Page 348 - Orthopedic Casts and Splints2

Performance Measures GO NO GO

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

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

5. Checked capillary refill of patient's hands/fingers. —— ——
6. Gathered equipment. —— ——

7. Assembled materials. —— ——
8. Prepared cast padding ( webril) for thumb spica splint. —— ——
9. Prepared plaster splint for the radial side of the hand and forearm. —— ——

10. Measured patient's injured wrist w/ goniometer. —— ——
11. Applied thumb spica splint to injured thumb. —— ——

12. Secured thumb spica splint to injured thumb and arm. —— ——
13. Molded splint to thumb. —— ——

14. Checked range of motion( ROM) of phalanges. —— ——
15. Checked alignment of injured wrist 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. Fitted patient with a sling. —— ——
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
TM 6-840

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