Manila Central University

COLLEGE OF NURSING

SKILLS REVALIDATION RUBRICS

NCM ____: IV MEDICATION INCORPORATION INTO VOLUMETRIC CHAMBER

NAME: ____________________________ DATE:_____________________ 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)
2 – DEVELOPING (provides limited 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)

PROCEDURE 4 3 2 1 Remarks
I. IV MEDICATION INCORPORATION INTO VOLUMETRIC
CHAMBER
1. Verify written doctor’s prescription.
2. Observe twelve (12) rights of medication administration.
3. Explain the procedure to the patient.
4. Do hand washing/hand hygiene before and after the procedure
5. Prepare the necessary materials.

6. Check intravenous fluid labels.

7. Incorporate drug as prescribed into volumetric chamber and add
desired diluents aseptically.
8. Regulate flow rate accordingly.
9. Discard sharp and other wastes according to Health Care Waste
Management (DOH/DENR).
10. Do hand hygiene.
11. Document the procedure and hand-off accordingly.
TOTAL

REMARKS:
___________________________________________________________________________________________________
___________________________________________________________________________________________________

______________________________ Date: __________________________

Student’s Printed Name & Signature
_______________________________
Instructor’s Printed Name & Signature Date: __________________________