Entrustable Professional Activities

LG10: Procedures

Learning Goal 10

Procedures

Plan, prepare for, perform, and provide aftercare for important practical procedures

This activity requires the ability to:

  • select patient appropriate procedures in partnership with patients, their families, whānau, and/or carers
  • obtain informed consent
  • set up the equipment, maintaining an aseptic field where appropriate
  • perform procedures, including appropriate analgesia and sedation
  • manage unexpected events and complications during and after procedures
  • provide aftercare for patients
  • communicate aftercare protocols and instructions to patients and medical and nursing staff
  • interpret the results and outcomes of procedures, including imaging and reports
  • communicate the outcome of procedures and associated investigations to patients

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • select procedures by assessing patient-specific factors, including risks, benefits, and alternatives
  • confidently and consistently perform a range of common procedures
  • communicate all identified allergies / adverse reactions to team members, and take precautions to avoid reactions during procedures
  • select appropriate patients, including muscle selection for botulinum toxin A dosing
  • select and use appropriate modalities for muscle localisation, including, but not limited to, musculoskeletal ultrasound
  • select appropriate analgesia and/or sedation for procedures in children (tamariki)
  • check that patients have complied with preprocedural preparation
  • confirm the correct position / site / side / level on patients for planned procedures
  • recognise and effectively manage complications arising during or after procedures
  • recognise and correctly interpret normal and abnormal findings of diagnostic procedures
  • test dosing of intrathecal baclofen, including dosage and administration of lumbar punctures
  • perform routine management of intrathecal baclofen pumps, including management of dosage adjustment and pump refilling
  • investigate and manage intrathecal baclofen adverse events, including pump programming and side port catheter access

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • assess patients, and identify indications for procedures
  • check for allergies and adverse reactions
  • consider risks and complications of procedures
  • interpret results of common diagnostic procedures
  • organise and document postprocedural review of patients

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • document procedures in the clinical notes accurately, including informed consent, procedures requested and performed, reasons for procedures, medicines given, aseptic technique, and aftercare
  • explain procedures clearly to patients, families, whānau, and/or carers, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
  • counsel patients sensitively and effectively, and support them to make informed choices
  • address patients’, families’, whānau, and/or carers’ concerns relating to procedures, providing opportunities to ask questions
  • tailor language according to individual patients’ age and capacity to understand
  • communicate effectively with team members, patients, families, whānau, and carers prior to, during, and after procedures
  • confirm team members are confident and competent in their assigned roles

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • explain the process of procedures to patients without providing a broader context
  • help patients, families, whānau, and/or carers choose procedures
  • communicate with members of procedural teams so all team members understand who each member is
  • discuss postprocedural care with patients, families, whānau, and/or carers
  • complete relevant patients’ documentation, and conduct appropriate clinical handovers

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • confirm patients’ identification, verify the procedure, and, where appropriate, the correct position / site / side / level for the procedure
  • obtain informed consent or other valid authority before undertaking any procedure
  • set up all necessary equipment, and consistently use universal precautions and aseptic technique
  • check that information on patients’ consent forms matches procedures to be performed
  • identify, document, and appropriately notify of any adverse events or equipment malfunction

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • provide information in a manner so that patients, families, whānau, and/or carers are fully informed when consenting to any procedures
  • demonstrate an inconsistent application of aseptic technique
  • identify patients using approved patients’ identifiers before any treatment or intervention is initiated
  • attempt to perform a procedure in an unsafe environment

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • refer to and be familiar with relevant published procedural guidelines prior to undertaking procedures
  • organise or participate in in-service training on new technology
  • provide specific and constructive feedback and comments to junior colleagues
  • initiate and conduct skills training for junior staff

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • participate in continued professional development
  • help junior colleagues develop new skills
  • actively seek feedback on personal technique until competent

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • consider individual patients’ cultural perception of health and illness, and adapt practice accordingly

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • respect religious, cultural, linguistic, and family values and differences

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • confidently perform common procedures
  • identify appropriate proxy decision makers when required
  • show respect for knowledge and expertise of colleagues
  • maximise patient autonomy in decision making

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • perform procedures when adequately supervised
  • follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • identify roles and optimal timing for diagnostic procedures
  • critically appraise information from assessment and evaluation of risks and benefits to prioritise patients on a waiting list
  • make clinical judgements and decisions based on available evidence
  • select the most appropriate and cost-effective diagnostic procedures
  • adapt procedures in response to assessments of risks to individual patients
  • select appropriate investigations on the samples obtained in diagnostic procedures

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • prioritise which patients receive procedures first (if there is a waiting list)
  • assess personal skill levels, and seek help with procedures when appropriate
  • use tools and guidelines to support decision making
  • recommend suboptimal procedures for patients

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • explain critical steps, anticipated events, and equipment requirements to teams on planned procedures
  • provide staff with clear aftercare instructions, and explain how to recognise possible complications
  • identify relevant management options with colleagues, according to their level of training and experience, to reduce error, prevent complications, and support efficient teamwork
  • coordinate efforts, encourage others, and accept responsibility for work done

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • ensure all relevant team members are aware that a procedure is occurring
  • discuss patients’ management plans for recovery with colleagues

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • discuss serious incidents at appropriate clinical review meetings
  • initiate local improvement strategies in response to serious incidents
  • use resources efficiently when performing procedures

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • perform procedures in accordance with the organisational guidelines and policies

For each procedure/investigation, trainees should be able to perform the components of the procedure indicated below. Please select a procedure/investigation from the dropdown to see its components.

Yes

Not applicable n/a

Select appropriate procedures in partnership with patients, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Set up the equipment, maintaining an aseptic field where appropriate

Perform procedures, including appropriate analgesia and sedation

Manage unexpected events and complications during and after procedures

 

Provide aftercare for patients

Communicate aftercare protocols and instructions to patients and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports

Communicate the outcome of procedures and associated investigations to patients

Select appropriate procedures in partnership with patients, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Set up the equipment, maintaining an aseptic field where appropriate

Perform procedures, including appropriate analgesia and sedation

Manage unexpected events and complications during and after procedures

 

Provide aftercare for patients

Communicate aftercare protocols and instructions to patients and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports

Communicate the outcome of procedures and associated investigations to patients