Hinds Community College

Respiratory Care Technology

Procedural Competency Evaluation for Training

Staff Therapist (preceptor) Name:

Employed by:

Incentive Spirometry
Check one box for each line below:
Verifies physician order and scans chart for pertinent data.
Washes or disinfects hands.
Attains, assembles, troubleshoots equipment as indicated.
Introduces self to patient.
Checks patient identification.
Explains purpose of procedure to patient.
Assesses patient as indicated (B.S., pulse and respiratory rate)
Positions patient as indicated.
Sets and explains volume goals.
Instructs patient on how to perform inhalations and breath hold.
Instructs patient to cough.
Instructs patient on splinting technique.
Instructs patient on how and when to repeat therapy.
Washes or disinfects hands.
Charts therapy and notifies appropriate personnel of modifications as indicated

Satisfactory: no errors of omission or commission.

Unsatisfactory: errors of omission or commission occurred, or step was not viewed on video.


Because if you are not breathing, you are not doing anything else either.

Hinds Community College, P.O. Box 1100, Raymond, MS 39154 | 1.800.HINDSCC
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Hinds Community College is an Equal Opportunity Employer