further practice and a repeat assessment in simulation. The assessment criteria should strongly influence your decision but minor omissions or errors that do not constitute unsafe practice may still constitute a pass. This is at your own discretion. However, any students displaying unsafe practice that could put their patients, their colleagues or themselves at risk, should be automatically awarded a fail for the relevant skill(s). A column has been provided on each marksheet for you to make notes during the assessment. You should note any observations/feedback comments that you will wish to discuss with the student at the end of the assessment. Feedback to the student will be both verbal and written. The marksheets will be collected at the end of the assessment period and returned to the School Office. All students will receive a copy of their marksheets and your written comments. These are mastery assessments and to be eligible for a pass, the student must successfully perform venepuncture (i.e. obtain a sample) and cannulation (i.e. fully insert a cannula into a vein). Students failing to do so will be required to resit the relevant part of the assessment i.e. venepuncture or cannulation. Students who fail to cannulate the vein of the manikin arm should not proceed to perform the remaining parts of the assessment (i.e. preparation and administration of Phase 2a IACSS 2017 Page 11

13 the intravenous antibiotic and intravenous fluid administration). Their examination should be terminated at this point and a resit arranged. Students who successfully cannulate the vein, but who are to be awarded a fail for cannulation due to inadequate practice or unsafe practice (e.g. not disposing of sharps in the sharps bin), should still undertake the remaining parts of the assessment and return to resit cannulation at a later date. At the end of the assessment, please provide the student with immediate verbal feedback on their performance. Up to 6 minutes will be allocated for feedback between candidates. The Clinical Staff will indicate the start and end of the IACSS assessment. They will also direct the students to their respective stations. If you have any queries regarding the station or if there is a problem with equipment then do let one of the staff members know. An examiner briefing will be held prior to the start of the IACSS assessments. You will then have some time to meet your patient and familiarise yourself with the station. Phase 2a IACSS 2017 Page 12

14 Pre- assessment questions to be asked by students before measuring vital signs, performing venepuncture and intravenous cannulation Vital signs Ask the patient that within the last 30 minutes if they have eaten a large meal or had a hot or cold drink, had a hot bath, smoked a cigarette or undertaken vigorous exercise or exerted themselves. Enquire if they are taking any blood pressure lowering medications. Ask the patient if they are wearing a hearing aid or if they have any ear infections. Enquire about presence of an arterio-venous fistula in the arm, any operations on arms, axillae or breasts, any pain, swelling or weakness in the arm. Please note: The use of electronic stethoscopes is allowed if required by the student For venepuncture and intravenous cannulation Enquire about presence of an arterio-venous fistula in the arm, any operations on arms, axillae or breasts, any pain, swelling or weakness in the arm (Please note: If these questions have already been asked for vital signs then they do not need to be repeated) Phase 2a IACSS 2017 Page 13

15 Student s name: Date Phase 2a: Initial Assessment of Clinical Skills in Simulation (IACSS) MARKSHEET: HANDWASHING Assessment criteria: a) Arms are bare below the elbows and student is not wearing any jewellery (except wedding ring) b) Checks water temperature and flow c) Wets hands and forearms d) Correctly applies soap e) Performs the following, using a minimum of 5 strokes (in any order): Palm to palm Palm to palm with fingers interlaced Palm of hand to back of opposite hand, with fingers interlaced Back of fingers to opposing palms with fingers interlaced Rotational rubbing of the tips of fingers and thumb Rotational rubbing of thumb clasped in opposite palm Washes wrists f) Rinses in correct direction (fingertips to elbow) g) Turns off tap (using appropriate method) h) Dries hands thoroughly i) Incorporates safe moving and handling practice during procedure Feedback: Result (Please circle) PASS FAIL Assessor s name Assessor s signature Phase 2a IACSS 2017 Page 14

16 Student s name: Date Phase 2a: Initial Assessment of Clinical Skills in Simulation (IACSS) MARKSHEET: Vital signs (Page 1 of 2) Assessment Criteria: Initiating the procedure - to include: a) Gathers relevant equipment b) Introduces self c) Identifies the patient d) Explanation and rationale e) Gains consent Preparation of equipment/patient to include: a) Washes hands / uses alcohol gel b) Asks series of pre-assessment questions (see examiner briefing notes) c) Ensures patient s arm is properly positioned and adequately supported Performance of body temperature to include: a) Places disposable cover on thermometer probe b) Inserts probe gently into patient s ear canal at correct angle c) Activates and waits for signal before removing thermometer and reading result Performance of radial pulse to include: a) Locates radial artery b) Palpates radial artery for a minimum of 15 seconds Feedback: Please note: The use of electronic stethoscopes is allowed if required by the student Phase 2a IACSS 2017 Page 15

17 Student s name: Date Phase 2a: Initial Assessment of Clinical Skills in Simulation (IACSS) MARKSHEET: Vital signs (Page 2 of 2) Assessment Criteria: Performance of respiratory rate a) Whilst appearing to palpate the radial pulse, counts the respiratory rate for minimum of 15 seconds Performance of Blood Pressure to include: a) Places cuff 2cm above antecubital fossa b) Inflates cuff and obtains estimated systolic pressure whilst palpating radial pulse. Then deflates cuff. c) Correctly places stethoscope over brachial artery. d) Re-inflates cuff to mmhg above estimated systolic pressure e) Whilst auscultating brachial artery, deflates cuff at rate of 2 mmhg/second to obtain systolic and diastolic pressure readings Oxygen saturation measurement to include: a) Correctly attaches saturation probe to patient s finger b) Notes the correct oxygen saturation Completes relevant documentation correctly Incorporates safe moving and handling practice during procedures Feedback: Result (Please circle) PASS FAIL Assessor s name Assessor s signature Phase 2a IACSS 2017 Page 16

18 Student s name: Date Phase 2a Initial Assessment of Clinical Skills in Simulation (IACSS) MARKSHEET: Venepuncture, managing blood samples and obtaining blood cultures Assessment criteria: Feedback: Initiating the procedure - to include: a) Gathers relevant equipment b) Introduces self (not repeated in continuous scenario) c) Identifies patient d) Explanation and rationale e) Gains consent f) Asks about any allergies (e.g. drugs, dressings, tape) Preparation: to include a) Washes hands / uses alcohol gel b) Dons gloves and apron (kindly indicate to the student ) c) Positions patient comfortably with elbow extended and supported d) Assesses arm and checks for any local contraindications e) Applies tourniquet approx 5cm above antecubital fossa f) Identifies suitable site by inspection and palpation Performance of task (on manikin) to include: a) Selects, prepares and assembles equipment correctly including cleaning the top of blood culture bottles. b) Applies tourniquet c) Identifies suitable site by inspection and palpation d) Cleans the site (as per local policy) e) Inserts needle correctly. Adjusts position of needle until sited intravenously f) Secures and maintains position of needle whilst filling culture bottles (1ml only in each bottle for assessment). g) Collects additional blood samples using correct order of draw (i.e. U&E before FBC; 1ml only for assessment) h) Releases tourniquet before removing needle i) Applies pressure to puncture site j) Discards sharps into sharps bin k) Labels blood samples correctly at bedside l) Checks patient s welfare m) Applies suitable dressing, checking for allergies n) Completes laboratory request form correctly o) Incorporates safe moving and handling practice during procedure Result (Please circle) PASS FAIL Assessor s name Assessor s signature Phase 2a IACSS 2017 Page 17

19 Student s name: Date Phase 2a: Initial Assessment of Clinical Skills in Simulation (IACSS) MARKSHEET: Cannulation of a peripheral vein Assessment criteria: Feedback: Initiating the procedure - to include: a) Gathers relevant equipment b) Introduces self (not repeated in continuous scenario) c) Identifies patient d) Explanation and rationale e) Gains consent f) Asks about any allergies (no need to ask if asked earlier) Preparation to include: a) Dons gloves and apron (does not need to change) b) Exposes and positions the patient s arm c) Assesses the arm checking for any local contraindications & identifies a suitable vein (avoiding antecubital fossa and wrist, if possible) d) Applies tourniquet and rechecks the vein by inspection and palpation Performance of task (on manikin) - to include: a) Identifies a suitable vein b) Cleans site c) Removes equipment from packaging using no touch technique d) Stretches skin and inserts needle correctly e) Advances needle until flashback of blood appears in the hub of the cannula. f) Slightly withdraws needle from cannula and correctly advances cannula into vein g) Releases tourniquet h) Elevates arm and applies proximal pressure then removes needle from cannula i) Discards needle into sharps bin j) Attaches bung to end of cannula k) Secures cannula with suitable dressing l) Flushes cannula with saline m) Labels the cannula with date and time n) Incorporates safe moving and handling practice during procedure Result (Please circle) PASS FAIL Assessor s name Assessor s signature Phase 2a IACSS 2017 Page 18

20 Student s name: Date Phase 2a: Initial Assessment of Clinical Skills in Simulation (IACSS) MARKSHEET: Making up drugs for parenteral administration Assessment criteria: Initiating the procedure - to include: a) Gathers relevant equipment b) Introduces self (not repeated in continuous scenario) c) Identifies patient and checks wristband and drug chart d) Explanation and rationale e) Gains consent Preparation - to include: a) Asks about allergies (no need to ask again if asked earlier) b) Checks drug chart to establish the drug, dosage, time, date and route of administration c) Collects drug and checks it against the prescription chart d) Checks the expiry date of the drug e) Dons gloves and apron (Does not need to change) f) Opens equipment using no-touch technique g) Removes protective cap from vial and cleans injectable bung h) Draws up diluent i) Injects diluent into vial j) Releases plunger and allows syringe to fill with air from vial k) Mixes powder and diluent l) Injects air in syringe back into vial m) Inverts syringe, needle and vial so that vial is uppermost n) Releases plunger and allows syringe to fill with drug o) Removes syringe and needle from vial and caps off syringe (as per local policy) p) Discards sharps safely Administration (on manikin arm) a) Rechecks patient s name, date of birth and hospital number b) Cleans injectable bung on cannula c) Flushes cannula to ensure patency c) Injects drug via cannula d) Checks patient s welfare whilst injecting drug e) Flushes cannula (or in continuous scenario, may proceed directly to connect iv fluids) f) Incorporates safe moving and handling practice during procedure Result (please circle): PASS FAIL Feedback: Assessor s name Assessor s signature Phase 2a IACSS 2017 Page 19

21 Student s name: Date Phase 2a: Initial Assessment of Clinical Skills in Simulation (IACSS) MARKSHEET: Setting up an intravenous infusion Assessment criteria: Initiating the procedure - to include: a) Gathers relevant equipment b) Introduces self (not repeated in continuous scenario) c) Identifies patient and checks wristband and drug chart d) Explanation and rationale e) Gains consent a) Asks about allergies (no need to ask if asked earlier) b) Checks drug chart to establish the fluid to be infused, volume, rate, time and date c) Collects the fluid and checks it against the prescription d) Checks the expiry date of the fluid e) Dons gloves and apron (does not need to change) f) Removes seal from infusion bag entry port aseptically (if re-using infusion bags for assessment purposes, omit this step) g) Opens iv administration set ( giving set ) aseptically, closes roller clamp and spikes infusion bag entry port aseptically h) Half-fills drip chamber with fluid i) Opens roller clamp and aseptically primes the line, expelling any air bubbles j) Maintain asepsis until connection to cannula k) Cleans bung and ensures patency of the cannula using a flush (can be omitted if proceeding directly from antibiotic administration in continuous scenario) l) Connects giving set to cannula m) Commences infusion at correct rate (by counting drips per minute) n) Checks patient s welfare o) Incorporates safe moving and handling practice during procedure Result (please circle): PASS FAIL Feedback: Assessor s name Assessor s signature Phase 2a IACSS 2017 Page 20