PERFORMANCE CHECKLIST

CHANGING DIAPER

NOT
PROCEDURE DONE SCORE
DONE
1. Inform the patient about the procedure. 3
2. Gather the materials needed. 3
3. Wash hands. 3
4. Provide privacy. 3
5. Remove pants/ undergarments. 4
6. Wear gloves. 4
7. Remove diaper tapes and cover the soiled part of
4
the diaper.
8. Cleanse the genitals from front to back with wet
4
tissue or cotton.

9. Place soiled tissues in a separate container.

3
10. Weigh and record the diaper and place the soiled
3
diaper in the proper disposal.
11. Remove gloves. 3
12. Put on clean diapers.Replace a clean underpad
5
when necessary.
13. Wash hands. 3
14. Record all the procedures done, time started &
finished, reaction of the patient to the procedure 5
and any deviations seen.
TOTAL 50

Name: ____________________ Score: _______________

Section: ___________________ Date: _______________
Instructor:__________________