RETURN DEMONSTRATION EVALUATION TOOL
FOR EAR IRRIGATION
Name: __________________ Grade: __________
Time started: _________ Time Ended: ______ Date of RD: ________
AREA FOR EVALUATION RATING COMMENTS
SKILSS (35%) 5 4 3 2 1 0
ASSESSMENT/PLANNING
1. Reviews physician’s order including
solution to be instilled and the
affected ear to receive irrigation.
2. Reviews medication record for history
of ruptured tympanic membrane using
an otoscope.
3. Inspect the pinna and external
auditory meatus for redness, swelling,
drainage and abrasions and presence
of cerumen or foreign objects.
a. Always attempt to remove foreign
object in the ear by first simply
straightening the ear canal.
b. If vegetable matter (such as dried
bean or pea) is occluded in the canal,
do not perform the irrigation.
4. Ask if the patient is experiencing
discomfort, note the patient’s ability
to hear clearly.
5. Review patient’s knowledge of
purpose for irrigation and of normal
care of ears.
IMPLEMENTATION
1. Washes hands.
2. Arranges supplies at bedside and done
gloves.
3. Positions the examination light to
illuminate the affected ear.
4. Assists patient to a sitting or lying
position with head turned toward the
affected ear.
5. Places towel under the patient’s head
and shoulder and have the patient hold
the emesis basin under the affected
ear.
6. Pours irrigating solution into the
basin.
7. Gently cleans auricle and outer ear
canal and moisten cotton ball
applicator.
8. Fills the syringe with warm solution
(98.6°F or 38°C) approximately 50
ml.
9. For adult and children over age 3
years old, gently pull upper portion of
pinna up and back; in children age 3
years and below, pull the pinna down
and back.
10. Slowly instills the solution by holding
tip of the syringe 1 cm or ½ inch
above opening to ear canal.
11. Direct the fluid towards the superior
aspect of the ear canal. Push the
plunger or depress the bulb in slowly
and carefully.
12. Allows fluid to drain out during
instillation into the basin. Continue
until canal is cleansed or until the
desired amount of solution ordered
has been used.
13. Inspects the ear canal to see if it is
clean. Dry the ear and neck area.
14. Leaves the cotton ball loosely in place
for 5-10 minutes.
15. Assist patient to a sitting position.
16. Clean the area. Disposes supplies and
remove gloves.
17. Performs handwashing.
EVALUATION
1. Asks patient if discomfort is noted
during installation of solution
2. Asks patient about sensation of
lightheadedness and dizziness.
3. Re-inspects condition of the meatus
and ear canal.
4. Let the patient describe the purpose of
irrigation and proper technique for ear
care.
5. Ask the patient about improved
hearing.
DOCUMENTATION
1. Records in the nurses notes the
procedure, amount of solution
instilled, time of administration and
ear receiving irrigation.
2. Notes the appearance of external ear
and patient’s hearing acuity in the
nurse’s notes.
3. Report’s adverse effects/patient’s
response and/ or withheld drugs to
nurse in-charge or physician.
KNOWLEDGE (15%)
1. Gives rationale of the procedure
2. Explain the elements and mechanics of the
procedure
3. Knows the elements of nursing process as
applied
4. States principles applied in procedure
ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time and
effort.
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.
Comments:
______________________________________________________________________________
__________________________________________________________________
Clinical Instructor’s Signature: ___________________________
