es) es · This document is adapted with permission from University of Manchester Principles of...

HEA2233/3

157: S

urg

ical C

om

pete

ncie

s

Pra

ctic

e A

sse

ssm

en

t Do

cu

me

nt

(Com

pete

ncie

s)

Stu

de

nt N

am

e:

Edge H

ill Univ

ersity

Stu

dent N

um

ber:

Pro

fessio

nal R

egistra

tion:

Mid

-term

| Fu

ll-term

S

SA

| M

A |

SS

A |

MA

Ap

plied

Practi

ce fo

rms –

Co

mp

eten

cies.

This d

ocu

men

t con

tains all co

mp

etencies fo

r HEA

22

33

& H

EA31

57

Ho

w to

com

plete

the fo

rms:

First mee

t with

you

r allocated

men

tor an

d d

iscuss th

e best w

ay you

can m

eet th

e com

peten

-cies w

ithin

these fo

rms. Th

is will en

able yo

u to

gain an

un

derstan

din

g of w

hat is req

uired

to

dem

on

strate that yo

u can

practi

ce com

peten

tly and

con

sistent-

ly. The m

ento

r’s role is to

guid

e you

thro

ugh

the p

rocess an

d

facilitate op

po

rtun

ities fo

r you

to gain

eviden

ce to sh

ow

that

you

are a com

peten

t intra-o

perati

ve practi

tio

ner.

1. Yo

u sh

ou

ld start to

wo

rk alon

gside yo

ur co

lleagues an

d clin

icians an

d exp

lore yo

ur

kno

wled

ge in p

ractice b

y asking q

uesti

on

s. You

r men

tor w

ill wo

rk alon

g side yo

u in

itially

bu

t then

as you

pro

gress, they m

ay ado

pt a stan

ce of p

roxim

al sup

ervision

wh

ere yo

u

un

dertake clin

ical activiti

es on

you

r ow

n.

2. Th

rou

gho

ut th

is mo

du

le you

will b

e guid

ed to

ward

s key do

cum

ents th

at will fo

rm th

e core

of yo

ur p

ortf

olio

eviden

ce. You

will b

e advised

on

ho

w to

make b

est use o

f these d

ocu

-m

ents to

dem

on

strate you

r kno

wled

ge and

un

derstan

din

g that u

nd

erpin

s each clin

ical skill.

3. M

ake sure yo

u co

nti

nu

e to gen

erate po

rtfo

lio evid

ence to

sup

po

rt the claim

you

are m

aking at th

e end

of th

e mo

du

le. This is im

po

rtant as yo

ur m

ento

r will review

you

r p

rogress again

st each co

mp

etency n

ot ju

st by o

bservati

on

alon

e bu

t thro

ugh

the refl

ective

or o

ther typ

es of evid

ence co

ntain

ed in

you

r po

rtfo

lio.

4. In

the [A

ssessmen

t Meth

od

/Eviden

ce] colu

mn

you

sho

uld

ind

icate wh

at meth

od

of

assessmen

t has b

een u

sed an

d typ

e of evid

ence yo

u h

ave with

in yo

ur p

ortf

olio

(inclu

din

g lo

catio

n) to

sup

po

rt you

r claim th

at you

are co

mp

etent in

practi

ce. You

will n

ote th

at there

are alre

ady re

com

me

nd

ed m

etho

ds o

f assessm

ent listed

in th

is colu

mn

. These are in

clud

-ed

as a guid

e to yo

ur m

ento

r as to w

hat th

e mo

st app

rop

riate meth

od

s of assessm

ent m

ay b

e for th

at parti

cular skill statem

ent. Item

s listed in

BLO

CK

CA

PITA

LS are com

pu

lsory.

5. SSA

= Stud

ent Self A

ssessmen

t, MA

= Men

tor A

ssessmen

t. C

om

peten

ce is record

ed b

y markin

g a 0 [n

ot yet co

mp

etent] o

r a 6 [co

mp

etence]. Yo

u are

requ

ired to

self-assess you

r com

peten

ce prio

r to d

iscussio

n w

ith yo

ur m

ento

r. You

r m

ento

r will also

com

plete th

e MA

bo

xes with

[initi

alled] 0 o

r 5 (d

iplo

ma) o

r 6 (d

egree).

6. If (fo

r wh

atever reason

) you

are no

t com

pete

nt an

d a ze

ro is reco

rded

then

an acti

on

plan

is req

uired

. This is th

e case at Full-term

as mu

ch as at M

id-term

. Stud

ents w

ill be o

ffered

o

ne o

pp

ortu

nity to

be re

-assessed fo

llow

ing a fail-in

-practi

ce grade b

eing reco

rded

at full-

term assessm

ent. Th

ere is an

op

po

rtun

ity to reco

rd th

is actio

n p

lan o

n th

e reverse of th

e Fu

ll-term A

ssessmen

t record

(Page 6

). Please d

iscuss th

is matt

er furth

er with

you

r men

tor

and

/or yo

ur m

od

ule co

ord

inato

r; if this is u

nreso

lved. It m

ay be so

meth

ing sim

ple th

at can

easily be recti

fied

by arran

ging an

alternati

ve allocati

on

or stu

dy o

pp

ortu

nity. Yo

ur acti

on

p

lan w

ill reflect th

is discu

ssion

. Please n

ote: yo

u w

ill no

t pass th

is mo

du

le un

less you

are

0 0

6 6

dee

med

com

peten

t in A

LL skill ite

ms.

7. Th

e bo

x to th

e right o

f the co

mp

etency

(illustrated

) is to en

able yo

ur m

ento

r to sign

to reco

rd co

mp

etence again

st each skill item

. So

me circu

mstan

ces may d

ictate that an

assessor w

orkin

g in co

nju

ncti

on

with

you

r allo

cated m

ento

r sign th

is. If this is th

e case then

this m

ust b

e cou

nter sign

ed b

y you

r allo

cated m

ento

r. If you

have b

een

wo

rking w

ith ad

diti

on

al men

tors, th

ey too

sho

uld

sign

in th

is bo

x. This d

emo

nstrates b

oth

sets of m

ento

rs are in

agreem

ent w

ith o

ne an

oth

er.

Wh

at to d

o n

ext with

the ap

plied

practi

ce fo

rms?

These fo

rms h

ave to b

e sub

mitt

ed eth

er by h

and

or b

y po

stal mail to

ensu

re the au

then

ticity

of sign

atures. Th

e ou

tcom

es are then

record

ed at Ed

ge Hill U

niversity. Yo

ur fo

rms w

ill be

return

ed to

you

at a later date fo

r inclu

sion

in yo

ur p

ortf

olio

. They are im

po

rtant b

ecause

they w

ill dem

on

strate to yo

ur em

plo

yer you

r com

peten

cy. You

sho

uld

take cop

ies of yo

ur

do

cum

ents p

rior to

po

stin

g.

Ple

ase return

the d

ocu

men

t to yo

ur m

od

ule co

ord

inato

r at eithe

r add

ress (see sub

missio

n

date in

you

r han

db

oo

k):

Edge H

ill Un

iversity Facu

lty of H

ealth

Arm

stron

g Ho

use

Oxfo

rd R

oad

M

anch

ester M

1 7

ED

Ed

ge Hill U

niversity

Faculty o

f Health

St. H

elens R

oad

O

rmskirk

Lancash

ire L3

9 4

QP

.……

……

Me

nto

r/Assesso

r Signatu

re

Prelim

inary In

terview

: Th

e stud

ent an

d m

ento

r sho

uld

use th

is interview

to d

iscuss th

e com

peten

cy do

cum

ent as a

wh

ole an

d n

ote item

s for acti

on

plan

nin

g. It is extremely im

po

rtant th

at skill items th

at can

no

t be tau

ght an

d assessed

with

in th

e curren

t allocati

on

are no

ted an

d th

at the acti

on

plan

refl

ects this d

iscussio

n.

Stu

dent N

am

e:

Page 4

No

tes (P

lease referen

ce to

AC

TION

PLA

N):

Signed

…

Stu

den

t:

Men

tor:

Acad

em

ic Sup

ervisor:

Date

:

Date

:

Date

:

Mid

-term

Asse

ssmen

t: Th

e stud

ent an

d m

ento

r sho

uld

use m

id-term

assessmen

t to b

ench

mark w

hat h

as alread

y b

een

achieved

against th

e skill statemen

ts. This w

ill enab

le actio

n p

lann

ing fo

r ou

tstand

ing

skill items. U

se this p

age to n

ote an

y po

tenti

al pro

blem

areas. It is extrem

ely imp

ortan

t that

skill items th

at can n

ot b

e taugh

t and

assessed w

ithin

the cu

rrent allo

catio

n are

no

ted an

d

that th

e actio

n p

lan refl

ects this d

iscussio

n.

Stu

dent N

am

e:

Page 5

No

tes (P

lease referen

ce to

AC

TION

PLA

N):

Signed

…

Stu

den

t:

Men

tor:

Acad

em

ic Sup

ervisor:

Date

:

Date

:

Date

:

Full-te

rm A

ssessm

ent:

At fu

ll-term th

e stud

ent sh

ou

ld b

e com

peten

t in A

LL skill item

s. A statem

ent o

f un

con

diti

on

al co

mp

etence sh

ou

ld b

e mad

e (bo

tto

m o

f page) b

y bo

th th

e stud

ent an

d m

ento

r, signed

, dated

an

d acco

mp

anied

(validated

) by b

oth

the stu

den

t’s and

men

tor’s p

rofessio

nal registrati

on

n

um

bers. If th

is is no

t po

ssible th

en a fu

rther A

CTIO

N P

LAN

MU

ST BE C

ON

STRU

CTED

to

add

ress this. P

lease u

se the ad

diti

on

al form

(overleaf) to

record

the o

utco

me o

f any fu

rther

actio

n.

Stu

dent N

am

e:

Page 6

Sum

mary:

I con

firm

that I…

……

……

……

……

……

……

……

……

……

(stud

ent) *h

ave/have N

OT co

nsiste

ntly

dem

on

strated

com

pete

nce

in all o

f the en

closed

skill statemen

ts.

Stud

ent:

Date

: (P

IN: )

I con

firm

that …

……

……

……

……

……

……

……

……

……

(stud

ent) *h

as/has N

OT co

nsisten

tly d

emo

nstrate

d co

mp

eten

ce in

all of th

e enclo

sed skill statem

ents.

M

ento

r: D

ate:

(PIN

: )

PR

INT N

AM

E:

A

cade

mic Su

perviso

r: D

ate:

*Delete as ap

pro

priate

Full-te

rm A

ssessm

ent: R

EVIEW

o

f AC

TION

PLA

N to

com

plete

Co

mp

eten

cies P

lease list th

e ou

tstand

ing skill item

s in th

e table b

elow

and

record

the o

utco

me o

f the

Acti

on

plan

devised

to ad

dress th

ese: A

s with

the p

reviou

s form

, a statemen

t of u

nco

nd

itio

nal co

mp

etence sh

ou

ld b

e mad

e (b

ott

om

of p

age) by b

oth

the stu

den

t and

men

tor, sign

ed, d

ated an

d acco

mp

anied

(validated

) b

y bo

th th

e stud

ent’s an

d m

ento

r’s pro

fession

al registratio

n n

um

bers.

Stu

dent N

am

e:

Page 7

Sum

mary:

I con

firm

that I…

……

……

……

……

……

……

……

……

……

(stud

ent) *h

ave/have N

OT co

nsiste

ntly

dem

on

strated

com

pete

nce

in all o

f the en

closed

skill statemen

ts.

Stud

ent:

Date

: (P

IN: )

I con

firm

that …

……

……

……

……

……

……

……

……

……

(stud

ent) *h

as/has N

OT co

nsisten

tly d

emo

nstrate

d co

mp

eten

ce in

all of th

e enclo

sed skill statem

ents.

M

ento

r: D

ate:

(PIN

: )

PR

INT N

AM

E:

A

cade

mic Su

perviso

r: D

ate:

*Delete as ap

pro

priate

Sk

ill R

ef.

Sk

ill item

S

SA

M

A

Me

nto

r Sig

na

ture

Page 8

INSER

T Men

tor Fo

rm

HER

E

This document is adapted with permission from University of Manchester Principles of Operating Room Practice Clinical Competency Portfolio (2008) Intellectual Property of this document remains with University of Manchester .

Section 1 Preparation for Intra-operative Care

1.1 Competency Preparation of self and others for Intra-operative Roles

Knowledge and Skills Indicators Method/Evidence

Principles of asepsis. Rationale and evidence base for selection and application of each of the attire listed. Correct selection, application and use of each item in accordance with National Guidelines and local policy. This should include decontamination of non-disposable items:

Discuss selection of each item for use in the contexts of risk to: Patient (s) Practitioner

Discuss National Guidelines and local policy for theatre attire. Demonstrate and discuss correct application of theatre attire including:

Operating Room Clothing Hats Shoes Jewellery Masks Eye protection Aprons Lead aprons Scrubbed attire Gloves

Notes [ ]

DISCUSSION [ ] DIRECT OBSERVATION [ ]

Student Name: Page 9

Mid-term | Full-term

SSA | MA | SSA | MA

.…………Mentor/Assessor Signature [Performance Criteria on

reverse of this page]

This workforce competence was developed by Skills for Health

1.1 Competency Preparation of self and others for Intra-operative Roles

Performance Criteria

These performance criteria offer specific guidance to mentors and assessors regarding the way in which this competency should be demonstrated.

Notes

1. Apply standard precautions for infection prevention and control and other appropriate health and safety measures when preparing and dressing for scrubbed and non-scrubbed roles

2. Select and wear appropriate personal protective equipment in line with organisational policies and national guidance

3. Wash and dry your hands and arms effectively in accordance with organisational policies and protocols

4. Select and put on suitable size sterile gown and gloves according to approved procedures 5. Promptly change personal protective equipment which becomes unsuitable for use 6. Remove and dispose of all used personal protective equipment and theatre clothing in a way

which minimises the risk of cross-infection



1.2 Competency Preparation of Environment for Intra-operative Care


Preparation, checking and rectification of faults/issues with standard operating theatre equipment and equipment that is specialty specific. National and local requirements/recommendations in respect of optimal operating conditions. Decontamination, cleansing and traceability requirements between cases and between operating lists.

Discuss national/local guidelines for OR equipment Demonstrate and discuss the rationale behind routine check and preparation of the following:

Operating Lights & Camera Apparatus

Electro-surgical Equipment

Suction Apparatus

Heating and Ventilation Operating Tables and Attachments

Operating list distribution

Warming devices and anti-embolus devices

Microscopes

Audio-visual equipment (Camera stacks) Insufflation Devices

Patient Trolleys Stock Levels

Notes [ ]

Discussion [ ] DIRECT OBSERVATION [ ]



SSA | MA | SSA | MA




1.2 Competency Preparation of Environment for Intra-operative Care

Performance Criteria Notes:

1. Apply standard precautions for infection prevention and control and other relevant health and safety measures

2. Ensure that your position and movements do not compromise the sterile field 3. Take appropriate action without delay if there is any breakdown of the sterile field 4. Obtain, prepare and position the requested medical devices and equipment 5. Correctly in an appropriate manner and time, according to the patient’s clinical status and as

requested 6. Take appropriate action where you identify a problem in relation to an item 7. Promptly clarify any uncertainty over requirements with a registered practitioner 8. Obtain the correct items, check and maintain integrity of items, and make selected item availa-

ble to the appropriate member of the team in the prescribed manner, manufacturers instruction and organisational policies and procedures

9. Monitor and count surgical items with the registered practitioner, in line with organisational policies and procedures

10.Handle and connect medical devices and equipment safely and correctly, in line with manufac-turers’ instructions and organisational policies

11.Ensure waste is disposed of appropriately 12.Correctly handle and manage contaminated items in line with organisational policies 13.Comply with organisational policies for replacing used items from stock and tracking and

traceability requirements




1.3 Competency Preparation of Materials and Equipment for Intra-operative Care


The types, purpose and function of surgical instruments and supplementary items in common use in the clinical specialties relevant to practice. The requirements for, and suitability of, surgical instru-ments and supplementary items for the clinical specialties relevant to practice. The factors to consider in selecting surgical instruments and supplementary items for individual patients:

Demonstrate preparation of, and discuss the rationale for items and equipment for a range of minor intermediate and major surgical procedures:

surgical instrumentation from sets or supplementary packs

peel packs, tape seal packs, fluids, sharps, patient implants and grafts, drainage systems, drugs, and swabs

sutures, dressings and drains power tools, endoscopic equipment, microscope,

exsanguinators drape packs, topical medicinal preparations

Notes [ ]

Discussion [ ] ANNOTATED Guidelines [ ]

ANNOTATED Instrument Checklist [ ] DIRECT OBSERVATION [ ]



SSA | MA | SSA | MA




1.3 Competency Preparation of Materials and Equipment for Intra-operative Care



2. Prepare and maintain sterile instrumentation and supplementary items in a designated prepara-tion area to ensure asepsis

3. Select and prepare the correct surgical instrumentation and supplementary items according to the clinical specialty, the anticipated requirements of the operative procedure, and the patient’s individual needs

4. Check date controlled items and confirm them as being within their expiry date 5. Safely handle, move and check surgical instrumentation and supplementary items in line with

manufacturers instructions, confirming them as safe and functioning correctly before preparing them ready for use

6. Take the appropriate action to remedy or report any faults where you find surgical instrumenta-tion and supplementary items are faulty or unsafe during preparation

7. Correctly set up surgical equipment in line with manufacturer’s instructions, and to meet the needs of the operative procedure and the patients’ plans of care

8. Count and record instruments, needles, swabs and supplementary items in conjunction with a registered practitioner as the second authorised checker prior to commencing the case, in line with organisational policies and protocols

9. Prepare the surgical trolley, positioning surgical instrumentation and supplementary items in a way which facilitates their access and use, according to the anticipated sequence of the opera-tive procedure




Method/Evidence

Section 2 Duties of the Scrubbed Practitioner

2.1 Competency Management of the Sterile Field

Knowledge and Skills Indicators

Demonstrate and discuss the management of the sterile field for a variety of surgical proce-dures within chosen speciality. Principles of asepsis in relation to the provision of surgical instrumentation and supplemen-tary items and the maintenance of the sterile field The risks posed to the sterile field and how these risks may be managed. Standard precautions and the instances whereby additional measures may be required by policy/guidelines e.g. CJD, MRSA

Demonstrate sterile technique. Demonstrate the ability to manage instruments in a way that promotes the maintenance a safe and effective sterile environ-ment. Discuss the risks of compromise to the sterile field and the ways in which

these may be reduced (in the context of own specialty) an intra-operative breach in asepsis may be safely

managed Discuss the instances whereby additional measures may be required to manage asepsis/sterility.

Notes [ ]


ANNOTATED Scrub Policy [ ] OPERATING ROOM LAYOUT for chosen

specialty [ ]



SSA | MA | SSA | MA




2.1 Competency Management of the Sterile Field



2. Ensure your, position, posture and movements do not compromise the sterile field or patient safety

3. Communicate clearly and assertively with others, giving appropriate information, instruction and advice so that they do not compromise the sterile field

4. Effectively monitor the activities of the surgical team and anticipate their requirements for surgical instrumentation and supplementary items

5. Complete records accurately and legibly in accordance with national guidelines 6. Carefully remove drapes from the patient, ensuring their dignity and safety, and dispose of

drapes as appropriate




2.2 Competency Management of Instrumentation, equipment and consumables


In-depth knowledge of surgical procedures within chosen specialty and the instrumentation and equipment requirements of each. Understands the needs and requirements of the surgical team and can respond appropriately to changes in these needs. The risks posed by failure to manage instrumentation and how these risks may be minimised and managed. Manufacturers’ requirements for checking of instrumentation and procedures for managing defective and/or faulty instrumentation or equipment.

Apply principles of aseptic technique. Demonstrate the ability to manage instruments in a way that promotes the maintenance a safe and effective aseptic environ-ment. Demonstrate correct and safe checks of all equipment and instrumentation:

Swabs Needles/sutures Blades Instrumentation

Discuss the role of the scrubbed practitioner in anticipating the surgeon’s instrument requirements in a timely manner for:

Routine procedures Unexpected changes/complications to planned surgical

intervention Discuss the procedure to be followed when an item is missing. Demonstrate safe disposal of clinical waste and sharps in accord-ance with trust/hospital policy.

Notes [ ]




SSA | MA | SSA | MA




2.2 Competency Management of Instrumentation, equipment and consumables



2. Ensure your, position, posture and movements do not compromise the sterile field or patient safety

3. Communicate clearly and assertively with others, giving appropriate information, instruction and advice so that they do not compromise the sterile field

4. Effectively monitor the activities of the surgical team and anticipate their requirements for surgical instrumentation and supplementary items

5. Handle surgical instrumentation and supplementary items correctly and safely, ensuring the sterile field and patient safety is not compromised when handing them to the surgical team

6. Promptly clarify any uncertainty over requirements with the appropriate member of the surgical team where you identify a problem in relation to: an instrument or item, the sterile field or contamination of instruments immediately report and take appropriate action

7. Provide the correct instrumentation and supplementary items to meet the surgical team’s needs according to the patient, the clinical specialty and procedure

8. Count and record instruments, needles, swabs and supplementary items in conjunction with a registered practitioner as the second authorised checker during the case and prior to closure and completion, in accordance with organisational policies and procedures

9. Clearly inform the surgical team of the instrumentation and supplementary item counts at appropriate stages of the procedure

10.Dispose of and transfer used instrumentation and supplementary items to the non-sterile area for accounting and compliance with tracing requirements for medical devices in line with local policies

11.Complete records accurately and legibly in accordance with national guidelines




2.3 Competency Management of Specimens


Knowledge of surgical proce-dures within chosen specialty and the specimens that may be taken within each. The types and management of each type of specimen. Understanding of the risks posed by contamination or mis-handling of specimens. The risks posed by failure to label and record specimens correctly and how these risks may be minimised and managed.

Discuss the management of specimens for each of the following types: dry containers, formalin, normal saline, charcoal medium, agar and Stuart’s medium, designated transplant media Discuss the procedure for labelling and recording each of the types of specimen listed above. Demonstrate the ability to follow correct procedure for speci-men management within: Scrubbed role Non-scrubbed (circulating) role Discuss the procedures to be followed to prevent mislabelling and misplacing of specimens within own hospital/trust.

Notes [ ]


ANNOTATED specimen policy



SSA | MA | SSA | MA




2.3 Competency Management of Specimens


1. Apply standard precautions for infection prevention and control and other appropriate health and safety measures

2. Confirm the clinician’s requirements for the type of clinical specimen to be collected and that relevant consent has been obtained

3. Ensure the correct transport medium and container are available for the type of specimen being collected by the clinician/surgeon

4. Receive the specimen correctly and safely in line with organisational policies and procedures, place it in the appropriate container/transport medium, and pass it in a safe manner to the circulating practitioner, ensuring maintenance of the sterile field

5. Confirm that the circulating practitioner‘ labels specimen containers correctly and clearly with all relevant information and that necessary documentation has been completed

6. Confirm dispatch of the specimen to the correct destination for investigation 7. Clearly and accurately record information regarding specimen retrieval in the patient care plan/

theatre records




[Note where it is not possible to observe transfer of a patient type (e.g.

unconscious) within the student’s chosen specialty SIMULATION should

be deployed as the assessment method]

Section 3 Maintain the Safety of the Peroperative Patient

3.1 Competency Transfer of the Surgical patient


Equipment used for transfer procedure and for safely securing patients following transfer. Safe transfer of the surgical patient within policy/guidelines. Knowledge of Health and Safety policy/guidelines and how these affect patient positioning. The risks that manual handling of patients poses to the patient, staff and organisation.

Demonstrate management of safe transfer between trolley/bed and operating table:

conscious patients semi-conscious patients unconscious patients

Discuss the risks posed when transferring/positioning patients with:

intravenous infusions drains urinary catheters

Discuss procedures for managing adverse incidents occurring as a result of transfer or positioning procedures.

Notes [ ]


SIMULATION [ ]



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3.1 Competency Transfer of the Surgical patient


1. Apply standard precautions for infection prevention and control and take other appropriate health and safety measures when assisting in the transfer, movement and positioning of patients for perioperative procedures

2. Refer to the patient’s risk assessment documentation for pressure area scoring system to check position and equipment required

3. Ensure the required positioning equipment is available, fit for purpose and ready for use before beginning the positioning procedure

4. Prepare the immediate surroundings appropriately for the transfer, move and position required, removing any potential hazards

5. Inform the patient of the nature and purpose of the transfer, move or position in a manner which encourages their understanding and co-operation

6. Move and handle the patient during transfer, movement and positioning in a way which minimises their pain, discomfort and friction, maintains their safety and maximises their dignity, taking account of all ancillary equipment

7. Offer the patient information, support and reassurance in a manner sensitive to their needs and concerns 8. Follow instructions from the lead practitioner ensuring your actions are coordinated effectively 9. Use safe and suitable moving and handling techniques ensuring:

you avoid exceeding your personal weight and reach limits

endangering the patient

endangering other members of staff

causing damage to equipment or the environment 10. Use positioning equipment safely and correctly in line with manufacturers’ instructions and local policies 11. Promptly report any unexpected change in the patient’s condition to the appropriate member of the care team 12. Confirm with the registered practitioner that the patient is in the correct position to:

a) facilitate the clinical procedure

b) maintain skin integrity

c) avoid nerve damage 13 Use appropriate equipment:

a) for preventing injury

b) promoting patient comfort

c) preventing heat loss 10. Contribute to the assessment and evaluation of the patients skin integrity and document as appropriate




Student Name:

3.2 Competency Positioning the Surgical patient


Safe positioning of the surgical patient within policy/guidelines. Positioning of the surgical patient that optimises surgical access whilst maintaining the safety of the patient and access for the anaesthetic personnel.

Demonstrate the ability to manage the position of the surgical patient:

conscious patients semi-conscious patients unconscious patients

in the following positions:

supine prone lithotomy/lloyd davis trendelenberg/reverse trendelenberg lateral OTHER...please state

Discuss the risks posed when positioning patients with:

intravenous infusions drains urinary catheters

Discuss procedures for managing adverse incidents occurring as a result of transfer or positioning procedures.

Notes [ ]


SIMULATION [ ]

Page 23


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.…………Mentor/Assessor Signature

[OTHER...where the mentor deems it appropriate to assess additional

position (s) relevant to speciality ]

[Note where it is not possible to observe transfer of a patient type (e.g.

unconscious) within the student’s chosen specialty SIMULATION should

be deployed as the assessment method]

[Performance Criteria on reverse of this page]


3.2 Competency Positioning the Surgical patient


1. Apply standard precautions for infection prevention and control and take other appropriate health and safety measures when assisting in the transfer, movement and positioning of patients for perioperative procedures

2. Refer to the patient’s risk assessment documentation for pressure area scoring system to check position and equipment required

3. Ensure the required positioning equipment is available, fit for purpose and ready for use before beginning the positioning procedure

4. Prepare the immediate surroundings appropriately for the transfer, move and position required, removing any potential hazards

5. Inform the patient of the nature and purpose of the transfer, move or position in a manner which encourages their understanding and co-operation

6. Move and handle the patient during transfer, movement and positioning in a way which minimises their pain, discomfort and friction, maintains their safety and maximises their dignity, taking account of all ancillary equipment

7. Offer the patient information, support and reassurance in a manner sensitive to their needs and concerns 8. Follow instructions from the lead practitioner ensuring your actions are coordinated effectively 9. Use safe and suitable moving and handling techniques ensuring:

you avoid exceeding your personal weight and reach limits

endangering the patient

endangering other members of staff

causing damage to equipment or the environment 10. Use positioning equipment safely and correctly in line with manufacturers’ instructions and local policies 11. Promptly report any unexpected change in the patient’s condition to the appropriate member of the care team 12. Confirm with the registered practitioner that the patient is in the correct position to:

a) facilitate the clinical procedure

b) maintain skin integrity

c) avoid nerve damage 13 Use appropriate equipment:

a) for preventing injury

b) promoting patient comfort

c) preventing heat loss 10. Contribute to the assessment and evaluation of the patients skin integrity and document as appropriate




Section 4 Intra-operative Patient Care

4.1 Competency Able to complete routine pre-operative checklist

The local checklist applies, but must include the following categories of infor-mation: Patient identification; Fasting; Patient Preparation for Theatre Suite; Consent; Pre-operative investigations; Known Hazards; Allergies; Pre-medication.

The Perioperative Practitioner [PP] should understand the principles of obtaining or amending consent in pre-medicated patients, and should know the protocol for patients who are unable to give informed consent. The PP must understand infection risks and use standard precautions and appropriate additional precau-tions where relevant.


Uses WHO Pre-operative Checklist: Accurately acquires information required to complete pre-operative checklist. Avoids leading questions. Correctly identifies those situa-tions when accuracy of infor-mation is likely to be compro-mised. Can highlight important aspects of checklist information and bring these to the attention of relevant team members – including where routine drug therapy has been given or withheld inappropriately. Systematically identifies the proposed site of operation and reports discrepancies to the

Discuss the rationale for the individual components of the local checklist.

Discuss national guidelines (AfPP / NATN, 2004). Demonstrates awareness of situations which compromise

patient checking procedures. Communicate information to the surgeon regarding admin-

istration of non-administration of drugs likely to impact on anaesthesia.

Systematically identifies the proposed site of operation and reports discrepancies.

DISCUSSION [ ]

DIRECT OBSERVATION [ ] ANNOTATED CHECKLIST [ ]

ANNOTATED WHO CHECKLIST [ ]



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Page 26

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4.2 Competency Understands legal issues surrounding informed consent for anaesthesia and surgery


Theatre team members, roles and responsibilities in routine care and during emergencies. Knowledge of clinical ability of theatre personnel is an im-portant factor during clinical emergencies. Knowledge of (including scope of) specific non-medical periop-erative roles: Assistant Practitioners Advanced Scrub Practitioners Surgical Care Practitioners Anaesthetic Care Practitioners Emergency Care Practitioners

Discuss the PP’s role in communicating patient’s concerns in regard to consent to the appropriate members of the multidis-ciplinary team.

Demonstrate the rationale for patient identification and confirmation of consent with scrub practitioner.

Discuss the Adults with Incapacity Act (Scotland) 2000.

Discuss the law regarding consent for minors. Discuss the implications of Jehovah’s Witnesses with regard to

consent to receive blood products Demonstrate an awareness of the individual’s right to withhold

consent to receive blood products.

Utilise nationally produced guidelines to inform practice

REFLECTIONS ON SCENARIOS x 3 (Law & Ethics Unit) [ ]

DIRECT OBSERVATION [ ]



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Page 28



Demonstrate concern and respect for the individual patient.

Does not refer to patient by operation. Maintain patient dignity at all times.

Provides additional patient warming with appropriate equip-ment as required.

4.3 Competency Assesses, plans, implements and evaluates perioperative care


Demonstrates the ability to plan and accurately document all aspects of a perioperative care plan for all patient groups. Is able to modify a care plan in response to changes in a pa-tient’s condition.

Utilises bio-psychosocial data where possible from pre-operative visits /pre-operative period to inform holistic care planning.

Anticipates individual patient care requirements. Assess, plan, implement and evaluate effectiveness of interven-

tions.

Annotated CARE DOCUMENTATION x 3

Minor [ ] Intermediate [ ]

Major [ ] DIRECT OBSERVATION [ ]

Questions [ ]

4.4 Competency Able to maintain patient’s comfort and dignity throughout the perioperative period


Maintains privacy, comfort and dignity as far as possible through-out the perioperative period.

Annotated CARE DOCUMENTATION x 3

Minor [ ] Intermediate [ ]

Major [ ] DIRECT OBSERVATION [ ]

Questions [ ]


General Patient Care The Perioperative Practitioner [PP] must provide safe, holistic patient care, which is as far as possible, evidence-based. The professional practice of the PP must have a sound ethical and legal basis.


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Page 30



4.5 Competency Recognises signs of anxiety, describes their adverse effects, and offers reassurance


Can assess a patient’s level of anxiety, offers appropriate reassurance. Recognises where anxiety may lead to patient harm, and acts appropriately to reduce anxiety where possible. Clinical effects of anxiety includ-ing altered drug dosages and increased risk of cardiac arrhyth-mias. Anxiety is common and may be distressing: the PP should ensure that they recognise anxiety and responds appropriately.

Demonstrate ability to recognise signs of patient anxiety.

Promote autonomy by encouraging active participation by the patient in their treatment and care where appropriate.

Provide information and the rationale to patients regarding anaesthetic procedures.


Discussion [ ]



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Page 32



4.6 Competency Demonstrates personal and professional accountability in relation to the role of

Perioperative Practitioner


Demonstrates the principles of accountability in professional practice. Practises within limitations of own scope of professional practice.

Behaves consistently with the NMC / HPC professional stand-ards

Recognise own limitations and seek advice from members of the multidisciplinary team.

Reflect on own performance.

Assume responsibility for personal development plan. Demonstrate knowledge of and apply to practice the following

(where relevant): Association for Perioperative Practice guidelines; NHS Policies and Guidelines;

NMC guidelines;

HPC guidelines; NES guidelines. www.nes.scot.nhs.uk/nursing/

publications NHS QIS standards and guidelines & Association of

Surgeons guidelines

SIGN Guidelines.


REFLECTIONS ON SCENARIOS x 3 (Law & Ethics Unit) [ ]

Discussion [ ]



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Page 34



4.7, 4.8 Competencies Aware of management of confused patients or patients with incapacity Able to assess and manage patients with learning disabilities


Shows an ability to assess the requirements of confused patients or patients with incapac-ity, and to protect them from undue distress. Is patient and caring at all times.

Demonstrate ability to apply the Adults with Incapacity Act (Scotland) 2000.(See also 2.2)

Demonstrate ability to assess and manage the requirements of confused patients or patients with incapacity


Law & Ethics Scenario 3 [ ]

4.9 Competency Able to assess and manage elderly or paediatric patients (as relevant to scope of normal practice)


Shows an ability to assess the requirements of elderly or paediatric patients (as normal practice), and to protect them from undue distress. Is patient and caring at all times.

Use appropriate patient care and communication skills to protect the patient from undue stress as far as is reasonably practicable.


Law & Ethics Scenario 3 [ ]

This document is adapted from NHS Education for Scotland Portfolio of Core Competencies for Anaesthetic Assistants (2007). Copyright and Intellectual Property of this document remains with NHS Scotland.


Care for Specific Patients Confused, demented, or educationally impaired patients represent a challenge for the perioperative team. Management is highly individualised, and the PP must be able to play an appropriate part in assisting the surgeon. Carers, relatives, or interpreters may be permitted into the anaesthetic room and must be supported appropriately.


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