PT8087C - Interventions I - Modalities Skills Check and Final Practical Exam Rubric (25 points max)

Student Name: Duke, Nicholas Skill check #: 4 Scenario #: 6

Evaluator: AH Date: 11/26/19 Description: LB DJD, deep ht, mech TX, TENS
Evaluation Items Yes =1 ;No = 0 Comment/Observation
Professional Behaviors
Proper Introduction 1
Verifies ID & Informed Consent 1
Agreement to Treat 1
Language appropriate to Pt 1
Confident & Positive 1
Patient Positioning
Appropriate transfer or assistance 1
Appropriate for condition 1
Checks on Pt comfort 1
Protect PT body mechanics 1
Appropriate Draping (if required) 1
Allows for efficient delivery of Tx 1
Patient Information/Instruction
Description of Modality and Tx 1
Goal of Tx 1
Contraindications/Precautions 1
What Pt should expect to feel 1
Safety switch or shut-off (if required) 1
Application of Modality(ies)
Appropriate for age, sex, condition 1
Appropriate for contraindications 1
Appropriate rationale for set-up 1
Appropriate dose 1
Appropriate accessory equipment 1
Able to ascertain changes in Pt 1
Appropriate technique/delivery 0 Put straps on table first then have pt lay on table
Appropriate management of skin 1
Followed all safety measures 1
Score/Result 24 General Comment/Observation
≥ 80% to pass 96%
Technical Result Pass
Safety Result Pass
ubric (25 points max)

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