Manila Central University

College of Nursing

NCM 103 SKILLS LABORATORY CHECKLIST

Administering Otic Instillations

NAME: ____________________________ DATE:_____________________

YEAR & SECTION ____________________ SCORE:____________________
Direction: Please rate the student’s performance using the scale below.
4 – EXEMPLARY (provides complete and accurate evidence in demonstrating knowledge, skills and attitude
necessary to facilitate client examination, assessment and intervention)
3 – PROFICIENT (provides clear evidence in demonstrating knowledge, skills and attitude necessary to facilitate
client examination, assessment and intervention)
3 – PROFICIENT (provides clear evidence in demonstrating knowledge, skills and attitude necessary to facilitate
client examination, assessment and intervention)
1 – BEGINNING (provides little or no evidence in demonstrating knowledge, skills and attitude necessary to
facilitate client examination, assessment and intervention facilitate client examination, assessment and
intervention

Procedures 4 3 2 1 Remark

1. Introduced self and verified client’s identity.

2. Explained procedure to client and discussed how results will be used.
3. Gathered appropriate equipment.
4. Compared label on medication container with the medication record
and checked expiration date.
5. If necessary, calculated medication dosage.
6. Performed hand hygiene and observed other appropriate infection
prevention procedures.
7. Prepared client.
a. Assisted client to a comfortable position for eardrop administration.
8. Cleaned the pinna of the ear and the meatus of the ear canal.
a. Applied gloves if infection was suspected.
b. Used cotton-tipped applicators and solution to wipe pinna and
auditory meatus.
9. Administered the ear medication.
 a. Warmed medication container in hand, or placed in warm water
for short time.
b. Partially filled ear dropper with medication.
c. Straightened auditory canal.
d. Instilled correct number of drops along side of ear canal.
e. Pressed gently but firmly a few times on tragus of ear.
f. Asked client to remain in side-lying position for about 5 minutes.
g. Inserted small piece of cotton fluff loosely at meatus of auditory
canal for 15 to 20 minutes.
10. Dispose all materials used in an appropriate receptacle
11. Perform hand washing after the procedure.
12. Chart the administration of the drug, writing down the name of the drug, time of
administration, and the site of administration.
13. Document findings.
Total

___ Used effective body mechanics throughout procedure.

Communicated appropriately with the client.
Documented all relevant information

.
Remarks:
_____________________________________________________________________________________________

_____________________________________________________________________________________________

______________________________
Student’s Printed Name & Signature Date: ___________________

______________________________
Instructor’s Printed Name & Signature