Arterial Blood Gas Procurement Evaluation Rubric (2022):

Arterial Blood Gas Procurement

Exemplary Accomplished Developing Comments
LEVEL
REDO REDO
❑ Confirms physician’s ❑ Does not check the physician’s
order and order or unable to identify
CHECKS ORDER & ❑ Identifies contraindications in patient’s
CHART contraindications chart.
present in patient’s chart.
Maintains ideal infection Break of infection control
control. This includes washing compromising safety
INFECTION hands, using appropriate PPE
CONTROL and maintaining aseptic
technique throughout the ABG
procedure.
Gathers all required Retrieves missing supplies on Retrieves missing supplies on more .
GATHERS supplies for the ABG no more than one occasion than one occasion prior to starting the
SUPPLIES procedure. prior to starting the ABG ABG procedure, or is missing supplies
procedure. and has started the insertion procedure.
Dressed professionally. Identifies the patient, obtains Does not identify the patient, or

Shows initiative and positive consent and completes all but obtains consent, or misses at least
attitude. one of the following: two of the following:
S ▪ Identifies self and dept.
PROFESSIONALISM Communicates effectively with ▪ Identifies self and dept.
patient: U ▪ Explains procedure to patient
▪ Explains procedure to patient
AND C ▪ Answers questions appropriately
▪ Identifies self and dept. ▪ Answers questions
PATIENT ▪ Identifies the patient appropriately C
INTERACTION ▪ Explains procedure to patient E
▪ Obtains consent from pt. S
▪ Answers questions S
appropriately F
Confirms steady state Confirms steady state U Does NOT confirm steady state
conditions and notes HR, conditions and notes all but L conditions, or does NOT note two or
PATIENT STATUS RR, SpO2, and current oxygen one of the following: HR, RR, more of the following: HR, RR, SpO2,
therapy and/or specific FiO2. SpO2, and current oxygen  and current oxygen therapy and/or
therapy and/or specific FiO2. specific FiO2.
Correctly performs the Does not perform the Modified Allen’s
CONFIRMS Modified Allen’s Test ensuring Test, or incorrectly performs the
the hand stays blanched until Modified Allen’s Test. (e.g. Hand does
COLLATERAL the Ulnar artery is released. not remain blanched when opened,
CIRCULATION Confirms refill time is less than wrong artery released.)
10 s.
Completes all steps of the Completes all steps of the Is unable to complete the steps of the
PROCURES ABG ABG procedure smoothly, ABG procedure with some ABG procedure or makes a mistake
without any hesitation or hesitation and/or mistakes that that causes harm to the patient (.
ACCORDING TO mistakes. are self-corrected in a timely Improper redirect, excessive blood
PROCEDURE fashion and cause no harm to loss…)
the patient.
Places ABG sample in a ABG sample not placed in biohazard
biohazard bag. All sharps and bag, or does not disposes of
BIOHAZARD & biohazardous material disposed biohazardous waste or sharps, OR
SAFETY of properly. Sharps handled demonstrates unsafe needle practice
properly
Sample label includes all of Sample label is missing one Sample label is missing two or more of
the following: of the following the following:
• Date and Time of draw • Date and Time of draw • Date and Time of draw in 24h
in 24h notation in 24h notation notation
• Sample Type • Sample Type • Sample Type
• Patient Name and ID# • Patient Name and ID# • Patient Name and ID#
ABG LABEL • Oxygen Therapy or • Oxygen Therapy or • Oxygen Therapy or specific
specific FiO2 or R/A if specific FiO2 or R/A if FiO2 or R/A if no Oxygen
no Oxygen Therapy no Oxygen Therapy Therapy
• Clinician’s Name and • Clinician’s Name and • Clinician’s Name and
designation designation designation

Note: Any section scoring in the above columns

PASS/NOT PASS will require a REDO for the entire competency.

Peer Evaluation Conducted by: ________________ for: __________________ Date:___________