Type: Individual
| Tools & Equipment | Materials |
|---|---|
| Table | Writing material |
| Chair | Stationaries |
| Writing material | Flip charts |
| Stationaries | |
| Flip charts | |
| Communication logbook | |
| CME recording book |
| S/N | Item | Quantity |
|---|---|---|
| 1 | Table | 1 per Candidate |
| 2 | Chair | 1 per Candidate |
| 3 | Writing material | 1 set per Candidate |
| 4 | Stationaries (pens, notepads) | 1 set per Candidate |
| 5 | Flip charts | 1 per Candidate |
| 6 | Simulated surgical team and support staff | 3 persons per Candidate |
| 7 | CME recording book | 1 per Candidate |
| 8 | Communication logbook | 1 per Candidate |
| Items to be Evaluated | Marks Available | Marks Obtained | Comments |
|---|---|---|---|
| TASK 1: Facilitate effective communication during perioperative procedure | |||
| Wears appropriate identification and professional attire for theatre liaison role (Award 1 mark or zero) | 1 | ||
| Sets up communication area with necessary materials (logbook, flip charts, writing materials) (Award 1 mark each or zero x 2 = 2 Marks) | 2 | ||
| Greets surgical team and support staff, introduces self, and explains role (Award 1 mark or zero) | 1 | ||
| Facilitates clear and timely exchange of information between surgical team and support staff (Award 1 mark per clear communication instance up to 4) | 4 | ||
| Records key communications and instructions accurately in the communication logbook (Award 1 mark each or zero x 3 = 3 Marks) | 3 | ||
| Uses flip charts or visual aids to clarify complex instructions where necessary (Award 1 mark or zero) | 1 | ||
| Encourages participation and questions from support staff and surgical team (Award 1 mark each or zero x 2 = 2 Marks) | 2 | ||
| Manages and resolves any communication breakdowns professionally during the procedure (Award 1 mark each or zero x 3 = 3 Marks) | 3 | ||
| Summarizes key points and confirms understanding before the end of the procedure (Award 1 mark each or zero x 2 = 2 Marks) | 2 | ||
| Documents the communication summary and any action points in the CME recording book (Award 1 mark or zero) | 1 | ||
| Sub-Total | 20 | ||
| PRODUCT CHECKLIST | |||
| Completed and accurate communication logbook entries reflecting all key exchanges and instructions (Award up to 5 marks for completeness and accuracy) | 5 | ||
| Clear, legible, and well-organized documentation in CME recording book of communication activities (Award up to 6 marks for clarity and completeness) | 6 | ||
| Sub-Total | 11 | ||
| GRAND TOTAL | 31 | ||
Type: Individual
| Tools & Equipment | Materials |
|---|---|
| Pen | Patient transfer form |
| Clipboard | Handover checklist |
| Patient wristband | |
| Stationery |
| S/N | Item | Quantity |
|---|---|---|
| 1 | Patient transfer form | 1 Pc per Candidate |
| 2 | Handover checklist | 1 Pc per Candidate |
| 3 | Pen | 1 Pc per Candidate |
| 4 | Clipboard | 1 Pc per Candidate |
| 5 | Patient wristband | 1 Pc per Candidate |
| 6 | Theatre bed or trolley | 1 Pc per Candidate |
| 7 | Stationery (writing material) | Sufficient per Candidate |
| Items to be Evaluated | Marks Available | Marks Obtained | Comments |
|---|---|---|---|
| TASK 1: Prepare patient transfer documentation | |||
| Confirmed patient identity using wristband (Award 1 mark each or zero x 2 = 2 Marks) | 2 | ||
| Accurately filled patient transfer form with all required fields (Award 1 mark each or zero x 4 = 4 Marks) | 4 | ||
| Included time and date of transfer on the form (Award 1 mark or zero) | 1 | ||
| Signed transfer form by sending nurse/assistant (Award 1 mark or zero) | 1 | ||
| Prepared handover checklist accurately with patient condition details (Award 1 mark each or zero x 3 = 3 Marks) | 3 | ||
| Ensured handover checklist signed by sending and receiving personnel (Award 1 mark each or zero x 2 = 2 Marks) | 2 | ||
| Used clipboard to organize documents during transfer (Award 1 mark or zero) | 1 | ||
| Ensured all documentation was legible and complete (Award 1 mark each or zero x 2 = 2 Marks) | 2 | ||
| Sub-Total | 16 | ||
| TASK 2: Perform patient handover communication | |||
| Introduced self and role to receiving theatre personnel (Award 1 mark or zero) | 1 | ||
| Communicated patient details clearly including name, diagnosis, and allergies (Award 1 mark each or zero x 3 = 3 Marks) | 3 | ||
| Reported current patient condition and any special care instructions (Award 1 mark each or zero x 3 = 3 Marks) | 3 | ||
| Allowed receiving personnel to ask questions and responded appropriately (Award 1 mark each or zero x 2 = 2 Marks) | 2 | ||
| Confirmed receipt of patient and documentation by receiving personnel (Award 1 mark or zero) | 1 | ||
| Sub-Total | 10 | ||
| PRODUCT CHECKLIST | |||
| Completed patient transfer form with all fields correctly filled and signed (Award 1 mark each or zero x 4 = 4 Marks) | 4 | ||
| Handover checklist accurately completed and signed by both parties (Award 1 mark each or zero x 4 = 4 Marks) | 4 | ||
| Documentation legible, organized, and ready for filing (Award 1 mark each or zero x 2 = 2 Marks) | 2 | ||
| Sub-Total | 10 | ||
| GRAND TOTAL | 36 | ||