Ambulate with Walker

Name______

Ambulate with walker

Criteria / Points / Not Adequate / Acceptable
21/30=70% / Exceptional
COMMUNICATION / 2 / 0 / 1 of 2 / 2 of 2
Introduce self
Explain procedure
PATIENT PRIVACY / 1 / 0 / 0 / 1 of 1
Assess patients desire for privacy
PATIENT SAFETY / 3 / 1 of 3 / 2 of 3 / 3 of 3
Wash hands prior
Identify patient
Call light in reach when finished
PERSONAL SAFETY / 2 / 0 / 1 of 2 / 2 of 2
proper body mechanics
Wash hands after
HUMAN AWARENESS / 6 / 4 of 6 / 5 of 6 / 6 of 6
Provide quiet environment
Awareness of patient’s individual differences
Adjust approach to meet patient’s individuality
Conversation as appropriate
Ensure patient comfort
Maintain dignity of patient
AMBULATION WITH WALKER / 16 / 11 of 16 / 12 of 16 / 16 of 16
Gather equipment and have within reach of patient
Demonstrate use of walker to patient
·  All four points of walker touch floor at the same time
·  Walker/affected foot/non-affected foot
·  Do not cross front plane of walker
Apply gait belt to patient snuggly at waist
Place walker in front of patient
Have patient grasp grips of walker
Assist patient to stand using gait belt
Measure walker to patient
Have patient return demonstration
Hand on gait belt with palm up
Other hand on patient’s shoulder
Return patient to chair – back of knees against chair
Grasp arms of chair to sit
Make sure patient is comfortable

*A score of at least 70% is required to pass all skills. All items in bold are considered critical and must be performed to pass the skill regardless of total percent performed.

Results: Pass Fail Date:

Comments:

Evaluator(s): ______