IMPLANTS REMOVAL

CLINICAL SKILL COMPETANCY ASSESSMENT CHECKLIST

Instructions:
This observation checklist is to be used by trainer/s to observe the provider Implant removal skills
during post training follow-up or clinical monitoring and coaching visit. The trainer marks one of
the following scores to represent the performance level of each Implant removal task/step
observed:
Use the following rating scale:
2 = competently performed (step performed correctly)
1 = Needs improvement (step performed partially or incorrectly)
0 = Step omitted (step not done)
The provider must perform satisfactorily and in the correct sequence all the tasks and the steps of
the procedure, to be considered complying with standard steps of Implant removal skill. Steps that
appear with bold font are considered as critical steps. If the trainee scores less than 2 in any step,
he/she needs improvement.
The trainer fills out one form for each trainee/provider observed.

Trainee/Provider Name ________________________ Name of Health Facility___________________

IMPLANTS REMOVAL CLINICAL SKILLS

TASK/STEPS Rating scale
CLIENT ASSESSMENT
1. Asks client her reason for removal and answers any questions {2}
2. Reviews client's present reproductive goals and asks if she wants {2}
another method or a new implant
PRE-REMOVAL TASKS
3. Checks the client has thoroughly washed and rinsed her entire arm. {2}
REMOVAL TASKS
4. Washes hands thoroughly with soap and water and dries with clean, dry {2}
towel or air dries
5. Cleans twice where implant is inserted with the antiseptic solution {2}
6. Anaesthetizes with 1-2 ml of 1%lidocaine applied just under the lower {2}
tip of the implant(s)
7. Makes 2-3 mm horizontal incision at the lower tip of the implant(s) {2}
(closest to the elbow)
8. Gently dissect fibrous tissue around Implant and pull out with Artery {2}
forceps.
POSTREMOVAL TASKS
9. Applies sterile gauze with a pressure for few seconds {2}
10. Disposes of waste materials {2}
11. Gives post-removal instructions {2}

Competency rating
Trainee/Provider is _______ (Competent/ Not Competent)
Trainer Name ___________ Trainer Code___________ Date________________