Page 20 - Orthopedic Casts and Splints2

Performance Steps
d. Instruct patient not to stick anything down the cast, do not remove the cast, and do not alter
the cast( e.g. writing on it, coloring).
42. Annotate the procedure applied to patient in medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to patient in medical record or
Standard Form 513 and sign your

43. Escort patient or direct family member to front desk to make a follow-up appointment.

Performance Measures GO NO GO
1. Received or reviewed the order from the physician. —— ——

2. Identified yourself to patient. —— ——
3. Explained the procedure to patient. —— ——
4. Inspected patient's arms. —— ——

5. Checked patient's capillary refill. —— ——
6. Gathered equipment. —— ——

7. Assembled materials. —— ——
8. Prepared stockinette. —— ——
9. Prepared plaster reinforcement volar splint . —— ——

10. Prepared plaster reinforcement posterior splint. —— ——
11. Manufactured loop. —— ——

12. Applied stockinette to patient's injured arm. —— ——
13. Applied finger traps on injured hand ( if not used go to step 14). —— ——

14. Measured patient's injured elbow and wrist with goniometer. —— ——
15. Applied cast padding (webril ) to injured arm. —— ——

16. Prepared casting materials. —— ——
17. Placed fiberglass casting gloves on hands. —— ——
18. Opened fiberglass casting package . —— ——

19. Applied 1st plaster/fiberglass roll. —— ——
20. Laminated the cast materials. —— ——

21. Applied reinforcement splint to volar aspect of cast. —— ——
22. Applied reinforcement splint to posterior aspect of cast. —— ——

23. Applied 2nd plaster/fiberglass roll( repeat steps 19-20 ) —— ——
24. Molded cast material to wrist/forearm. —— ——

25. Molded cast material to the biceps muscle. —— ——
26. Checked range of motion ( ROM ) of phalanges and thumb. —— ——
27. Checked alignment of injured wrist with goniometer. —— ——

17