PROCEDURE3-17: Perform HCG Pregnancy Test

Name______Date______Time______

PROCEDURE3-17: Perform HCG Pregnancy Test

Equipment/Supplies:Patient’s labeled urine specimen, CLIA waived HCG pregnancy kit, timer, gloves, hand sanitizer, surface sanitizer, biohazard waste container

Standards: Given the needed equipment and a place to work, the student will perform this skill with _____ % accuracy in a total of _____ minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.)

Key: 4 = Satisfactory0 = UnsatisfactoryNA = This step is not counted

Procedure Steps / self / PARTNER / INSTRUCTOR
1. Checked the physician order; washed your hands; put on personal protective equipment /  /  / 
2. Assembled the equipment and supplies; checked expiration dates /  /  / 
3. Verified that the name on the specimen container is for the correct patient and that the HCG test kit is not expired. /  /  / 
 /  / 
 /  / 
4. Perform the test as indicated on the test kit package insert directions. /  /  / 
5. Sampled the positive and negative controls as directed for the test kit.
6. Set the timer for running the test as indicated in the package insert
7. Read the reaction results at the end of the prescribed period of time
8. Verified the results of the controls before documenting the patient’s results; logged the controls and patient information on the worksheet according to office policy and procedure.
9. Properly disposed of the supplies and your gloves in a biohazard waste container
10. Washed your hands
11. Documented the procedure in the paper or electronic medical record /  /  / 
 /  / 

Calculation

Total Possible Points: _____

Total Points Earned: _____ Multiplied by 100 = _____

Divided by Total Possible Points = _____%

PassFail



Student’s signature ______Date ______

Partner’s signature ______Date ______

Instructor’s signature ______Date ______