INSTITUTE OF CLINICAL LABORATORY SCIENCES

SILLIMAN UNIVERSITY
Dumaguete City

Internship Program (2nd Semester) A. Y. 2018 - 2019: Practical Examination

CLINICAL CHEMISTRY

NAME: ___________________________________________________________________________________ DATE: ___________________

INSTITUTION: _____________________________________________________________________________

Correctly and accurately rate the intern by writing a score (numerical value from 0 - 5) corresponding to his or her performance. Whenever an intern is given a
level of 0, 1, or 2 in any given parameter, please provide an explanation as to why the intern is given such. For specific tasks deemed not applicable, kindly write
N/A on the left side of the levels column. Write your comments on the next page when appropriate.
EVALUATION PARAMETERS SCORE
(10%) SET-UP, PERSONAL SAFETY, AND CLEAN-UP
Wears complete uniform and personal protective equipment
Carries out and maintains aseptic techniques throughout the performance of the procedures
Performs complete and effective decontamination before and after starting the procedures
Demonstrates neatness, cleanliness and orderliness
Provides complete and appropriate equipment/supplies needed in the procedures
Returns all materials and reagents to their proper places upon completion of the examination
Discards all used materials (e.g. litter, slides, tubes, etc.) to appropriate containers
___ /35 x 100 x 0.10 =
(70%) SKILLS, COMPETENCE, AND OUTPUT
1. (PHLEBOTOMY: Syringe Method)
Properly identifies the patient with correct patient identifiers (name and birthdate)
Applies tourniquet 3-4inches above the site of collection
Correctly chooses the site of collection (antecubital fossa) and palpates the vein using forefinger
Removes the tourniquet before disinfection
Disinfects the site (concentric manner) with 70% isopropyl alcohol.
Allows the area to completely dry.
Prepares the materials needed for collection
a. Makes sure that the needle is tightly attached to the barrel.
b. Pulls and pushes the plunger.
c. Prepares dry cotton with plaster.
Re-applies tourniquet on patient’s arm.
Instructs patient to make a fist.
Correctly inserts the needle to the vein of the patient
a. Correct angle at 15˚-30˚
b. Needle is bevelled-up
Anchors the syringe properly while pulling the plunger.
Removes tourniquet and instructs patient to unfist.
Places the cotton with plaster on the site of collection and removes the needle.
Instructs the patient to press the site for 5 minutes or until bleeding stops.
Recaps the needle by fishing out cap and pushes on a hard structure (table)
Removes the needle and discards into the sharps container.
Transfers correct volume of blood sample to appropriate tubes.
Inverts tube according to appropriate number of inversions.
Discards the barrel and other wastes to appropriate waste containers.
Labels tube properly with (full name of patient, birthdate, age & sex, date and time of collection with initials of the phlebotomist)
Thanks the patient.
2. (QUALITY CONTROL)
Gives the Westgard multirules error
Correctly identifies the type of error (random or systematic)
Gives one reason for the type of error
___ /135 x 100 x 0.70 =
(20%) ATTITUDE AND VALUES
Demonstrates punctuality in coming to the scheduled examination
Shows confidence with the minimum level or absence of awkwardness
Demonstrates respect and courtesy to superiors and peers
Demonstrates good grooming and a positive attitude towards the performance of the procedures
Observes academic honesty in all test results
___ /25 x 100 x 0.20 =
TOTAL SCORE:
Legend:
(0) Task Not Performed/Attempted: No response or task not done by the intern
(1) Beginning: Tasks attempted but always done unsuccessfully
(2) Developing: Tasks always done with many inconsistencies and fails expectations
(3) Approaching Proficiency: Tasks always done with some inconsistencies but still within expectations
(4) Proficient: Tasks always done with little inconsistencies and within expectations
(5) Exemplary: Tasks always done perfectly within or beyond expectations
Remarks:

__________________________________
Clinical Instructor’s Name and Signature