ABTECH SUR 111 CLINICAL PRACTICUM

#2

Name______Date______

INSTRUCTOR______Student: ______

Key: S = Satisfactory (2)U= Unsatisfactory (Points 0-1)

Students must accomplish 80% to pass this exam. There are 50 skills to be demonstrated, each worth 2 points. There may be up to two attempts. Certain tasks MUST be completed within 10 minutes. Unrecognized contaminations by the student will result in termination of

this practical attempt and therefore automatic failure. No exceptions.

Procedure / 1st Attempt
S U / 2nd Attempt
S U
1. Student is properly attired (no jewelry, all PPEetc), can state proper pre-op procedures (cleaning/ damp dusting, arranging furniture etc)
2. CPI’s and opens pack on back table (first) and basin set (second)
3. Open instrument container without lid shift, checks internal indicator and filter
4. CPI’s and opens own gown and gloves on Mayo
5. CPI’s and opens peel pack onto sterile field
6. CPI’s and opens wrapped package onto sterile field
7. Gathers supplies, rolls sleeves, wears goggles, Prescrub (not basic hand wash) and cleans nails under water
8. Scrubs all surfaces using the brush stroke method and follows proper wash sequence
9. Maintains prayer position with hands during scrub, fingers towards ceiling, hands/arms away from body
10.) Rinses hands and arms (properly bends, dips), enters OR properly (backs in)
11. Secures, opens towel dries hands and arms properly with proper flip (10 minute time start)
12. Secures, unfolds and dons gown
13. Gloves self using closed glove technique
14. Turns gown (before approaching back table) and applies outer gloves
15. Appropriately drapes and towels (3) mayo stand (optional to towel at this point)
16. Drapes out Back Table with appropriate # of towels and transfers instruments from container to back table
17. Sets up back table for umbilical herniorrhaphy (economy of motion)
18. Counts all instruments, sponges, sharps, and miscellaneous correctly
(10 minute time end)
19. Sets up mayo stand for umbilical herniorrhaphy (instrument tips down, all needed instruments for case on mayo, economy of motion)
20. Prepares drapes, surgeon gown and gloves in order of use and places in ring basin or on backtable
21. Prepares bovie, suction, light handle covers, safety passing zone for use on mayo stand
22. Gowns and gloves surgeon (instructor) correctly
23. Answers questions regarding preference card
24. Properly loads #10 blade on knife handle
25. Loads and passes tie on a passer (tonsil or right angle) properly
Procedure / 1st Attempt
S U / 2nd Attempt
S U
26. Loads sponge on a stick (sponge stick) properly. Loads kittner/peanut on a Kelly properly
27. Properly applies the surgical prep to the patient and can answer questions about different types of prep
28. Properly passes 4 blue towels to MD (instructor) and drapes using laparotomy sheet
29. Properly passes laparotomy sheet to MD (instructor) and drapes appropriately
30. Hands off initial supplies (bovie/suction/light gloves) and secures them to the drape.
31. Waits for Time-Out and properly passes scalpel (safe zone)
32. Properly passes scalpel free hand
33. Properly passes and recognizes instrumentation from minor tray as
verbally requested by surgeon/instructor
34. Properly passes and recognizes instrumentation from minor tray as
requested by hand signal by surgeon/instructor
35. Properly loads and passes clip appliers
36. Accepts medications to field in correct manner
37. Identifies & verifies medications/irrigations with MD before passing
38. Properly loads needle holder
39. Properly passes needle holder (right and left handed/back-handed)
40. Performs ALL closing counts properly
(begins with field, mayo, backtable)
41. Identifies suture properties (absorbable/nonabsorbable) and needle
properties (taper/cutting)
42. Discusses position and positioning aids
43. Discusses safe cautery practices
44. Discusses safe medication practices (6 rights, labeling, passing up)
45. Identifies tower equipment (monitor, light source, camera box,
insufflation box, printer)
46. Identifies and connects camera and light cord to scope
47. Identifies trocars, insufflation tubing, veress needle
48. Identifies various tracheotomy instrumentation and supplies
(and considerations regarding the use of the Shiley trach tube)
49. Identifies miscellaneous orthopedic instrumentation
50. Identifies miscellaneous gynecological instrumentation

NOTES: ______