Competency Performance Checklist Skill: Applying a Urine Collection Bag

Student: _______________________________________
Essential/ critical element?

Date: _______________
Competency Demonstrated? Yes No

Element 1. Identified self and verified the childs identity. Performed hand hygiene. 2. Put on clean, non-sterile gloves. 3. Removed diaper and cleaned the skin well, ensuring any skin folds were opened for access to cleaning. 4. Avoided touching the inside of the bag as it was handled. 5. Attached the bag with the adhesive tabs: for girls, around the labia; for boys, around the penis. 6. Made sure the seal was tight to prevent leakage. 7. Checked the bag frequently for urine.

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Used effective body mechanics throughout procedure Communicated appropriately with client Verbalized follow-up indicated for client, physician, and others taking into account age and other case factors

Comments: ________________________________________________________________________ ________________________________________________________________________ Overall Performance: Satisfactory Unsatisfactory

Evaluator: _____________________________________________

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