iRubric: Ventilator-Patient Initiation Practicum rubric

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Ventilator-Patient Initiation Practicum

Evaluation of the following objectives 1. Demonstrate appropriate communication skills with the patient and other health care professionals 2. Assess the pertinent asspects of the patients condition 3. Plan an appropriate ventilation strategy for the patient

Rubric Code: JA65B2

By scotjones

Draft

Public Rubric

Subject: Medical

Type: Assessment

Grade Levels: Undergraduate

Preparation
	Advanced Performs all aspects with no mistakes, shows advanced critical thinking and application where applicable 5 pts	Proficient Able to perform all aspects with minor mistakes / self-corrects on non-critical aspects 4 pts	Minimally Below Standards Able to perform basic aspects of scenario area, requires some interventions 3 pts	Not Proficient Unable to perform without significant interventions 1 pts
Initiation 1. Reviews provided patient information, asks pertinent questions of information to be looked up in chart. 2. Prepares for patient contact by conducting hand hygiene and identifying appropriate PPE 3. Introduces him/herself to the patient. 4. Performs initial chart review and PPE in reasonable period of time	Advanced Complete chart review in < 2 minutes, makes all required infection control steps, and identifies self to patient and others.	Proficient Performs more than three initial steps required in the skill listed.	Minimally Below Standards Performs less than two initial steps required in the skill listed.	Not Proficient Does not perform any of the initial steps required in the skill listed
Patient Assessment 1. Obtains information regarding patient's history/ entrance complaint 2. Observes the patient's vital signs displayed on the monitor. 3. Checks position and patency of ETT 4. Performs patient assessment to minimally include chest auscultation with appropriate placement, under gown	Advanced Recognizes, verbalizes, and demonstrates all assessment steps in a systematic manner consistently without difficulty. Achieves all 4 skill areas.	Proficient Recognizes, verbalizes, and demonstrates the assessment steps in a systematic manner with a minimum of 3 skills met	Minimally Below Standards Able to recognize, verbalize, and demonstrate the assessment steps in a systematic manner with a minimum of 2 skills met	Not Proficient Fails to recognize, verbalize, and/or demonstrate the assessment steps in a systematic manner with less than 2 skills met
Initiation of Mechanical Ventilatio Performs all tasks necessary to safely initiate mechanical ventilation
	Advanced Performs all aspects with no mistakes, shows advanced critical thinking and application where applicable 5 pts	Proficient Able to perform all aspects with minor mistakes / self-corrects on non-critical aspects 4 pts	Minimally Below Standards Able to perform basic aspects of scenario area, requires some interventions 3 pts	Not Proficient Unable to perform without significant interventions 1 pts
Pre-Use 1. Identifies components of ventilator required for initiation, including appropriate ventilator (critical care versus home care) 2. Assembles circuit, connects to wall outlets, utilizes "red outlet", and turns ventilator on 3. Performs or describes steps required for pre-use check. Able to describe rationale behind pre-use check.	Advanced Recognizes, verbalizes, and demonstrates all steps in a systematic manner consistently without difficulty. Achieves all 3 skill areas.	Proficient Recognizes, verbalizes, and demonstrates all steps in a systematic manner with minimum difficulty. Achieves all 3 skill areas with some intervention/prompting or self-corrects non-critical aspects	Minimally Below Standards Recognizes, verbalizes, and demonstrates all steps in a systematic manner with minimum difficulty. Achieves all 3 skill areas with moderate intervention/prompting or self-corrects critical aspects	Not Proficient Recognizes, verbalizes, and demonstrates all steps in a systematic manner. Requires significant intervention/prompting or fails to initiate key elements of Pre-Use
Mode Selection 1. Able to identify appropriate mode and rationale for mode selection 2. Sets mode with appropriate parameters 3. Tidal Volume, when appropriate, set by IBW and appropriate cc/kg for disease or disorder 4. Ensures appropriate alarms are set for all parameters	Advanced Performs all 4 elements with no assistance and in a reasonable period of time	Proficient Performs a minimum of 3 elements with no correction/intervention or self-corrects non-critical aspects	Minimally Below Standards Performs a minimum of 2 elements with no correction/intervention or self-corrects non-critical aspects	Not Proficient Fails to perform at least 2 elements without intervention or correction. Unable to identify critical components (placing sedated patient on spontaneous mode, etc.)
Initial Assessment 1. Identifies need to achieve clinical tests (CXR, ABG, CBC) 2. Auscultates after placing pt on ventilator 3. Verbalizes or reviews graphics and return data from ventilator after initiation	Advanced Performs all 3 elements with no assistance or self-corrects prior to leaving patient area	Proficient Performs a minimum of 2 elements with no correction/intervention or self-corrects non-critical aspects	Minimally Below Standards N/A	Not Proficient Fails to perform at least 2 elements without intervention or correction. Unable to identify critical components
Intervention and Monitoring
	Advanced Performs all aspects with no mistakes, shows advanced critical thinking and application where applicable 5 pts	Proficient Able to perform all aspects with minor mistakes / self-corrects on non-critical aspects 4 pts	Minimally Below Standard Able to perform basic aspects of scenario area, requires some interventions 3 pts	Not Proficient Unable to perform without significant interventions 1 pts
Reviews Initial ABG 1. Interprets Metabolic and Ventilatory components of provided ABG 2. Identifies appropriate oxygenation components of provided ABG	Advanced Classifies ABG correctly	Proficient Classifies one component of ABG (ventilation or oxygen) correctly	Minimally Below Standard N/A	Not Proficient Fails to classify either component of ABG correctly
Makes Therapeutic Changes 1. Identifies appropriateness of Mode 2. Makes appropriate ventilatory changes 3. Makes appropriate oxygenation changes	Advanced Performs all 3 elements with no assistance or self-corrects prior to leaving patient area	Proficient Performs a minimum of 2 elements with no correction/intervention or self-corrects non-critical aspects	Minimally Below Standard N/A	Not Proficient Fails to perform at least 2 elements without intervention or correction. Unable to identify critical components
Monitors critical patient data 1. Reviews Vital Signs during all elements 2. Identifies and interprets PIP, Pplat, Raw, CL 3. Performs appropriate follow-up patient assessment to minimally include chest auscultation 4. Makes appropriate therapeutic recommendations based upon available PIP, Pplat, Raw, CL	Advanced Performs all 4 elements with no assistance or self-corrects prior to leaving patient area	Proficient Performs all 3 elements with no assistance or self-corrects prior to leaving patient area	Minimally Below Standard Performs all 2 elements with no assistance or self-corrects prior to leaving patient area	Not Proficient Fails to perform at least 2 elements without intervention or correction. Unable to identify critical components
Troubleshooting Student to be given trouble-shooting element (alarm, patient condition)
	Advanced Performs all aspects with no mistakes, shows advanced critical thinking and application where applicable 5 pts	Proficient Able to perform all aspects with minor mistakes / self-corrects on non-critical aspects 4 pts	Minimally Below Standards Able to perform basic aspects of scenario area, requires some interventions 3 pts	Not Proficient Unable to perform without significant interventions 1 pts
Identifies Potential Causes Able to identify causes of alarm, abnormal graphic, -patient condition	Advanced Quickly identifies potential causes of alarm, graphic, condition	Proficient Identifies major causes of alarm, graphic, condition	Minimally Below Standards Omits at least one major cause of alarm, graphic, condition	Not Proficient Fails to identify key causes of alarm, graphic, condition
Systematic Application Demonstrates systematic approach to troubleshooting	Advanced Demonstrates efficient, systematic approach	Proficient Disorganized approach, but arrives at correct answer	Minimally Below Standards N/A	Not Proficient Fails to utilize systematic approach
Implements appropriate intervention Utilizes critical thinking skills to implement and correct troubleshooting scenario	Advanced Implements appropriate intervention	Proficient Identifies multiple interventions, able to intervene with prompting	Minimally Below Standards Requires significant intervention to arrive at correct answer	Not Proficient Fails to intervene appropriately
Weaning Identifies strategies to wean, utilizes appropriate weaning tools, performs SBT and identifies readiness to liberate
	Advanced Performs all aspects with no mistakes, shows advanced critical thinking and application where applicable 5 pts	Proficient Able to perform all aspects with minor mistakes / self-corrects on non-critical aspects 4 pts	Minimally Below Standards Able to perform basic aspects of scenario area, requires some interventions 3 pts	Not Proficient Unable to perform without significant interventions 1 pts
Identifies Weaning Appropriateness Identifies key elements related to appropriateness to wean	Advanced Identifies all elements related to readiness to wean	Proficient Identifies multiple elements, misses 1-2 key elements	Minimally Below Standards Identifies multiple elements, requires prompting	Not Proficient Fails to identify key elements of weaning
Ventilator Management Makes appropriate mode and parameter changes in response to patient weaning	Advanced Performs appropriate ventilator changes, including mode and parameters	Proficient Requires prompting to make appropriate mode and parameter changes	Minimally Below Standards N/A	Not Proficient Fails to make appropriate mode and parameter changes despite prompting
Assessment Performs appropriate assessment elements following mode and parameter changes: 1. Vitals 2. Auscultation and WOB 3. Ventilator Data (RR, VT, PIP) 4. ABG 5. Subjective (Dyspnea)	Advanced Identifies all 5 elements of assessment	Proficient Identifies a minimum of 4 elements, including vitals	Minimally Below Standards Identifies a minimum of 3 elements, including vitals	Not Proficient Fails to identify a minimum of 2 elements -or- fails to identify monitoring of vitals
SBT 1. Identifies readiness to place on SBT and identifies SBT as required step 2. Identifies key manners to perform SBT in patient, including minimum and maximum times on SBT for safety 3. Utilizes weaning tools (minimally RBSI) 4. Recommends extubation or failure of SBT based upon patient presentation	Advanced Performs all 4 elements in a systematic approach	Proficient Performs all 4 elements with minimal prompting or self-correction	Minimally Below Standards Performs minimum of 3 elements with moderate prompting and self-correction, fails to use systematic approach	Not Proficient Fails to perform minimum of 3 elements, any failure related to patient safety
Professional Elements
	Exemplifies 5 pts	Consistent 4 pts	Improvement Needed 3 pts	Fails to Meet Standard 1 pts
Professional Manner Stays Calm throughout scenario, ensures patient comfort and explanations when appropriate	Exemplifies	Consistent	Improvement Needed	Fails to Meet Standard
Pathophysiology Ability to explain and make decisions in context of identified pathophysiology of disease or disorder	Exemplifies	Consistent	Improvement Needed	Fails to Meet Standard
Time Management Makes decisions in a reasonable period of time, systematically works through scenario using appropriate amounts of time for assessment in light of clinical context	Exemplifies	Consistent	Improvement Needed	Fails to Meet Standard
Infection Control Utilizes appropriate infection control / PPE at all times or identifies appropriate interventions	Exemplifies	Consistent	Improvement Needed	Fails to Meet Standard
Self-Reflection Able to reflect after scenario: Strengths, Areas to Grow, Overall performance	Exemplifies	Consistent N/A	Improvement Needed N/A	Fails to Meet Standard

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