Get Nc Dhsr/ac 4605 2014-2025

Completing the NC DHSR/AC 4605 Medication Administration Clinical Skills Checklist is essential for ensuring that unlicensed staff demonstrate competency in medication administration. This guide will walk you through the process of filling out the form online, providing clear and supportive instructions.

Follow the steps to complete your checklist accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Write the name of the employee and the adult care home on each page of the checklist. Note that the checklist is not transferable.
3. Ensure all documentation is completed in ink. Only a registered nurse should check off items marked with an asterisk (*).
4. When the employee demonstrates competency for a task or skill, complete the 'Satisfactory Completion Date' block and initial or sign in the designated area.
5. Complete sections 1 through 14 for each unlicensed staff member, as specified in the checklist and guidelines.
6. Use methods such as questioning or written tests to determine competency in section 1.
7. For sections 2 through 13, observe the employee performing the task or skill, or have them demonstrate their competency verbally.
8. After tasks are completed, both the employee and instructor must sign and date the checklist.
9. For any additional tasks that require validation after signing, check off and document these on the original checklist or use a new one.
10. Utilize the comment section for any additional notes or signatures, ensuring all relevant information is documented.
11. Ensure that the completed checklist is maintained on file in the facility for compliance.
12. Once all sections are filled out, save the changes made to the checklist, and then download, print, or share the completed form as required.

Start filling out your NC DHSR/AC 4605 checklist online today!