Page 203 - Orthopedic Casts and Splints2

Performance Steps
NOTE: Record the procedure applied and cast care instruction provided to the patient in patient's
medical record or Standard Form 513 and sign your name.
23. Escort patient to front desk to make a follow up appointment.

Performance Measures GO NO GO

1. Received the order from the physician (reviewed if in writing). —— ——
2. Identified yourself to patient. —— ——

3. Explained the procedure to the patient. —— ——
4. Inspected patient's injured leg/ankle . —— ——

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

8. Prepared plaster splint for the injured leg. —— ——
9. Prepared padding for splint. —— ——

10. Measured patient's injured ankle w/ goniometer. —— ——
11. Applied posterior splint to injured leg. —— ——
12. Secured splint to injured leg. —— ——

13. Molded the splint to the ankle/leg. —— ——
14. Checked range of motion( ROM) of phalanges and knee. —— ——

15. Checked alignment of injured ankle with goniometer. —— ——
16. Checked splint dimensions. —— ——

17. Checked patient's capillary refill. —— ——
18. Cleaned plaster off patient's skin using a damp wash cloth, towel or alcohol pad. —— ——

19. Administered a crutch ambulation treatment ( see task number 081-836-0041). —— ——
20. Gave patient verbal and written instructions on cast care —— ——
21. Annotated the procedure applied to patient in medical record or SF 513. —— ——

22. Escorted patient to front desk to make a follow up appointment. —— ——

Evaluation Guidance: Score the orthopaedic technician a GO on the task, if all steps are passed (P).
Score the orthopaedic technician a NO-GO( NG ) if any step is failed (F). All performance measures must
be passed to receive a go.

References
Required Related
0812110-0765
0-8342-0763-X
38709590
COPPARD, B. M. & LOHMAN
TM 6-840
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