Type: Individual
| Tools & Equipment | Materials |
|---|---|
| Pen | Patient Hospital File |
| Face Mask | Patient Identification Wristband |
| Gloves | Surgical Consent Form |
| Hand Sanitizer | Patient Identification Chart |
| S/N | Item | Quantity |
|---|---|---|
| 1 | Patient Hospital File | 1 Pc per Candidate |
| 2 | Patient Identification Wristband | 1 Pc per Candidate |
| 3 | Surgical Consent Form | 1 Pc per Candidate |
| 4 | Pen | 1 Pc per Candidate |
| 5 | Patient Identification Chart | 1 Pc per Candidate |
| 6 | Face Mask | 1 Pc per Candidate |
| 7 | Hand Sanitizer (70% alcohol) | 50 ml per Candidate |
| 8 | Gloves (Latex or Nitrile) | 1 Pair per Candidate |
| Items to be Evaluated | Marks Available | Marks Obtained | Comments |
|---|---|---|---|
| TASK 1: Patient Identification and Surgical Procedure Verification | |||
| Performed hand hygiene using hand sanitizer before patient interaction (Award 1 mark or zero) | 1 | ||
| Donning of appropriate PPE (face mask and gloves) before verification (Award 2 marks for all PPE worn correctly or zero) | 2 | ||
| Physically checks and reads patient identification wristband (Award 2 marks or zero) | 2 | ||
| Compares patient wristband details with hospital file and surgical consent form (Award 3 marks or zero) | 3 | ||
| Confirms patient name, date of birth, and hospital identification number match across all documents (Award 3 marks or zero) | 3 | ||
| Verifies the surgical procedure name and site as per the consent form and patient chart (Award 3 marks or zero) | 3 | ||
| Confirms the surgical site marking is present and matches the procedure (Award 2 marks or zero) | 2 | ||
| Communicates with patient to confirm identity and procedure verbally (Award 2 marks or zero) | 2 | ||
| Documents the verification process accurately in the patient file or checklist (Award 2 marks or zero) | 2 | ||
| Sub-Total | 20 | ||
| PRODUCT CHECKLIST | |||
| Accurate and complete patient identity and procedure verification documented (Award 5 marks for complete and accurate documentation or zero) | 5 | ||
| Sub-Total | 5 | ||
| GRAND TOTAL | 25 | ||
Type: Individual
| Tools & Equipment | Materials |
|---|---|
| Sterile gauze swabs | Antiseptic solution (Povidone-Iodine 10%) |
| Sterile cotton balls | Soap liquid antiseptic |
| Sterile gloves | Clean running water |
| Face mask | |
| Protective goggles | |
| Sterile drapes | |
| Clean basin |
| S/N | Item | Quantity |
|---|---|---|
| 1 | Sterile gauze swabs | 10 Pcs per Candidate |
| 2 | Sterile cotton balls | 5 Pcs per Candidate |
| 3 | Antiseptic solution (Povidone-Iodine 10%) | 100 ml per Candidate |
| 4 | Sterile gloves | 1 pair per Candidate |
| 5 | Face mask | 1 Pc per Candidate |
| 6 | Protective goggles | 1 Pc per Candidate |
| 7 | Sterile drapes | 1 Pc per Candidate |
| 8 | Clean basin | 1 Pc per Candidate |
| 9 | Clean running water | Sufficient for Candidate |
| 10 | Soap liquid antiseptic | 50 ml per Candidate |
| 11 | Waste disposal bin (color coded) | 1 Pc per Candidate |
| Items to be Evaluated | Marks Available | Marks Obtained | Comments |
|---|---|---|---|
| TASK 1: Skin Preparation and Antiseptic Application | |||
| Performed social hand wash before procedure (Award 1 mark or zero) | 1 | ||
| Donned appropriate PPE: sterile gloves, face mask, protective goggles (Award 5 marks for all PPE or zero) | 5 | ||
| Prepared antiseptic solution and clean water for skin cleansing (Award 2 marks or zero) | 2 | ||
| Positioned the patient appropriately and exposed the surgical site (Award 2 marks or zero) | 2 | ||
| Performed initial skin cleansing using soap liquid antiseptic and clean water (Award 3 marks or zero) | 3 | ||
| Rinsed the surgical site with clean water after cleansing (Award 1 mark or zero) | 1 | ||
| Applied povidone-iodine antiseptic solution on the 15cm x 15cm surgical site using sterile gauze swabs in circular motions from center outwards (Award 5 marks or zero) | 5 | ||
| Allowed antiseptic to dry naturally without wiping (Award 1 mark or zero) | 1 | ||
| Covered the prepared surgical site with sterile drapes maintaining aseptic field (Award 2 marks or zero) | 2 | ||
| Disposed of used materials in appropriate color coded waste bins (Award 2 marks or zero) | 2 | ||
| Performed social hand wash after procedure (Award 1 mark or zero) | 1 | ||
| Documented the skin preparation and antiseptic application procedure accurately (Award 2 marks or zero) | 2 | ||
| Sub-Total | 27 | ||
| PRODUCT CHECKLIST | |||
| Surgical site skin is clean, free of visible dirt or debris (Award 3 marks or zero) | 3 | ||
| Antiseptic solution applied evenly over entire 15cm x 15cm surgical site (Award 4 marks or zero) | 4 | ||
| Aseptic field maintained with sterile drapes correctly positioned (Award 3 marks or zero) | 3 | ||
| No contamination of prepared site observed during and after procedure (Award 3 marks or zero) | 3 | ||
| Sub-Total | 13 | ||
| GRAND TOTAL | 40 | ||