CA Skills – MEDICATION ADMINISTRATION ~ METERED-DOSE INHALER – Emergency Medical Services University, LLC

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Candidate:

First

Last

Student ID:

EMT student ID’s are usually in this format: 123456FT-01. For refresher or skills only, place “CE” in this field

16) Section 11

Examiner:

First

Last

Date:

Actual Time Started:

Military Time Only (example: 1523)

Skills Section

Action

Points Possible

Points Awarded

Dons or verbalizes appropriate PPE for skill.

Point 1

Assesses mental status of patient and explains procedure.

Point 2

Assesses respiratory status and confirms appropriateness of intervention.

Point 3

Note: Examiner states: “Patient is responsive, tachypneic, and has a pulse of 92/minute.”

Verbalizes obtaining medical direction for assisting with inhaler use.

Point 4

Verifies that the inhaler is not expired.

Point 5

Verbalizes and ensures the “5 Rights” of medication administration are present.

Point 6

Confirm that the patient has not already taken a dose of the inhaler recently.

Point 7

Note: Examiner states: “Medical direction has approved the use of the inhaler.”

Shakes metered-dose inhaler for 30 seconds prior to use.

Point 8

Instructs patient to exhale.

Point 9

Instruct patient to place mouthpiece in mouth past their teeth, and above the tongue.

Point 10

Instructs patient to activate inhaler once while initiating a slow deep breath.

Point 11

Instructs patient to hold their breath 5-10 seconds to allow medication absorption.

Point 12

Resume oxygen therapy as appropriate.

Point 13

Verbalizes waiting 15-30 seconds to repeat dose if approved by medical direction.

Point 14

Reassesses patient’s respiratory status for effectiveness.

Point 15

Identifies/Verbalizes how to properly chart medication administration in PCR.

Point 16

Total Points (Out of 16)

Actual Time Ended:

Military Time Only (example: 1523)

Critical Criteria Section

Critical Criteria

Failure to take or verbalize proper PPE for situation.
Failure to properly assess and recognize need for prescribed inhaler therapy.
Failure to confirm expiration date of medication or the “5 rights” of medication administration.
Failure to obtain medical direction approval prior to assisting with mediation administration.
Failure to properly explain the procedure and coach the patient before and/or during the procedure.
Uses or orders an inappropriate or dangerous intervention during skill.
Does not manage patient as a competent EMT.
Demonstrates an inappropriate or unprofessional affect with the patient or EMS personnel.

Notes

Administrative Section

Instructor State

Exam Location:

Instructor Certification Number:

Attempt 1 Result

Attempt 2 Result

Attempt 3 Result

Instructor Signature

Clear Signature

EMS University

Skills Section

Critical Criteria Section

Administrative Section

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