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|Employee Name | |Campus | |

|Instructor | |Date of Training | |Review Date | |

| | | | | | |

|In order to us a pulse oximeter on students, employees must complete training and demonstrate the ability to perform the following tasks: |

| | |TRAINED |REVIEWED |

|1 |Review doctor’s order, IHP, and Plano ISD guidelines for pulse oximetry. | | |

|2 |Use universal precaution. Wash hands before and after procedure. | | |

|3 |Identify and explain the procedure to the student at his/her level of | | |

| |understanding. | | |

|4 |Assemble all equipment: pulse oximeter. | | |

|5 |Place the student sitting in an upright position. | | |

|6 |Instruct the student to breathe normally. | | |

|7 |Select appropriate site to apply probe based on peripheral circulation. | | |

|8 |Attach pulse oximeter probe to selected site. The clip-on probe attaches like a | | |

| |clothespin to a fingertip. | | |

|9 |Observe waveform display. Correlate oximeter pulse rate with student’s apical or | | |

| |radial pulse. | | |

|10 |Read saturation level on digital display when readout reaches constant value and | | |

| |pulse display is strong. | | |

|11 |Verify alarm limits and volume, if applicable. | | |

|12 |Remove probe. | | |

|13 |Clean with alcohol and store according to manufacturer recommendations. | | |

|14 |Wash hands. | | |

|15 |Document readings and observation of respiratory status | | |

|16 |Notify nurse, family health care provider or 911 if applicable | | |

|17 |Record and document. | | |

I have received instructions on the procedures to be followed in the use of the pulse oximeter at school following Plano ISD guidelines and understand my responsibilities.

|Employee Signature | |Date | |

|Instructor Signature | |Date | |

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Plano Independent School District

Benefits and Risk Management

School Health Service

Pulse Oximetry Training Checklist

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