Mosby's Nursing Video Skills

Student __________________________________________________ Date ________________________

Instructor ________________________________________________ Date ________________________

PERFORMANCE CHECKLIST FOR USING A PREPACKAGED STERILE KIT

S U NP Comments

1. Verified the health care providers orders.

2. Gathered the necessary equipment and supplies.

3. Performed hand hygiene, using an alcohol-based hand

rub or antimicrobial soap and water.

4. Introduced self to the patient and family.

5. Provided for the patients privacy.

6. Applied PPE as needed.

7. Selected a clean, flat, dry work surface above the level of

the waist.

8. Prepared a sterile work surface. If using a sterile

commercial kit or pack containing sterile items:

A. Placed the package on a clean, dry, flat work surface

above the level of the waist.

B. Opened the outside cover and removed the package

from the dust cover. Placed the package on the work

surface.

C. Grasped the outer surface of the tip of the outermost

flap.

D. Opened flap away from body, keeping arm

outstretched and away from the sterile field. Did not

touch any part of the sterile wrap except the one inch

margin around the edge.

Copyright 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.

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E. Grasped the outside surface of the edge of the first side

flap.

F. Opened the side flap, pulling it to the side and

allowing it to lie flat on the table. Kept arm to the side,

not over the sterile surface.

G. Opened the second side flap, pulling it to the side and

allowing it to lie flat on the table. Kept arm to the side,

not over the sterile surface.

H. Grasped the outside border of the innermost flap.

Stood away from the sterile package, and pulled the

flap back, allowing it to fall flat on the table.

9. After the procedure, helped the patient into a comfortable

position, and placed toiletries and personal items within

reach.

10. Placed the call light within easy reach, and made sure

the patient knows how to use it to summon assistance.

11. Raised the appropriate number of side rails and lowered

the bed to the lowest position.

12. Disposed of used supplies and equipment. Left the

patients room tidy.

13. Removed and disposed of gloves, if used. Performed

hand hygiene.

14. Documented and reported the patients response and

expected or unexpected outcomes.

Copyright 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.