Performance Checklist for Perineal Care: Female

Preparation for Procedure: ___ Organize equipment ___ Introduce self and explain procedure to the patient ___ Washes hands ___ Don gloves ___ Raise bed to appropriate height and lowers side rail on near side ___ Place protective pad or towel under the patient ___ May position patient on bedpan and/or drape appropriately Clean the Perineum: **May need to place on a bedpan. ___ Pour water on the perineum ___ Separate labia with one hand to expose urethral and vaginal openings ___ Wipe labia minora (inner) from front to back in downward motion using clean surface of wash cloth for each swipe ___ Wipe labia majora (outer) from front to back in downward motion using clean surface of wash cloth for each swipe. ___ Wash inner thighs from proximal to distal ___ Wipe down the center of the meatus from front to back. ___ Rinse with warm to tepid water ___ Pat dry using clean towel in same order as wash ___ Remove bedpan if one is used ___ Conclusion of Procedure: ___ Remove soiled equipment ___ Remove gloves ___ Position patient for comfort and warmth ___ Lower the bed and raises the side rail ___ Wash hands ___ Document appropriately the procedure Outcome: Pass ___ Comments: Student signature: Instructor signature: Fail ___