Procedural Skills

Core Generalist#

Knowledge#

CG.K.1#

Identify common and important procedures for the patient

CG.K.2#

Describe indicators for undertaking a procedure

CG.K.3#

Describe relevant anatomy of pathology

CG.K.4#

Discuss risks and benefits of each procedure

CG.K.5#

Identify standards associated with individual procedures, for example procedural sedation

CG.K.6#

Identify procedures that require additional training or certification to conduct

CG.K.7#

Describe informed consent, patient and equipment preparation methods, sterile techniques, pain management and proper techniques for handling specimens and fluids obtained, and test results

CG.K.8#

Identify the presence of psychomotor impairment or medical conditions that may affect the ability to successfully and safely perform technical tasks

CG.K.9#

Describe other procedural related risks, such as the transmission of blood borne viruses and their potential for transmission between patients and healthcare providers during procedures

Skills#

CG.S.1#

Ensure that practice facilities are appropriately equipped and resourced to meet procedural task requirements

CG.S.2#

Ensure adequate preparation for the procedure

CG.S.3#

Perform procedural skills identified in the Procedural Skill Logbook to required level of competency

CG.S.4#

Ensure that procedural tasks meet the ethical and legal requirements for patient informed consent including documentation

CG.S.5#

Recognise and manage complications of procedures performed by self or others

CG.S.6#

Document consent, procedure, after care and follow up appropriately

Attributes#

At.20#

Sensitivity

At.1#

Accountability

At.11#

Integrity

Procedural skills list#

Adult Internal Medicine#

Essential

  • Arterial blood gas sampling
  • Blood culture collection
  • Lumbar puncture
  • NMSE/Dementia screening
  • Nasogastric tube insertion
  • Nebulisation therapy
  • Spirometry and peak flow measurement
  • Thrombolytic therapy
  • Urethral catheterisation on male
  • Venepuncture
  • Suprapubic catherisation

Important

  • Proctoscopy
  • Ascitic tap/paracentesis
  • Pleural tap/drainage
  • Pericardiocentesis
  • Sigmoidoscopy

Anaesthetics#

Essential

  • Administer nitrous oxide (as analgesia)
  • Bag/mask ventilation (adult)
  • Bougie
  • Digital nerve block
  • Endotracheal intubation(adult)
  • Intranasal analgesia
  • Intravenous sedation in intubated patient
  • Laryngeal mask airway (LMA)
  • Orogastric tube insertion
  • Peripheral line seldinger
  • Procedural sedation (adult)

Important

  • Femoral nerve block/fascia iliaca block
  • Intercostal nerve block
  • Biers block

Dermatology#

Essential

  • Biopsy of skin lesion- curette
  • Biopsy of skin lesion – excision
  • Biopsy of skin lesion – incision
  • Biopsy of skin lesion – punch
  • Biopsy of skin lesion – shave
  • Cryotherapy
  • Dermatoscope/dermatoscopy
  • Fungal skin scraping
  • Glue superficial skin laceration
  • Infiltrate local anaesthetic
  • Removal of subcutaneous foreign body
  • Suture deep skin laceration (multi-layer closure)
  • Suture superficial skin laceration (adult)
  • Wound swab for microscopy, culture, and sensitivity

Important

  • Burn dressings
  • Viral PCR swab of vesicle
  • Flap repairs
  • Skin graft repair

Diagnostic Imaging#

Essential

  • Focused assessment with sonography for trauma (eFAST)
  • Ultrasound in early pregnancy
  • Ultrasound guided peripheral vascular access

Ear, Nose, and Throat#

Essential

  • Nasal swab
  • Throat swab
  • Cauterise nasal bleeding
  • Ear toilet- dry mopping
  • Foreign body removal- ear
  • Hearing assessment- Rinne and Webber Test
  • Insert wick into external ear canal
  • Packing of nasal cavity (anterior/posterior)
  • Epley manoeuvre for benign paroxysmal positional vertigo

Important

  • Quinsy incision and drainage
  • Foreign body removal- nose

Emergency care#

Essential

  • Apply ALS algorithm
  • Perform a primary survey
  • Apply a pelvic binder
  • Apply a tourniquet
  • Basic airway manoeuvres (chin, lift, jaw thrust)
  • C-Spine immobilisation with collar/inline stabilisation
  • Nasopharyngeal airway
  • Laryngeal mask airways
  • Rapid sequence induction
  • Rapid sequence induction with C-Spine immobilisation
  • Can’t intubate, can’t ventilate drill
  • Cricothyroidotomy/front of neck access
  • CPAP/BiPAP
  • Emergency use of mechanical ventilators
  • Oxygen saturation monitoring
  • Oxygen therapy (NP, Hudson, NRB mask, HFNP, concentrators)
  • Intercostal catheter(chest drain/chest tube)
  • Jet insufflation
  • Reduce tension pneumothorax- needle thoracocentesis/finger thoracostomy
  • Fluid resuscitation
  • Intravenous access- large bore (16G)
  • Blood transfusions
  • ECG- set up and record a 12 lead ECG
  • External cardiac massage/cardiopulmonary resuscitation (adult)
  • Defibrillation (synchronised)
  • Defibrillation (automated external defibrillation)
  • Intraosseous access
  • Synchronised DC cardioversion (adult)
  • 3-4 person log roll
  • Glasgow coma scale
  • Stabilisation of injured spine
  • Mental state exam
  • Suicide risk assessment
  • Chemically restrain an agitated patient
  • Pressure immoblisation bandage

Important

  • Central vein cannulation
  • Arterial line insertion
  • External cardiac pacing
  • NAC therapy in paracetamol poisoning

Musculoskeletal#

Essential

  • Application of finger splint
  • Application of lower limb cast/back slab
  • Application of upper limb cast/back slab
  • Application of upper limb sling
  • Intramuscular injection
  • Joint aspiration
  • Reduction of dislocated shoulder
  • Reduction of lower limb fracture/dislocation
  • Reduction of upper limb fracture/dislocation (elbow/wrist/finger)
  • Soft tissue injury strapping/ankle strapping
  • Subcutaneous injection
  • Joint injection (large joints)

Important

  • Unlocking knee
  • Unlocking temporomandibular joint

Obstetrics and Gynaecology#

Essential

  • Cervical screening test/pap smear
  • Cardiotocography
  • Foetal heart sound detection
  • Fundal height assessment
  • High vaginal swab
  • Insert and remove implanon
  • Manage normal vaginal delivery with complications
  • Urethral catherisation on female
  • Urine pregnancy testing
  • Manage shoulder dystocia

Important

  • Episiotomy
  • Perineal repair

Ophthalmology#

Essential

  • Application of eye patch
  • Eyelid eversion
  • Irrigation of eye
  • Measurement of intra-ocular pressure
  • Removal of corneal foreign body
  • Removal of corneal rust ring
  • Removal of subtarsal foreign body
  • Staining cornea with fluorescein
  • Topical anaesthesia of cornea
  • Use ophthalmoscope
  • Use slit lamp
  • Visual acuity and field assessment

Paediatrics#

Essential

  • Assess hydration status
  • Fluid therapy/fluid resuscitation (child/neonatal)
  • Nasogastric tube insertion
  • Venepuncture (child/neonate)
  • Intravenous access
  • Vaccinations
  • Nebulisation therapy (child)
  • Use of inhalers/respiratory medical delivery device
  • Use of spacer devices
  • Reduction of fracture
  • Reduction of joint dislocation
  • Repair of superficial skin laceration
  • Procedural sedation
  • Six week baby check
  • Topical wound anaesthesia
  • Bag mask ventilation
  • Basic airways manoeuvres
  • Endotracheal intubation (child)
  • Endotracheal intubation (neonate)
  • External cardiac massage/CPR (child and neonate)
  • Intraosseus access (child and neonate)
  • Neonatal resuscitation
  • Synchronised DC cardioversion (child)
  • Umbilical catheter (neonate)

Important

  • Thoracocentesis
  • Defibrillation
  • Emergency use of mechanical ventilators
  • Intercostal catheter – chest drain/chest tube (child)
  • Suprapubic aspiration
  • Urethral catheterisation

Surgery#

Essential

  • Drainage of subungual haematoma
  • Incision and drainage of abscess
  • Wound debridement
  • Wound dressing and management
  • Toenail- Wedge excision/ingrown toenail surgery

Important

  • Drainage of thrombosed external haemorrhoid
  • Drainage of perianal abscess

Description of competency levels

Performed the procedure to the standard of a: A. Practitioner operating independently – demonstrated on a real patient B. Pass in an accredited course or certified satisfactory by a supervisor – demonstrated on a simulated patient C. Practitioner under supervision – demonstrated on a real patient D. Practitioner assisting an independent practitioner – demonstrated on a real patient

Last updated on by acrrmbot