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Nursing, Midwifery and Allied Health Professions

Portfolio of Core Competencies for Anaesthetic Assistants

Nursing, Midwifery and Allied Health Professions

Portfolio of Core Competencies for Anaesthetic Assistants

Name

Assessor

Commencement Date

June 2012

page 3

Index

Introduction Common Themes 1– 4 Part A Sections 1–10

Introduction

The Purpose of this Document

Attitudes and Values

Document Structure

Timeframe

Maintaining Competency

Assessment Process

Routes for CPD in Competent Practice

Guidelines for Continuous Assessment

What Constitutes Evidence

Learning Contract

Record of Clinical Assessor(s) and

Nominated Anaesthetist(s)

– Competencies 1 – 10 – Competencies 11 – 20

Theme 1 Communication skills and professional relationships

Theme 2 Professional development

Theme 3 Clinical leadership

Theme 4 Clinical governance

General Core Competencies

Section 1.1–1.8 Preparation of patients for theatre

Section 2.1–2.10 Aspects of patient care

Section 3.1–3.9 Involvement in common anaesthetic procedures

Section 4.1–4.17 Involvement in airway management

Section 5.1–5.13 Care of anaesthetic machine, monitoring and related equipment

Section 6.1–6.16 Care of equipment relevant to anaesthesia

Section 7.1–7.8 Participation in intra-operative patient care

Section 8.1–8.15 Involvement with routine drugs / fluid therapy

Section 9.1–9.8 Participation in post-operative patient care

Section 10.1–10.12 Involvement in emergency management

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Index

Part B Sections 11– 20 AppendicesSpeciality-specific Core Competencies

Section 11.1–11.7 Obstetric anaesthesia and analgesia

Section 12.1–12.6 ENT

Section 13.1–13.6 Cardiac anaesthesia

Section 14.1–14.4 Thoracic anaesthesia

Section 15.1–15.3 Neurosurgery

Section 16.1–16.6 Paediatrics

Section 17.1–17.10 Anaesthesia in Remote Locations (Interventional radiology (a) and ECT (b))

Section 18.1 Maxillo-facial surgery

Section 19.1–19.3 Burns

Section 20.1– 20.5 Inter-hospital adult patient transfer

Appendix 1 Qualification Framework

Appendix 2 Glossary of Abbreviations

page 1

Introduction

In the UK anaesthesia is administered under the supervision of a medically trained anaesthetist. The profession has a good safety record, with morbidity and mortality figures which compare favourably with other first-world countries. The anaesthetist is either a fully qualified specialist or an experienced anaesthetist working under supervision.

Hospitals must provide a safe working environment for the practice of anaesthesia. Hospitals which have trainees may be subject to inspection by the Royal College of Anaesthetists to ensure that appropriate standards are maintained. Both the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland would expect such standards to be maintained in all hospitals where anaesthesia is provided regardless of who administers it and recognise the competencies within this document as appropriate for this group of Health Professionals.

The provision of a suitably trained Anaesthetic Assistant (AA) is an essential safety standard, as published in the NHS Healthcare Improvement Scotland (NHS HIS) document Anaesthesia: Care Before, During and After Anaesthesia – Standards 1.4.1 and 1.4.2 www.healthcareimprovementscotland.org/previous_resources/standards/anaesthesia.aspx

AAs are members of the theatre team. They are essential for the safe delivery of anaesthesia which requires two practitioners with complementary skills and knowledge. AAs are involved in many routine aspects of peri-operative care and play an important role in the safe management of unforeseen clinical adverse events.

Training for AAs in Scotland is not unified. There are two streams:

● Operating Department Practitioners (ODPs), who complete a nationally recognised programme leading to the BSc in Operating Department Practice and are regulated by the Health Professions Council;

● AAs, who are Registered Nurses regulated by the Nursing and Midwifery Council.

Training recognised by NHS HIS can either be a registered ODP qualification or completion of Core Competencies 1 - 10 defined in this document.

Following the publication of the Core Competencies for Anaesthetic Assistants in 2006, a group was formed by NHS Education Scotland and the Advisory Board to the Royal College of Anaesthetists in Scotland to address the issues of endorsement of nursing courses and ensuring uniformity of standards across Scotland. This group advised the setting up of the Scottish Multiprofessional Anaesthetic Assistants Development Group (SMAAD Group) which first met in 2007. Key to this process is the role of nominated Consultant Anaesthetists in every hospital in Scotland who perform a final sign-off and apply for certificates to be awarded by the SMAAD Group to all nurses who complete their competencies. Registers are held of both Nominated Anaesthetists and nurses who have completed their competencies by this Group.

Nurses in Scotland, working as AAs, should possess a certificate of competency, signed by a nominated Consultant Anaesthetist for each competency required in their work-place. Certificates are issued either after completion of a recognised course provided by a Health Education Institution or by completion of a portfolio following an in-house programme under clinical supervision.

This structure addresses the issues relating to quality and consistency of education and training raised in the Scottish Medical and Scientific Advisory Committee (SMASAC) report Anaesthetic Assistance – A Strategy for Training, Recruitment and Retention and the Promulgation of Safe Practice (2003).www.scotland.gov.uk/Publications/2003/05/17153/21988

Portfolio of Core Competencies for Anaesthetic Assistants Introduction

http://www.scotland.gov.uk/Publications/2003/05/17153/21988

page 2

The Purpose of this Document

The following pages define in detail the competencies described in the NHS Education for Scotland (NES) document Core Competencies for Anaesthetic Assistants (2011) www.nes.scot.nhs.uk/media/4239/anaesthetic_core_competencies_2011.pdf and guide the assessment process. It is intended that the framework should form an overall level equivalent to level 9 of the Scottish Credit and Qualifications Framework (SCQF). See Appendix 1.

The layout of this portfolio is intended to make it easy to use by the Anaesthetic Assistant in the clinical area. The Anaesthetic Assistant can also add evidence of learning, reflective commentary etc into either a loose-leaf format or by links using the electronic pdf format. Throughout the portfolio there are internet links to relevant documents to aid the Anaesthetic Assistant in achieving the stated competency.

Using the reflective and competency based elements of the portfolio, Anaesthetic Assistants can accumulate evidence to demonstrate continuing competence, professional development and on-going education to meet KSF and to satisfy NMC/HPC requirements for registration purposes.

The competencies meet the needs of the Association of Anaesthetists of Great Britain and Ireland referred to in the publication The Anaesthesia Team 3 (2010) www.aagbi.org/sites/default/files/anaesthesia_team_2010_0.pdf and the current NHS HIS standards for Anaesthesia: Care Before, During and After Anaesthesia (2010) www.healthcareimprovementscotland.org/previous_resources/standards/anaesthesia_care_before,_duri.aspx

The competencies do not include a number of mandatory training courses, such as moving and handling; basic life support; immediate life support; venepuncture and cannulation; intravenous therapy; safe blood transfusion and medical devices. This document is intended to build on such aspects of induction and orientation, rather than replace them.

The competencies also do not specify some elements of near-patient testing which may be delegated locally to the anaesthetic assistant.

Attitudes and Values

The framework is underpinned by the NHS QIS healthcare governance standards (2005), to ensure that:

● patients’ views and experiences are taken into account in the planning and delivery of services

● patients are involved in, and informed about, all decisions made during their journey of care

● systems are in place to ensure that patient safety is a core principle underpinning all aspects of healthcare delivery

● information is used appropriately to maximise benefit in all sectors of healthcare

● policies and procedures are in place to encourage and enable continuous quality improvement

● staff from across NHS Scotland are fully supported and adequately trained, both personally and professionally, to provide high quality health services

● quality systems are in place to enable employees to play a full and active role in providing effective and efficient healthcare services for patients

● structures and processes are in place for the adequate review of service delivery.


http://www.nes.scot.nhs.uk/media/4239/anaesthetic_core_competencies_2011.pdf

http://www.nes.scot.nhs.uk/media/4239/anaesthetic_core_competencies_2011.pdf

http://www.aagbi.org/sites/default/files/anaesthesia_team_2010_0.pdf



http://www.healthcareimprovementscotland.org/previous_resources/standards/anaesthesia_care_before,_duri.aspx



page 3


Document Structure

This document presents the competencies in two parts.

Part A presents 10 competencies which form the essential core of AA education and training. All competent Anaesthetic Assistants will be expected to have achieved all ten of these competencies or their equivalent such as an ODP qualification. These are broadly ordered as follows:

● background knowledge / core skills

● walk-through: pre-operative, intra-operative, post-operative

● emergency management.

Part B comprises further groups of competencies which are specific to certain anaesthetic specialities. To practise independently in one of these specialities an AA will need to have achieved – and maintain where relevant – the corresponding competencies. Not all Anaesthetic Assistants will be expected to have completed every specific competency in this Section.

The twenty sections of the portfolio are broken down further into competencies. The number of competencies varies from section to section depending on the complexity of the competency. The skills and knowledge required to achieve each of the competencies is provided beneath each competency. The final aspect of the framework layout is the indicators column. The indicators provide guidance as to what the trainee would be reasonably expected to know or demonstrate in the clinical setting. It also provides guidance to the clinical assessor(s) in what they should be looking for when assessing the trainee. The indicators provided are not exhaustive and are provided as examples. The trainee can demonstrate competency in other ways, provided that this fits into the overall framework and assessment process. The indicators should not be viewed as a tick list, but used to ensure that across Scotland, individual trainees are being assessed in a similar way. Some sections also contain an overview relevant to that area of practice.

page 4

Timeframe

These competencies should be used in tandem with a personal development plan, linked to Flying Start and the NHS Knowledge and Skills Framework.

Under normal circumstances it is expected that education and training follows the timeframe suggested by the SMASAC Report (2003) www.scotland.gov.uk/Publications/2003/05/17153/21988, with a further consolidation period undertaken during independent practice.

Month 1 Supernumerary.

Months 2-3 Supervised daytime work.

Months 3-9 Supervision as required during the day, supervised night work.

Months 9 on Confirmation of competencies, completion of training (including moving and handling, ILS and in-house practical skills training). Independent practice.

The following core competencies are subject to local guidelines and assessment and should be completed during supervised practice:

● immediate life support (ILS) (10.7)

● insertion of an IV cannula (3.3)

● IV drug administration / PCA (8.10 et seq)

● the siting of an LMA in an adult patient (4.15).

Maintaining Competency

The SMAAD Group expects that where an AA’s time spent in clinical practice falls below a threshold (e.g. eight hours per week or 360 hours annually, on average) then regular CPD should be undertaken to ensure that clinical competency is maintained. The timing and content of this would depend on individual circumstances. AAs who intend to work in tertiary specialist centres may need to acquire a considerable number of speciality-specific competencies in addition to the general competencies in part 1. They will have a greater requirement for CPD activities

Those who work in rural or remote hospitals may be occasionally called on to assist with anaesthesia for emergencies without the benefit of regular elective practice in that speciality. They may therefore wish to acquire the competencies in the appropriate sections in part 2. For some specialities it may be appropriate to set up refresher courses which address the management of occasional emergencies.




page 5

Assessment Process

The purpose of this package is to provide individual staff with a portfolio to assist in the development of knowledge, skills and attitudes to function at a competent level as an Anaesthetic Assistant within their current sphere of practice. Existing knowledge, skills and attitudes are acknowledged and will be utilised as the basis for the achievement of specialty specific outcomes.

Knowledge and Skills Framework

It is proposed that these competencies will link to the Knowledge and Skills Framework (KSF) enabling the trainee to evidence learning for their development review and future Personal Development Plan.

The KSF will link individual, team and organisational demands and development and will facilitate improvements in patient care and help the trainee to understand their role in the effective delivery of services.

All courses must be supported by a nominated consultant anaesthetist

Every hospital providing clinical training for anaesthetic assistance must have at least one nominated consultant anaesthetist, who has been trained in teaching, proposed by the hospital and approved by the SMAAD Group. They will have evidence of experience of teaching, training and assessment and will take responsibility with the clinical assessors to sign off every trainee on completion of their training. It may be necessary for several consultant anaesthetists to be named as nominated anaesthetists.

Where training is provided in the specialist anaesthetic services in Part B of the competency book, nominated anaesthetists working in each of these specialties will be required to sign off the competencies. A register of nominated consultant anaesthetists will be kept both by the organisation seeking endorsement and the SMAAD Group.

Competencies will be supported and signed off by registered clinical assessors

Clinical assessors will be experienced, qualified, practising Anaesthetic Assistants or, in some circumstances, anaesthetists who will have evidence of experience of teaching, training and assessment and will take responsibility with the nominated anaesthetist to sign off every trainee on completion of their training. A register of clinical assessors and nominated consultant anaesthetists will be held locally by the Theatre Manager and centrally by the SMAAD Group.


page 6

The system is relatively straightforward and relies on the trainee and clinical assessor working together to determine the level of performance on commencement of the portfolio, with regular review until complete.

The clinical assessor must measure the trainee’s performance in relation to each competency, utilising the indicated knowledge / skills and indicators.

The formulation of a Learning Contract is suggested as one way to address areas of practice identified by the trainee as requiring specific attention. Clinical assessors and trainees can utilise locally available learning contracts or identify specific areas of practice requiring attention through their knowledge skills framework outline (KSF). A sample learning contract is provided on pages 11 and 12.

The Record of Competency Achievement at the end of each Section is to be used by the trainee to record:

● Evidence of achievement – Examples of types of evidence are provided at the top of each table and in Appendix 4.

● Reflection on Learning Process – The trainee is free to choose a reflective model that suits their needs.

Additional record of competency achievement sheets should be inserted for the sections with a large number of competencies

Experienced Anaesthetic Assistants

For experienced Anaesthetic Assistants, recognition of prior learning should allow for completion of the competency portfolio rapidly. This may be accomplished by demonstrating Recognised Prior informal Learning (RPL) www.nes.scot.nhs.uk/education-and-training/educational-development/initiatives/recognition-of-prior-learning-(rpl).aspx via a self assessment tool. The nominated anaesthetist and clinical assessor for that hospital will be able to sign off the appropriate competencies.

It is recognised that managers will need to be supportive of these proposals as adequate resource is needed to provide appropriately trained clinical assessors and nominated anaesthetists and adequate time to perform these tasks.

It is the responsibility of the trainee and the clinical assessor to complete the portfolio, ensuring all competencies are achieved. Where access to other clinical areas is necessary to complete a competency this will be facilitated by the clinical assessor or nominated anaesthetist in collaboration with line managers and practice education staff. Other Anaesthetists may assess and sign off specific competencies, but should discuss this with the clinical assessor or nominated anaesthetist. Each anaesthetic department will nominate an appropriately experienced Consultant to work with clinical assessors and practice education staff or managers in maintaining standards of training. The assessment and signing of the competency portfolio can only be performed by the identified nominated anaesthetist(s) and clinical assessors to ensure consistency.


Final sign off of the general core competencies and any speciality specific core competencies will be by both the nominated anaesthetist and the clinical assessor.

http://www.nes.scot.nhs.uk/education-and-training/educational-development/initiatives/recognition-of-prior-learning-(rpl).aspx



page 7

Routes for CPD in Competent Practice

Clinical assessor assigned. Initial practice (Month 1) in supernumerary capacity.

Registered Nurse new to Anaesthetic Assistance Less than 1 year’s experience

Supervised practice and ongoing assessment utilising the general core competencies. (Months 2 to 3)

Supervised practice as required until individual competencies reached. Ongoing assessment utilising

competency portfolio. (Months 3 to 9)

Completion of Competency Portfolio (Months 9 and on)

Qualified experienced staff (2 years post qualification) can use the competencies in the following ways:

• Access competencies to develop core or specialist practice

• Identify, through self assessment, areas for personal/professional development

• Use as part of an APEL process in accessing an academic development programme

Self-assessment and discussion with clinical assessor/ nominated anaesthetist.

Experienced Anaesthetic Nurse More than 1 year’s experience

Setting of baseline competency agreed with clinical assessor/nominated anaesthetists.

Clinical Mentorship with Identified Anaesthetists, Experienced Colleagues and clinical assessor.

Completion of Competency Portfolio


page 8

Competency Performance Criterion Level Role specific competence

● Provides safe and accurate care delivery.

● Understands the rationale for care provided.

● Recognises developing problems and takes appropriate actions.

Guidelines for Continuous Assessment

The Level of performance achieved is judged in relation to the criteria for clinical assessment set out below. The review of performance levels should be an ongoing process, but this must be reviewed formally every two weeks.

● Provides rationale for adapting treatment strategies in response to clinical changes.

● Demonstrates awareness of personal limitations and acts appropriately.

● Demonstrates comfort and confidence with the developed role.


page 9

Appendix 4

What Constitutes Evidence?

Learning and Development Category

Independent Learning and Development examples

e-learning CD-ROM, Internet/intranet

Private Study Reading journals/books, Researching, Internet

Reflective Practice Reflective Journal

Internal Learning and Development examples

Internal Courses/ Soft Skills, ManagementWorkshops Leadership Skills, Statutory/

Mandatory Courses, Clinical Courses, Risk Management Courses, Projects/Secondments, Rotation

Learning from Peers Coaching, Mentoring, Shadowing, Clinical Supervision, Action Learning Sets

What is evidence?

Information that a post holder provides and submits in order to demonstrate achievement towards their KSF outline.

The five rules of evidence are:

1 Validity Does it meet the needs of the dimension/level/indicator it is being used towards?

2 Authenticity Can it be attributed to the post holder?

3 Sufficiency Is there enough evidence to infer achievement of that area of the KSF outline for the post?

4 Currency Is the evidence up to date and relevant?

5 Reliability Does it accurately reflect the knowledge and skills required?

Providing evidence assessment

Post Course Briefing Sheet

Witness Statements

Direct Observation

Self-Assessment /Questions

Minutes of Meetings

Certificate of Competence

Previous Appraisal and Development Planning summary

Projects and Assignments

Reflective Accounts

OSCEs


page 10

Appendix 5

Learning Contract Guidance Notes

Identified Learning/Development Need(s)

Using the portfolio as an assessment tool, identify areas which require deeper exploration and knowledge development relevant to your own practice.

Agreed Learning Outcome(s)

Set your own specific learning outcomes (3 – 5) which will be the first step in developing your learning contract for the module and help you to focus on your learning needs and clinical practice. Remember to take account of the module learning outcomes when you are setting your outcomes.

What learning outcomes underpin these identified needs? These could be regarded as a break down of the need identified above into objectives that represent different issues that will need to be addressed separately in order to ‘satisfy’ the overall learning need. Start to formulate a learning action plan which will demonstrate the activities you will carry out in order to meet your learning outcomes.

Additional Validation/Comments

One of the main components of this space is the way in which this individual learning contract is helping the wider staff base. Is it contributing to a wider effort? Will it help to develop or revise guidelines or protocols? Will it help us to better understand or tackle an operational or management problem and how?

Use the contract as a tool to develop the individual, but also your whole departmental skill base. Don’t double up on efforts, resources are limited enough. Allow information and skills to flow. There is no harm in having individuals share specific aspects of their learning contract with others where goals are shared or allowing them to work together on specific issues.

Resources Required

What will you require in the way of resources to complete this learning contract? Time? Skilled assistance? The opportunity to job shadow? Access to relevant guidelines, protocols or literature held centrally? Be realistic, as the contract document involves your assessor as much as it involves you; don’t rely on resources that may be difficult to access. Instead be creative about the resources you will access.

Evidence of Achievement

Define what specific evidence will be accepted by both you and your assessor that the learning contract has been successfully completed. Do these acknowledge each of the set learning outcomes? You should use the module learning activities and assessment as evidence if you can, and where possible link these to the competency portfolio. For example the formulation of guidelines on a particular subject may have been identified as an agreed objective, in which case completion and presentation of these guidelines to other staff by an agreed date may be the agreed evidence of achievement.


Learning Contract

Name

Date Set Clinical Supervisor

Identified Learning/Development Need(s)

Agreed Learning Outcome(s)

Resources Required

Evidence of Achievement

Additional Validation/ Comments

Trainee’s Signature

Clinical Supervisor’s Signature

page 11

page 12

Record of Clinical Assessor(s) and Nominated Anaesthetist(s) Competencies 1 – 10

Trainee Nominated Consultant Anaesthetist (Departmental)

Name Contact Details Name Contact Details

Clinical Assessor(s) Additional Nominated Anaesthetist(s) (Clinical)



Completion of Competency Portfolio Sign-off Competencies 1 –10

Date Signature

Trainee

Nominated Consultant Anaesthetist

Clinical Assessor

Clinical Assessor

Nominated Anaesthetist



page 13

Record of Clinical Assessor(s) and Nominated Anaesthetist(s) Competencies 11– 20

Trainee Nominated Consultant Anaesthetist (Departmental)


Clinical Assessor(s) Additional Nominated Anaesthetist(s) (Clinical)



Completion of Competency Portfolio Sign-off Competencies 11– 20

Date Signature

Trainee

Nominated Consultant Anaesthetist

Clinical Assessor

Clinical Assessor




page 15

Portfolio of Core Competencies for Anaesthetic Assistants Common Themes

Common Themes

Theme 1 Communication skills and professional relationshipsKnowledge and Skills Indicators Date Performance

Criterion AchievedTrainee Assessor

1.1 Understands and applies principles of good communication with patient, carers, members of the perioperative team and ward staff.

1.2 Provides accurate concise and relevant verbal and written information related to the perioperative care of the patient.

1.3 Alerts appropriate members of the multidisciplinary ream to changes in patient’s condition.

Knowledge of Record Keeping Guidance for Nurses and Midwives (NMC 2009) and Standards of conduct, performance and ethics (HPC, 2008).

● Assess, plan, implement and evaluate individualised patient care using a recognised nursing framework in collaboration with all members of the multidisciplinary team.

● Can complete a preoperative checklist and handover care communicating relevant findings to appropriate health professionals.

● Communicates changes in patients observations appropriately.

● www.nmc-uk.org/Documents/Guidance/nmcGuidanceRecordKeepingGuidanceforNursesandMidwives.pdf

● www.hpc-uk.org/publications/index.asp?id=38#publication SearchResults

● Ability to use appropriate keyboard and data management skills

● Treat patient in a non-judgmental and accepting manner, maintaining patient dignity at all times. Demonstrate concern and respect for patient and carers.

Throughout the initial drafts of this document, many comments were made regarding repetition of a number of ‘themes’. It was felt that to group these together would make the document more user friendly for practitioners and assessors. This part of the document also reflects the themes outlined in the Core Competencies document for post anaesthetic care produced by the Association of Anaesthetists of Great Britain and Ireland (in preparation)

The following common themes are all applicable to achieving the competencies. Once these have been demonstrated to a competent level they need not be reassessed. This is intended to make it easier for the practitioner to concentrate on the indicators specific to each competency in Part A and Part B.

http://www.nmc-uk.org/Documents/Guidance/nmcGuidanceRecordKeepingGuidanceforNursesandMidwives.pdf

http://www.nmc-uk.org/Documents/Guidance/nmcGuidanceRecordKeepingGuidanceforNursesandMidwives.pdf

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Theme 1 Communication skills and professional relationshipsKnowledge and Skills Indicators Date Performance


1.4 Demonstrate keyboard and data management skills and uses available information technology.

1.5 Uses appropriate listening and responding skills to develop relationships with patients, carers and other staff. Articulates role within perioperative team and demonstrates knowledge of teamwork strategies related to the perioperative environment.

1.6 Educates and informs patients and carers in the anaesthetic room and keeps accurate and comprehensive records complying with local and national policies.

● Uses effective communication strategies with patients, anaesthetists and surgeons.

● Utilise knowledge to anticipate individual patient requirements.

● Recognise patients feeling of vulnerability.

● Provide reassurance and comfort and appropriate physical / psychological support and patient care to the anaesthetised, awake or sedated patient.

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Theme 2 Professional Development Knowledge and Skills Indicators Date Performance


2.1 Maintains a professional portfolio of experiential learning in perioperative care. Using the portfolio, recognising own limitations, identifies professional development needs and develops a personal development plan.

2.2 Uses appropriate resources and reflective practice to develop skills and knowledge and demonstrates personal accountability for ensuring own clinical competence.

2.3 Contributes to perioperative teaching and learning programmes by promoting clinically effective practice, support and assessment of learners and clinical supervision of others as appropriate.

● Portfolio.

● Evidence of appraisal.

● Personal development plan.

● Evidence of continuing clinical learning.

● Evidence of support and teaching where appropriate.

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Theme 3 Clinical Leadership Knowledge and Skills Indicators Date Performance


3.1 Develops autonomy in own role in anaesthetic room.

3.2 Makes effective clinical decisions and manages resources.

3.3 Is aware of research findings and implementation when appropriate.

● Can work in anaesthetic room with distant supervision until Portfolio completed

● Can support implementation of clinical decisions and resources.

● Can implement evidence-based changes in practice.

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Theme 4 Clinical Governance Knowledge and Skills Indicators Date Performance


4.1 Understands the principles, issues and factors associated with risk management in the anaesthetic room and theatre and use of that knowledge to eliminate or reduce these risks in the care of patients in the perioperative environment. Knowledge of guidance on Decontamination of Surgical Instruments and Other Medical Devices (2001) www.sehd.scot.nhs.uk/publications/dsmid/dsimd-00.htm

4.2 Discusses and applies the principles of ethical, legal and professional issues that may affect patient care in the perioperative area, ensuring documentation follows national and local directives and maintaining confidentiality.

● Manual handling is appropriately applied in clinical setting using available aids. Attends regular updates. Demonstrates safe management of clinical waste, drugs and chemicals.

Awareness of National Infection Prevention and Control Manual from Health Protection Scotland www.documents.hps.scot.nhs.uk/hai/infection-control/ic-manual/ ipcm-p-v1.0.pdf and www.aagbi.org/sites/default/files/infection_control_08.pdf

● Complies with national and local guidance on single-use items and medical device decontamination.

● Ensures traceability pathways are completed.

● Applies principles of Health and Safety to practice. Implements local and national Health and Safety Policies.

● Awareness of concept of informed consent in adults and children, legal issues relating to patients with learning disabilities or mental health issues. Awareness of patient groups including Jehovah’s Witnesses and patient directives.

● Adhere to NMC/ HPC codes of conduct and organisational guidelines in maintaining accurate and concise written documentation of care and procedures carried out for the patient.

http://www.documents.hps.scot.nhs.uk/hai/infection-control/ic-manual/ipcm-p-v1.0.pdf

http://www.documents.hps.scot.nhs.uk/hai/infection-control/ic-manual/ipcm-p-v1.0.pdf

http://www.aagbi.org/sites/default/files/infection_control_08.pdf


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Theme 4 Clinical Governance Knowledge and Skills Indicators Date Performance


4.3 Uses knowledge of national and local measures of quality assurance in relation to care in the perioperative area to develop and participate in quality, audit and peer review audit.

4.4 Understands how to recognise a clinical incident or near miss and follow local and national reporting mechanisms.

4.5 Applies the principles of accountability to the care of the surgical patients. Practises within the limitations of personal scope of practice and, where appropriate, seeks guidance and support of colleagues when exposed to new or unfamiliar procedures or situations.

● SPSP indicators. Implementation of local policies relating to deep venous thrombosis (DVT), temperature control and management of diabetic patients. Adherence to surgical brief, surgical pause and” stop before you block” policies. www.scottishpatientsafetyprogramme.scot.nhs.uk/programme/home/Peri-opertive and www.rcoa.ac.uk/clinical-guidelines-and-documents/wrong-site-block/?PageID=1763

● Completion of local critical incident forms. Critical incidents occurring in the perioperative area are:

● Acute airway obstruction

● Cardiopulmonary arrest

● Drug errors

● Reflects on own performance. Recognises own limitations and seeks help from appropriate members of the team. Demonstrates accountability for actions an limitations of own clinical competence. Understands principles of Vicarious Liability in relation to extending clinical skills

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/programme/home/Peri-opertive

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/programme/home/Peri-opertive

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Notes

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Portfolio of Core Competencies for Anaesthetic Assistants Part A: General Core Competencies

Section 1 Preparation of Patients for Theatre

1.1 Competency Understands the assessment, significance, and limitations of the ASA scoreKnowledge and Skills Indicators Date Performance


The ASA score, including its correlationwith operative mortality.The anaesthetist may present a patientas ‘ASA 4’; the AA must understand theimportant clinical implications of this.

● Define the ASA classification.

● Discuss the clinical differences between the ASA scores.

● Demonstrate ability to prepare anaesthetic room and theatre to provide individualised patient care taking into account ASA scores.

Fitness for Anaesthesia and Surgery

Many clinical factors identified pre-operatively have a bearing on perioperative anaesthetic care. The AA must be aware of the factors, which affect patient care, and should be able to outline how these factors might influence choice of anaesthetic technique. Pre-operative investigations are part of the perioperative safety net: clinically significant abnormal values should be identified by the AA and their risks understood. The AA should be able to identify many pre-operative risks (e.g. a missed ranitidine pre-med) and bring these to the attention of the anaesthetist.

The concept of the American Society of Anaesthesiologists (ASA) www.asahq.org/Home/For-Members/Clinical-Information/ASA-Physical-Status-Classification-System scoring system is international, and a foundation for assessing fitness for anaesthesia and surgery. Airway assessment is an important part of anaesthetic assessment, and because the AA assists in securing the airway it is important that they understand how the anaesthetist anticipates difficulty with airway manipulations. Fasting protocols are designed to help protect patients from aspiration of gastric contents. These are part of routine pre-operative assessment, and the AA should be aware of those situations where the benefits of fasting are unpredictable, or where fasting is inappropriate. Transferring, positioning, and protecting the obese patient represents a shared challenge for the AA and the anaesthetist, as all aspects of local and general anaesthesia are made more difficult and more prone to complications.

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1.2 Competency Aware of anaesthetic factors in the pre-operative clinical assessment of patientsKnowledge and Skills Indicators Date Performance


Basic clinical assessment of cardiovascular, respiratory, renal,neurological, haematological, hepatic,endocrine and GI systems with emphasis on factors which have abearing on anaesthetic care.The AA should recognise importantfactors affecting anaesthesia,(see the checklist-related competencies,2.1 and 2.2) and know the moreimportant clinical implications.

● Use patient’s records to recognise those pre-existing medical conditions, which may adversely affect the patient during anaesthesia.

● Ensure anaesthetist and wider multidisciplinary team are aware of relevant

● pre-existing medical conditions.

1.3 Competency Aware of principles involved in assessing airway for potential difficulty with intubation and/or ventilationKnowledge and Skills Indicators Date Performance


Clinical assessment of potentialdifficulty with intubation.Techniques, scoring / grading.The AA must understand the importantclinical implications of MallampatiScore / Cormack and Lehane Grading.

● Anticipate potentially difficult intubations.

● Identify and report any previous problems with anaesthesia.

● Discuss the Mallampati Score.

● Discuss the Cormack and Lehane system.

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1.4 Competency Can state fasting guidelines, and clinical aspects of theseKnowledge and Skills Indicators Date Performance


Fasting protocols, their clinicalrationale, fasting risks, times whenfasting is inappropriate.Essential to minimise risk ofacid aspiration.AA must know when fasting maynot achieve its goal, and anaestheticimplications of this.

● Discuss the principles of pre-operative fasting.

● Discuss the local guideline for pre-operative fasting.

● Discuss strategies to minimise regurgitation.

● Discuss the circumstances when fasting may not prevent regurgitation.

● Discuss the management of regurgitation.

● Discuss the signs and management of aspiration.

● Discuss nationally produced guidelines www.rcn.org.uk/development/practice/perioperative_fasting

1.5 Competency Understands the anaesthetic consequences of obesityKnowledge and Skills Indicators Date Performance


Understands the anaesthetic consequences of obesity

● Define the term BMI and discuss the term obese.

● Discuss how obesity affects anaesthesia.

● Discuss the impact of surgical positioning.

● Anticipate the need for additional equipment to ensure patient safety and comfort.

● Recognise that weight bearing equipment must have sufficient load capacity

● and be fit for purpose.

● Use nationally produced guidelines to inform practice www.sign.ac.uk/guidelines/fulltext/115/index.html

http://www.rcn.org.uk/development/practice/perioperative_fasting

http://www.sign.ac.uk/guidelines/fulltext/115/index.html

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1.6 Competency Understands the significance of pre-operative investigations, and can demonstrate a basic level of interpretationKnowledge and Skills Indicators Date Performance


Pre-operative investigations.Clinical aspects of normal and abnormalvalues of: blood haemoglobin, platelets,white cell count, clotting studies, serumpotassium, urea and creatinine, bloodsugar, arterial blood gases.Takes appropriate action byhighlighting clinically significantabnormal values.Basic ECG interpretation.

● Discuss local recommendations for pre-operative investigations.

● Demonstrate ability to sample and interpret blood sugar.

● Discuss routine biochemical and haematological values.

● Discuss arterial blood gas values.

● Discuss the normal conducting pathway of the heart.

● Demonstrate ability to recognise sinus rhythm and significant dysrhythmias.

● Discuss national guideline for pre-operative investigations publications.nice.org.uk/preoperative-tests-cg3

1.7 Competency Understands principles involved in pre-medication and pre-operative therapyKnowledge and Skills Indicators Date Performance


Understands the purpose, basicpharmacology and clinical aspects ofpaediatric or adult pre-medicant drugs(including topical LA cream), andtherapies (including physiotherapy).

● Discuss the role of pre-medication.

● Discuss commonly used pre-medicant drugs.

● Discuss and describe effects of common pre-medicant drugs.

● Demonstrate awareness of indications for topical LA cream.

● Discuss the need to continue therapies in the pre-operative phase.

Pre-medication and Pre-operative Therapies

http://publications.nice.org.uk/preoperative-tests-cg3

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1.8 Competency Aware of roles and responsibilities of theatre personnelKnowledge and Skills Indicators Date Performance


Theatre team members, roles andresponsibilities in routine care andduring emergencies.Knowledge of clinical ability of theatrepersonnel is an important factor duringclinical emergencies.

● Demonstrate an understanding of the roles within the multidisciplinary team.

● Identify individual or shared responsibilities in the provision of care in an emergency situation.

Theatre Team and Individual Roles An emergency can occur at any time. The AA must know the roles of each member of the theatre team, and when and how to contact senior assistance if required.

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Record of Achievement Section 1

Competency No. Evidence of Achievement Reflection on Learning Process Date Achieved

Examples of Sources of Learning / Evidence of Development ● Certificate of study days ● Accredited Module ● Clinical Observation

● Clinical Supervision ● Literature Reviews ● Skills Lab / Simulator Training

● Evidence of Learning – Portfolio ● Master Classes /Action Learning Set ● OSCE Assessment

● Documents – guidelines / protocols ● Diaries – learning log ● Critical incident analysis


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Section 2 Aspects of Patient Care

2.1 Competency Able to complete routine pre-operative checklistKnowledge and Skills Indicators Date Performance


Accurately acquires informationrequired to complete pre-operativechecklist.Avoids leading questions.Correctly identifies those situationswhen accuracy of information is likelyto be compromised.Can highlight important aspects ofchecklist information and bring theseto the attention of relevant teammembers – including where routinedrug therapy has been given orwithheld inappropriately.Systematically identifies theproposed site of operation andreports discrepancies to theappropriate person.

● Discuss the rationale for the individual components of the local checklist.

● Discuss national guidelines (AfPP and SPSP). www.afpp.org.uk/careers/Standards-Guidance and www.scottishpatientsafetyprogramme.scot.nhs.uk/docs/WHO%20Surgical%20Safety%20Checklist.pdf

● Demonstrates awareness of situations which compromise patient checking procedures.

● Communicate information to the anaesthetist regarding administration or non-administration of drugs likely to impact on anaesthesia.

● Systematically identifies the proposed site of operation and reports discrepancies.

Pre-operative Checklist

The local checklist applies, but must include the following categories of information: Patient identification; Fasting; Patient Preparation for Theatre Suite; Consent; Pre-operative investigations; Known Hazards; Allergies; Pre-medication.

The AA should understand the principles of obtaining or amending consent in pre- medicated patients, and should know the protocol for patients who are unable to give informed consent. The AA must understand infection risks and use standard precautions and appropriate additional precautions where relevant.

http://www.afpp.org.uk/careers/Standards-Guidance

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/docs/WHO%20Surgical%20Safety%20Checklist.pdf

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/docs/WHO%20Surgical%20Safety%20Checklist.pdf

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2.2 Competency Understands legal issues surrounding informed consent for anaesthesia and surgeryKnowledge and Skills Indicators Date Performance


Legal issues relevant to informedconsent for anaesthesia and surgery.The AA has an important roleconfirming the validity of consent tocurrent legal standards.Demonstrates the ability to actas the patient’s advocate and tosupport the patient appropriately ininformed choices (Adults withIncapacity Act (Scotland) 2000).Understands consent issues for minors(Consent for Children, GMC document).Understands consent requirementsfor Jehovah’s Witnesses.

● Discuss the AA’s role in communicating patient’s concerns in regard to consent to the appropriate members of the multidisciplinary team. www.aagbi.org/sites/default/files/consent06.pdf

● Demonstrate the rationale for patient identification and confirmation of consent with scrub practitioner.

● Discuss the Adults with Incapacity Act (Scotland) 2000. www.scotland.gov.uk/Topics/Justice/law/awi

● Discuss the law regarding consent for minors

● Discuss the implications of Jehovah’s Witnesses with regard to consent to receive blood products www.aagbi.org/sites/default/files/Jehovah’s%20Witnesses_0.pdf

● Demonstrate an awareness of the individual’s right to withhold consent to receive blood products.

● Utilise nationally produced guidelines to inform practice www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_index.asp

http://www.aagbi.org/sites/default/files/consent06.pdf

http://www.scotland.gov.uk/Topics/Justice/law/awi

http://www.aagbi.org/sites/default/files/Jehovah�s%20Witnesses_0.pdf

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2.3 Competency Assesses, plans, implements and evaluates perioperative careKnowledge and Skills Indicators Date Performance


Demonstrates the ability to planand accurately document all aspectsof a perioperative care-plan for allpatient groups.Is able to modify a care-plan in responseto changes in a patient’s condition.

● Utilises biopsychosocial data where possible from pre-operative assessment and surgical briefing to inform holistic care planning.

● Anticipates individual patient care requirements.

● Assess, plan, implement and evaluate effectiveness of interventions.

2.4 Competency Able to maintain patient’s comfort and dignity throughout the perioperative periodKnowledge and Skills Indicators Date Performance


Maintains privacy, comfort and dignityas far as possible throughout theperioperative period.

● Demonstrate concern and respect for the individual patient.

● Does not refer to patient by operation.

● Maintain patient dignity at all times.

● Provides additional patient warming with appropriate equipment as required.

General Patient Care The AA must provide safe, holistic patient care, which is as far as possible, evidence-based.The professional practice of the AA must have a sound ethical and legal basis.

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2.5 Competency Recognises signs of anxiety, describes their adverse effects, and offers reassuranceKnowledge and Skills Indicators Date Performance


Can assess a patient’s level of anxiety,offers appropriate reassurance.Recognises where anxiety may leadto patient harm, and acts appropriatelyto reduce anxiety where possible.Clinical effects of anxiety includingaltered drug dosages and increased riskof cardiac arrhythmias.Anxiety is common and may bedistressing: the AA should ensure thatthey recognise anxiety and respondsappropriately.

● Demonstrate ability to recognise signs of patient anxiety.

● Promote autonomy by encouraging active participation by the patient in their treatment and care where appropriate.

● Provide information and the rationale to patients regarding anaesthetic procedures.

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2.6 Competency Demonstrates personal and professional accountability in relation to the role of an Anaesthetic AssistantKnowledge and Skills Indicators Date Performance


Demonstrates the principles ofaccountability in professional practice.Practises within limitations of ownscope of professional practice.

● Behaves consistently with the NMC / HPC professional standards www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf and www.hpc-uk.org/publications/index.asp?id=38#publicationSearchResults

● Recognise own limitations and seek advice from members of the multidisciplinary team.

● Reflect on own performance.

● Assume responsibility for personal development plan.

● Demonstrate knowledge of and apply to practice the following (where relevant):

– Association for Perioperative Practice guidelines; www.afpp.org.uk/careers/Standards-Guidance

– NHS Policies and Guidelines;

– NES guidelines. www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/workforce-development/smaad-group.aspx

– NHS Healthcare Improvement Scotland standards and guidelines www.healthcareimprovementscotland.org

– Association of Anaesthetists guidelines www.aagbi.org/publications/publications-guidelines/A/F

– SIGN Guidelines www.sign.ac.uk

http://www.afpp.org.uk/careers/Standards-Guidance

http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/workforce-development/smaad-group.aspx

http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/workforce-development/smaad-group.aspx

http://www.aagbi.org/publications/publications-guidelines/A/F

http://www.sign.ac.uk

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2.7, 2.8 Competencies Aware of management of confused patients or patients with incapacity

Able to assess and manage patients with learning disabilitiesKnowledge and Skills Indicators Date Performance


Shows an ability to assess therequirements of confused patients orpatients with incapacity, and to protectthem from undue distress.Is patient and caring at all times.

● Demonstrate ability to apply the Adults with Incapacity Act (Scotland) 2000. (See also 2.2)

● Demonstrate ability to assess and manage the requirements of confused patients or patients with incapacity www.scotland.gov.uk/Topics/Justice/law/awi

2.10 Competency Able to assess and manage elderly or paediatric patients (as relevant to scope of normal practice)Knowledge and Skills Indicators Date Performance


Shows an ability to assess therequirements of elderly or paediatricpatients (as normal practice), and toprotect them from undue distress.Is patient and caring at all times.

● Use appropriate patient care and communication skills to protect the patient from undue stress as far as is reasonably practicable.

Care for Specific Patients Confused, demented, or educationally impaired patients represent a challenge for the anaesthetic team. Management is highly individualised, and the AA must be able to play an appropriate part in assisting the anaesthetist. Carers, relatives, or interpreters may be permitted into the anaesthetic room and must be supported appropriately.

2.9 Competency This Competency has been incorporated into Common Theme 4.

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Competency No.

Evidence of Achievement Reflection on Learning Process Date Achieved





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Section 3 Involvement in Common Anaesthetic Procedures

3.1 Competency Can assist anaesthetist during establishment of peripheral IV accessKnowledge and Skills Indicators Date Performance


Demonstrates effective skin antisepsisand site preparation.Can effectively use venous tourniquets.Manages failed cannulation.Recognises strategies for increasingsuccess-rate in patients who have‘difficult’ veins.Aware of risks of infection to staff.

● Discuss risk from blood borne pathogens to staff.

● Demonstrate an awareness of local hospital procedure in the event of accidental exposure to patient’s blood.

● Select appropriate site for cannulation.

● Apply tourniquet correctly.

● Demonstrate ability to employ techniques which improve venous filling.

● Demonstrate ability to remove a cannula.

● Discuss prevention and management of needle-stick injury.

● Discuss importance of formally reporting any incident of exposure or near miss through hospital Risk Management procedures.

Securing IV Access

Anaesthetised patients usually require peripheral IV access. The AA must be able to assist effectively in informing patients, management of failed IV cannulation, and those factors, which improve the success rate of this procedure. Inadvertent loss of IV access may be life threatening.

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3.2 Competency Able to secure an IV cannula or local anaesthetic catheterKnowledge and Skills Indicators Date Performance


Demonstrates ability to secure a cannula, local anaesthetic catheter or infusion line to minimise the possibility of accidental displacement.

● Select and apply appropriate dressing and/or securing device.

3.3 Competency Can site a peripheral intravenous cannulaKnowledge and Skills Indicators Date Performance


Can select an appropriate vein, preparethe skin, site a peripheral intravenouscannula and confirm that it is patent.

● Undertake appropriate local training and education prior to performing the clinical skill.

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3.4 Competency Can assist anaesthetist during establishment of invasive monitoringKnowledge and Skills Indicators Date Performance


Able to prepare all required equipment.Assists in positioning, supportingpatient, skin preparation, and helpingto prevent inadvertent movementduring the procedure.Knowledge of complications and risksof procedures.Ability to recognise complications andact appropriately.

Invasive Arterial Pressure Monitoring ● Discuss why arterial monitoring is required.

● Discuss sites of cannulation and the associated risks.

● Demonstrate knowledge of equipment required.

● Prepare and assemble equipment, identify and troubleshoot common problems.

● Demonstrate ability to position patient correctly and support as appropriate throughout procedure.

● Discuss measures to secure cannula and connections.

● Demonstrate ability to remove cannula, apply pressure over puncture site and apply dressing if required.

● Demonstrate knowledge of transducer calibration.

● Discuss arterial waveforms.

● Discuss dangers of intra-arterial injection and safety precautions.

● Discuss management of accidental intra-arterial injection.

Invasive monitoring Invasive monitoring is most often required during major surgery, or where patients have severe systemic disease. The AA must be able to assist the anaesthetist in establishing invasive monitoring. This is an essential part of the management of emergencies and may be the routine care of ASA 3, 4 and 5 patients.

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Knowledge and Skills Indicators Date Performance Criterion Achieved

Trainee Assessor

Central Venous Pressure Monitoring ● Discuss central venous pressure and explain the normal values.

● Discuss use of ultrasonic location device for central venous cannulation.

● Demonstrate knowledge of factors which affect CVP.

● Demonstrate knowledge of sites used for central venous cannulation and associated potential complications.

● Demonstrate a knowledge of different central venous cannula.

● Demonstrate correct positioning of patient during central venous cannulation.

● Demonstrate appropriate support of awake patient.

● Identify the features of a normal CVP trace.

● Demonstrate knowledge of transducer calibration.

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3.5 Competency Understands the principles and hazards of IV sedationKnowledge and Skills Indicators Date Performance


Pharmacological basis of sedation.Clinical aspects of administering sedation.Principles of Conscious Sedation.Monitoring for sedated patients.

● Administer O2 therapy if required.

● Discuss basic pharmacology of commonly used sedative agents.

● Discuss principles, uses and advantages of conscious sedation.

3.6 Competency Can assist in the care of a patient during a procedure under sedationKnowledge and Skills Indicators Date Performance


Shows the ability to monitor depth ofsedation and takes appropriate actionon actual or impending over-sedation.Can monitor vital signs during sedationand notify the registered practitioner ofany adverse trends.

● Discuss side affects associated with the use of sedation.

● Discuss sedation scoring tools.

● Attach monitoring devices.

● Discuss reversal agents in relation to sedation.

Sedation Many procedures are performed under sedation by a Healthcare Practitioner (HCP) other than an anaesthetist. The responsibility for the conduct of the procedure lies with the registered practitioner.

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3.7 Competency Knows basic anatomy, physiology and pharmacology relevant to spinal, epidural and other regional analgesiaKnowledge and Skills Indicators Date Performance


Relevant anatomy of spinal canal,nerve plexuses, and importantindividual nerves, including those to theeye, which may be usefully blocked.AA must be able to position patientappropriately, maintain immobility atcritical times (see also 3.8), and followthe progress of the block.Knowledge of symptoms and signs oflocal anaesthetic toxicity and of AAGBI Safety Guideline: Management of Severe Local Anaesthetic Toxicity

● Discuss the anatomy of the spinal column.

● Compare and contrast spinal and epidural anaesthesia.

● Discuss altered physiology in spinal and epidural anaesthesia.

● Discuss vasopressors in relation to spinal /epidural anaesthesia.

● Discuss contraindications to spinal/epidural anaesthesia.

● Discuss complications of spinal/epidural anaesthesia.

● Demonstrate basic knowledge of nerve pathways commonly blocked during regional anaesthesia.

● Discuss contraindications to peripheral nerve block.

● Discuss complications of peripheral nerve block.

● Discuss basic local anaesthetic pharmacology.

● Demonstrate knowledge of signs and symptoms of local anaesthetic toxicity and of guidelines to treat and manage these. See www.aagbi.org/sites/default/files/la_toxicity_2010_0.pdf www.aagbi.org/sites/default/files/la_toxicity_notes_2010_0.pdf

● Discuss compartment syndrome in relation to regional anaesthesia.

Regional anaesthetic blocks Regional anaesthetic blocks may be performed as the sole anaesthetic technique, or in combination with sedation or general anaesthesia.However the AA must be able to ensure patient safety and comfort during these procedures and communicate with the registered practitioner. Inadvertent over-sedation may result in loss of airway.

http://www.aagbi.org/sites/default/files/la_toxicity_2010_0.pdf

http://www.aagbi.org/sites/default/files/la_toxicity_notes_2010_0.pdf

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3.8 Competency Able to assist anaesthetist during establishment of regional anaesthesiaKnowledge and Skills Indicators Date Performance


Preparation of equipment, preparationof nerve stimulator, preparation of ultrasound equipment, patient positioning, communication with the patient at all stages. Understands need for routine monitoring, IV access and accessibility of standard resuscitation equipment.Recognition of symptoms and signs oflocal anaesthetic toxicity. (See 3.7)Ability to assist in management ofpatient with symptoms and signs of local anaesthetic toxicity.

● Select and assemble appropriate equipment.

● Demonstrate ability to position patient correctly and support throughout procedure.

● Attach monitoring devices.

● Discuss the need for IV access.

● Discuss the features of spinal needles.

● Recognise when cardio/respiratory function has been compromised as a result of regional block.

● Alert anaesthetist to changes in patient’s vital signs.

● Discuss the stages involved in each type of block and ensure patient remains immobile at crucial points of the procedure.

● Able to locate 20% lipid emulsion for lipid rescue.

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3.9 Competency Understands principles of assessment of extent of regional anaesthetic blockKnowledge and Skills Indicators Date Performance


Knowledge of dermatomes. Testing using cold / pinprick. Should be able to assess extent of a block where this might be the cause of compromised respiratory function.Should be able to measure the degreeof block where this may compromise tissue viability or herald signs of cord compression.

● Discuss dermatomes.

● Discuss techniques to determine extent of regional block.

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Section 4 Involvement in Airway Management

4.1 Competency Recognises the role of the Anaesthetic Assistant in airway establishmentKnowledge and Skills Indicators Date Performance


The role of the AA in airwayestablishment.

● Support and maintain the patient’s airway as required.

● Anticipate anaesthetist’s requirements and provide suitable airway adjuncts.

● Discuss optimum position for airway management.

● Discuss the placement of a Guedel airway.

● Discuss the placement of a Laryngeal Mask Airway.

● Discuss the placement of a nasopharyngeal airway.

● Discuss the term ‘pre-oxygenation’.

● Assist the anaesthetist in securing the airway.

General Securing the airway is an important and occasionally very difficult part of the anaesthetist’s work. The AA plays an important complementary role in this.

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4.2 Competency Knows the anatomy of the upper airwayKnowledge and Skills Indicators Date Performance


Those aspects of the anatomy of theupper airway, which are relevant tolaryngoscopy, intubation and theplacement of LMAs and other airways.

● Describe airway anatomy.

● Relate anatomy / physiology and discuss the following:– inspired oxygen concentration (FiO2);– pulse oximetry;– end tidal CO2;– end tidal anaesthetic agent;– tidal volume (ml/kg) and expired minute volume;– airway pressure and factors which affect it.

● Discuss the term ‘Functional Residual Capacity’ and what may affect it.

4.3 Competency Can clear the airway where upper airway obstruction is presentKnowledge and Skills Indicators Date Performance


Can recognise upper-airwayobstruction. Can perform manoeuvresto clear the airway: effective headextension, jaw-thrust, oropharyngealsuction, insert an appropriate size ofGuedel airway or nasopharyngealairway. May have first-line involvementwith management of upper airwayobstruction in the theatre suite.

● Recognise airway obstruction.

● Demonstrate sufficient psychomotor skills to maintain patient’s airway.

● Demonstrate ability to manage airway obstruction.

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4.4 Competency Can set up for and assist the anaesthetist with routine intubation of the tracheaKnowledge and Skills Indicators Date Performance


Sets up intubation equipmenttray / trolley.Able to test the equipment.Positions the patient appropriately andassists the anaesthetist with routineintubation of the trachea.

● Demonstrate ability to prepare and check equipment for routine intubation.

● Demonstrate competency in assisting with the positioning of the patient to maximise patient comfort and provide optimal access for the anaesthetist.

● Provide appropriate support and assistance to the anaesthetist during intubation.

4.5 Competency Understands features of oxygen delivery equipmentKnowledge and Skills Indicators Date Performance


Face masks: types, design featuresincluding fixed and variableperformance designs.Nasal cannulae.Wall O2 flowmeters.

● Discuss types of oxygen supply.

● Discuss oxygen delivery devices.

● Consistently select appropriate size and type of facemask.

● Select appropriate O2 mask recognising patient’s individual requirements.

Airway Equipment A large number of pieces of equipment have been developed to assist in safely securing the airway. The AA must be familiar with both the common and less common equipment that may be required, and be able to produce that equipment on request. The AA must be familiar with the features, mode of use and hazards associated with these items.

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4.6 Competency Detailed knowledge of airway equipment, features, role and mode of useKnowledge and Skills Indicators Date Performance


Straight and curved bladed laryngo-scopes; specialised laryngoscopes fordifficult intubation (McCoy / Bullardor similar) videolaryngoscopes; forceps; bougies and introducers; ET Tubes (See 4.7);, including DLT / RAE / Microlaryngeal/NIM ® tubes intubating LMA; jet insufflationequipment; fibreoptic intubatingequipment.

● Discuss types of laryngoscopes.

● Discuss adjuncts used in intubation.

● Discuss types of endotracheal tube.

● Discuss the use of non-cuffed endotracheal tubes in children (where applicable).

● Discuss types of LMA.

● Discuss other locally available airway devices.

● Discuss jet insufflation / ventilation.

● Demonstrate competency in identification, assembly, decontamination, terminal disinfection / disposal and use of anaesthetic sundries.

4.7 Competency Can calculate endotracheal tube sizes and lengthsKnowledge and Skills Indicators Date Performance


Calculates endotracheal tube sizes andlengths using standard formulae.Morbidity associated with use of awrongly sized ET tube.

● Discuss the importance of endotracheal tube size and length.

● Demonstrate ability to correctly calculate endotracheal tube length and size.

● Demonstrate ability to prepare tube.

● Discuss complications due to wrongly sized endotracheal tube.

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4.8 Competency Can describe features of self-inflating bags and can set up and useKnowledge and Skills Indicators Date Performance


Ambu valves, self-inflating bags.Key part of emergency managementwithin theatre suite / recovery area, andduring intra-hospital patient transfer.

● Demonstrate features of self-inflating bags and pre-use checks.

● Discuss the use of self-inflating bags.

● Identify non-disposable / single use self-inflating bags and valves.

● Discuss the requirement for and location of self-inflating bags in the operating department and during intra / inter hospital transfer.

● Demonstrate competency in identification, assembly, decontamination, terminal disinfection / disposal and use of valves and self-inflating bags.

4.9 Competency Can set up a difficult intubation trolleyKnowledge and Skills Indicators Date Performance


Can list the important equipmentrequired for a difficult intubation trolley.Is able to prepare the equipment for use.

● Discuss the requirement for a difficult intubation trolley.

● Identify location and contents of difficult intubation trolley.

● Discuss the preparation and use of each piece of equipment in the difficult intubation trolley.

● Demonstrate competency in identification, assembly, decontamination, terminal disinfection / disposal and use of all items on the difficult intubation trolley.

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4.10 Competency Knows protocol for unexpected difficult intubation and failed intubation drillKnowledge and Skills Indicators Date Performance


Management of expected andunexpected difficult intubation.Detailed failed intubation protocolsincluding Difficult Airway Societyguidelines.

● Prepare anaesthetic room and equipment for patient with known

● difficult airway.

● Discuss protocol for failed intubation.

● Demonstrate ability to assist in the management of failed intubation.

● Use nationally produced guidelines to inform practice www.das.uk.com/guidelines/guidelineshome.html

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4.11 Competency Participates in Rapid Sequence Induction, including effective cricoid pressureKnowledge and Skills Indicators Date Performance


Sets up equipment, preparesenvironment and patient for RapidSequence Induction.Identifies cricoid cartilage.Applies appropriate pressure at theappropriate time.Is able to implement the safe procedurefor its release.Minimises risk of acid aspiration.

● Discuss rapid sequence induction.

● Describe the process of rapid sequence induction.

● Check trolley tips and is correctly orientated.

● When practicable ensure the use of two AAs.

● Identify cricoid cartilage in a broad selection of patients.

● Demonstrate correct application of cricoid pressure.

● Release cricoid pressure on anaesthetist’s instruction. (See also 4.10)

● Release pressure slowly and is prepared to re-apply if required.

● Secure endotracheal tube.

4.12 Competency Demonstrates ability to perform either role in two-person bag-mask ventilationKnowledge and Skills Indicators Date Performance


Can hold a facemask in position,ensuring a gas-tight seal; or performmanual IPPV. Can identify suitablebreathing systems.

● Identify suitable facemask type and size. (See also 4.3)

● Select correct type of breathing system.

● Ensure breathing system is set for manual / spontaneous ventilation.

● Demonstrate ability to ventilate patient.

Assist During the Securing of the Airway Two-person bag-mask ventilation and cricoid pressure are important interventions in which the AA must be competent. The AA must be practised and skilled at assisting the anaesthetists throughout the period before the airway is secured. Awake fibreoptic intubation or emergency cricothyroidotomy may have to be performed at any time as the safest way to secure the airway.

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4.13 Competency Can set up and assist with local anaesthesia for, and subsequent performance of, awake fibreoptic intubationKnowledge and Skills Indicators Date Performance


Can assemble equipment required forawake fibreoptic intubation and assistwith all aspects of this.Knowledge of extubation guidelines.

● Discuss the indications for fibreoptic intubation. (See also 1.3)

● Describe the process of and assist during awake fibre optic intubation.

● Discuss drugs used.

● Discuss anaesthetic equipment used during awake intubation.

● When practicable ensure the use of two AAs.

● Discuss extubation for this patient group. (See also 9.8)www.das.uk.com/content/das-extubation-guidelines

● Demonstrate competency in identification, assembly, leak tests and decontamination of Fibreoptic scope.

4.14 Competency Can assist with inhalation inductionKnowledge and Skills Indicators Date Performance


Can communicate effectively withthe patient. Anticipate and manageinadvertent patient movement duringinduction. Inhalation induction ofanaesthesia may have to be performedat any time (including periods with out-of-hours levels of support) as the safestway to achieve anaesthesia.

● Discuss indications for inhalation induction. (See also 3.1)

● Discuss Guedel’s classical signs of anaesthesia.

● Is prepared for and ensures patient safety throughout stages of anaesthesia.

● Ensures a quiet, calm environment.

● Discuss patient position during inhalation induction.

http://www.das.uk.com/content/das-extubation-guidelines

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4.15 Competency Demonstrates ability to place a laryngeal mask in an adult patientKnowledge and Skills Indicators Date Performance


Can place a laryngeal mask airway(LMA) in an adult patient (to ILS coursestandard).The AA may be asked, duringemergency management, to site anLMA – and should be practised in this.

● Complete ILS course / equivalent local training course.

4.16 Competency Can assist during cricothyroidotomyKnowledge and Skills Indicators Date Performance


Can identify and set up the equipmentrequired for a cricothyroidotomy, andknows how to assist the anaesthetistduring this procedure.Can rapidly connect this to anappropriate oxygen supply.

● Discuss indication for cricothyroidotomy.

● Discuss techniques and devices.

● Discuss optimal patient position.

● Demonstrate how to locate equipment.

● Demonstrate how to assemble equipment and connect to appropriate breathing system.

● Discuss patient management options. (See also 4.10, 10.1)

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4.17 Competency Can assist in management of patient with unstable cervical spineKnowledge and Skills Indicators Date Performance


Can position appropriately the patientwith an unstable cervical spine andassist the anaesthetist in managementof the patient and the airway.

● Discuss how the head is positioned and supported to prevent damage to the cervical spine.

● Demonstrate ability to provide manual in line stabilisation.

● Discuss methods of neck stabilisation.

● Discuss management of patient with neck brace/collar.

● Discuss the use of anaesthetic adjuncts in the event of difficult airway. (See also 4.10)

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page 56


Section 5 Care of Anaesthetic Machine, Monitoring and Related Equipment

Anaesthetic machine (including all anaesthetic delivery systems) The AA has a major role to play in systematically preparing and checking the anaesthetic machine. This important piece of equipment is central to the administration of general anaesthesia, and the AA must be able to assist the anaesthetist in solving problems. Patient safety depends on a correctly set-up anaesthetic machine.

5.1 Competency Able to set up an anaesthetic machine, check it, pass it as safe to use and record this informationKnowledge and Skills Indicators Date Performance


Demonstrates ability to set up ananaesthetic machine, check it toAssociation of Anaesthetist’s Guidelines(2012); and to theManufacturer’s Guidelines (includingbetween-case checks).Demonstrates awareness of importanceof vaporiser seating and suction.

● Check an anaesthetic machine in accordance with the current Association of Anaesthetists Guidelines www.aagbi.org/sites/default/files/checking_anaesthetic_equipment_2012.pdf and www.aagbi.org/sites/default/files/checklist_for_anaesthetic_equipment_2012.pdf

● Describe the purpose and function of the following items:

– Pin Index Safety System;– Bodok seals;– blanking plugs;– anti-hypoxic link.

www.aagbi.org/sites/default/files/checking_anaesthetic_equipment_2012.pdf

www.aagbi.org/sites/default/files/checking_anaesthetic_equipment_2012.pdf

www.aagbi.org/sites/default/files/checklist_for_anaesthetic_equipment_2012.pdf

www.aagbi.org/sites/default/files/checklist_for_anaesthetic_equipment_2012.pdf

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5.2 Competency Knows the safety features of the anaesthetic machineKnowledge and Skills Indicators Date Performance


Can demonstrate the safety featuresof the anaesthetic machine: includinggas specific components, oxygenfailure alarms, backup gas supplies,emergency oxygen flush, blow-offpressure valves, scavenging, anti-hypoxic mixture features.

● Discuss the purpose of the safety features of an anaesthetic machine:– volatile agent and gas monitoring devices;– anti-hypoxic features;– oxygen failure alarm;– gas supply back up;– emergency oxygen flush;– blow-off pressure valve function;– waste gas-scavenging functioning.

5.3 Competency Can identify common breathing systems, state the Mapleson classification and their functional

characteristics, check and pass as safe to useKnowledge and Skills Indicators Date Performance


Mapleson functional classification ofbreathing systems.Circle system set-up and features.Checking system patency and integrity.

● Describe the Mapleson classification of systems A – F and their clinical application.

● Demonstrate the ability to perform patency and safety checks on breathing systems.

● Discuss features of a circle system.

● Demonstrate ability to set up a circle system.

● Discuss the role of CO2 absorption agents.

● Demonstrate ability to safely change and refill CO2 absorption canister.

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5.4 Competency Understands purpose and features of Anaesthetic Machine VentilatorKnowledge and Skills Indicators Date Performance


Purpose and detailed functionof ventilators.Clinical aspects of the use of these.

● Demonstrate ability to check machine-integrated and stand-alone ventilators.

● Discuss features and function of ventilators and relate these to patient safety.

5.5 Competency Can identify gas cylinders. Knows how to safely handle and store gas cylindersKnowledge and Skills Indicators Date Performance


International colour schemefor gas cylinders.Safe storage and handlingof gas cylinders.Basic HSE guidelines.

● Discuss correct procedures in the storage and handling of gas cylinders.

● Demonstrate safe removal and replacement of cylinders on the anaesthetic machine.

● Locate Safety Data Sheets for cylinders within the department.

● Discuss Health and Safety Executive (HSE, 1999) guidelines regarding the use, storage and handling of medical gas cylinders www.hse.gov.uk/pubns/hse8.pdf

● Discuss the international colour scheme for gas cylinders.

● Identify cylinder sizes and connectors.

http://www.hse.gov.uk/pubns/hse8.pdf

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5.6 Competency Can safely connect and disconnect gas supplies. Can operate emergency shut-off valvesKnowledge and Skills Indicators Date Performance


Able to attach and detach connectors.Aware of site of emergencyshut-off valves, the circumstanceswhen these may need to be used,and who to inform.

● Demonstrate ability to safely connect / disconnect anaesthetic machine connectors.

● Perform a ‘tug test’ (see 5.1) to ensure safe connection.

● Discuss colour-codes for piped gases and vacuum.

● Identify location of emergency gas/vacuum shut off valve.

● Discuss the circumstances where the shut off valve would be used.

5.7 Competency Can identify and correct anaesthetic machine problems which may occur during useKnowledge and Skills Indicators Date Performance


Can identify and correct wherepossible, breathing system leaks; highpressure within patient circuit; vaporizermalfunction; failure of gas supply;electrical power failure; suction failure;CO2 absorption failure.

● Troubleshoot and correct the following:– breathing system leak;– breathing system failure;– high pressure in breathing system;– vaporizer malfunction;– gas supply failure;– power failure;– CO2 absorption failure;– suction failure. ● Seek advice from members of the multidisciplinary team.

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5.9 Competency Able to understand anaesthetic charts and trends, perform charting of physiological data

and describe monitoring status appropriately to the anaesthetistKnowledge and Skills Indicators Date Performance


Ability to chart monitoring valuesusing standard symbols. Can recogniseadverse trends, which indicate risk. Canidentify common artefacts. Can describemonitoring details to the anaesthetist.Alerting staff to adverse monitoringtrends may prevent the development oflife-threatening emergencies.

● Demonstrate ability to chart accurately using standard symbols.

● Discuss and interpret monitoring trends.

● Identify common artefacts and discuss their cause.

● Report monitoring information accurately to the anaesthetist.

Monitoring The AA needs to be able to understand and monitor values in the context of chart trends. The AA should be able to chart physiological data if required.

5.8 Competency Demonstrates ability to correctly establish routine monitoringKnowledge and Skills Indicators Date Performance


Able to establish routine monitoringSpO2; ECG; NIBP; Capnography.Nasopharyngeal temperature probeand urimeter as appropriate.

● Discuss the clinical significance of routine monitoring.

● Discuss anatomy and physiology relevant to routine monitoring.

● Attaches patient correctly to routine monitoring.

page 61


5.10 Competency Can describe principles of monitoring depth of anaesthesia, including clinical aspects of prevention of awarenessKnowledge and Skills Indicators Date Performance


Clinical depth of anaesthesiamonitoring principles.Risk of awareness.Responds appropriately to clinical signsof light anaesthesia.

● Recognise signs of light anaesthesia.

● Discuss anaesthetic awareness.

● Discuss the principles of the nerve stimulator in ensuring muscle relaxation.

● Discuss the principles of monitoring neuromuscular blockade.

5.11 Competency Can describe principles of calculating intra-operative blood lossKnowledge and Skills Indicators Date Performance


Intra-operative blood loss calculationincluding worked examples.

● Demonstrate ability to calculate, record and maintain a running total of blood loss.

● Discuss normal circulating blood volume in adult and paediatric patients.

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Electrical Equipment The AA sets up and manages electrical equipment in the theatre, and must understand the dangers involved and how to avoid patient and staff harm.

5.12 Competency Knowledge of electrical safetyKnowledge and Skills Indicators Date Performance


Electrical safety: including mains power,earthing, applied parts, micro-shock.(See also 6.13)

● Discuss workplace precautions to reduce the risk of injury to patients and staff.

● Discuss safe principles of diathermy.

● Select appropriate site and connect diathermy electrode.

5.13 Competency Can describe and implement safety measures required during surgical use of lasers or X-ray equipmentKnowledge and Skills Indicators Date Performance


Knows safety measures requiredduring surgical use of lasers or X-rayequipment.

● Discuss safety policies and procedures relating to use of X-ray / laser equipment for patients and staff.

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page 64


Section 6 Care of Equipment Relevant to Anaesthesia

6.1 Competency Able to set up an anaesthetic machine, check it, pass it as safe to use and record this informationKnowledge and Skills Indicators Date Performance


A strategy for introducing newequipment: including features, pitfalls,clinical relevance, set-up, checks,documentation, dissemination ofclinical warnings, manuals (storageavailability and updates).AAGBI guidelines for safe management of equipment

● Discuss the procedure within the operating department for the introduction of new equipment.

● Discuss the importance of ensuring new equipment has been checked and registered on asset register by medical physicians before clinical use.

● Discuss the importance of checking that any ‘on loan/ trial’ equipment has been checked by medical physics and indemnity form obtained from manufacturer before clinical use.

● Discuss the importance of servicing / maintenance of equipment.

● Demonstrate familiarity with checking and set up of any new equipment.

● Facilitate the dissemination of new equipment manuals and any relevant clinical warnings / information.

● Facilitate training for staff in the safe and effective use of new equipment.

● Discuss www.aagbi.org/sites/default/files/safe_management_2009_0.pdf

This section should be read in conjunction with the sections on airway management (Section 4) the anaesthetic machine (Competency 5.1– 5.8) and intra-operative patient care (Section 7).

General Care of Equipment The anaesthetist and the AA have at their disposal a wide range of equipment. They must know in detail how to use it effectively and safely. The AA has a role in factors affecting a team’s ability to provide anaesthetic services.

page 65


6.2 Competency Can implement standard precautions for infection control during the handling of anaesthesia equipmentKnowledge and Skills Indicators Date Performance


Shows ability to manage equipment ina way that does not pose an infectionrisk to either patient or staff.Understands importance of traceabilityof instruments.

Demonstrate knowledge of the Scottish Executive Health Department’s report and guidance on Decontamination of Surgical Instruments and Other Medical Devices (2001)www.sehd.scot.nhs.uk/publications/dsmid/dsimd-00.htm and www.aagbi.org/sites/default/files/infection_control_08.pdf

● Discuss and demonstrates an understanding of tracking and traceability.

● Discuss the additional precautions required in relation to variant Creutzfelds Jacob (vCJD).

6.3 Competency Understands factors to be considered when arranging routine maintenance of equipmentKnowledge and Skills Indicators Date Performance


Factors involved in equipmentmaintenance: including impact onservices, backup equipment.Liaison with Medical Physics.

● Demonstrate ability to ensure routine maintenance of equipment is carried out.

● Discuss local policy, manufacturers guidelines and Medical Devices Agency input (www.mhra.gov.uk ) with regard to equipment maintenance. (See also 6.1)

● Discuss the impact that poor maintenance of equipment can have on service delivery.

http://www.sehd.scot.nhs.uk/publications/dsmid/dsimd-00.htm


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6.4 Competency Can identify and manage faulty or broken equipmentKnowledge and Skills Indicators Date Performance


Demonstrates ability to identify faultyor unsafe equipment, to remedy thiswhere possible, and to report the faultappropriately.Knows local policy regarding equipment requiring cleaning before reuse.Liaison with Medical Physics.

● Demonstrate ability to identify faulty or unsafe equipment.

● Discuss importance of removing and replacing unsafe equipment.

● Adhere to local policy for reporting and documenting faulty equipment.

● Ensure equipment is decontaminated before being sent for or returning from repair.

6.5 Competency Knows features and management of syringes, needles and other sharpsKnowledge and Skills Indicators Date Performance


Demonstrates knowledge of the features of; safe handling of; disposal of; and clinically relevant problems associated with the following equipment: syringes, needles, sharps. Local needlestick management protocol.

● Adhere to local policy for the use and disposal of sharps.

● Discuss the role of Occupational Health in needle stick injury.

● Ensure only appropriate items are disposed of in sharps bin.

● Discuss local policy for the disposal of sharps bin.

IV Equipment

page 67


6.6 Competency Can set up IV infusion equipmentKnowledge and Skills Indicators Date Performance


Able to set up IV infusions, including fluid warming devices and pressure bags.Volumetric pumps.

● Discuss available IV infusion equipment.

● Correctly identify appropriate giving set.

● Discuss the use of fluid warming devices.

● Prepare fluid warming device.

● Use pressure infuser as appropriate.

● Ensure infusion device has adequate battery power or is connected to a mains power supply.

6.7 Competency Knowledge of the equipment associated with blood and blood product transfusionKnowledge and Skills Indicators Date Performance


Specific requirements relating to bloodtransfusion products. Platelet filtersand platelet giving sets. Local protocolsconcerning the safe administrationof blood products. (See 8.5) Currentnational BTS guidelines. Aware ofpurpose of cell-salvage equipment.Can use equipment for haemoglobinestimation from a capillary blood sample.

● Select and prepare correct giving set appropriate to blood product being utilised.

● Discuss the use of equipment for cell salvage.

● Use equipment (where available) for haemoglobin estimation.

● Calibrate (where available) equipment for haemoglobin estimation in accordance with manufacturer’s guidelines.

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6.8 Competency Can set up a pressure transducerKnowledge and Skills Indicators Date Performance


Able to set up, attach, and zero pressuretransducers.

● Select appropriate equipment and set up a pressure transducer.

● Demonstrate ability to reconfigure monitoring equipment to display numerical and/or waveform information.

● Demonstrate ability to correctly zero pressure transducers.

● Discuss the importance of regular pressure bag checks.

6.9 Competency Can describe the principles associated with train-of-four NMJ assessmentKnowledge and Skills Indicators Date Performance


Basic NMJ physiology, facilitation, fade.Clinical aspects of train-of-fourmeasurement.Surface anatomy of ulnar, common-peroneal, facial, radial and tibial nerves.

● Discuss the physiology of neuromuscular junctions.

● Discuss the clinical aspects of the train-of-four measurement and interpretation.

● Understand the principles and significance of train-of-four assessment during the reversal of anaesthesia.

● Identify and describe anatomy of commonly used sites for train-of-four assessment.

Equipment Associated with Monitoring

page 69


6.10 Competency Is able to set and apply a train-of-four stimulatorKnowledge and Skills Indicators Date Performance


Identifies appropriate site, attachestrain-of-four stimulator.

● Demonstrate ability to apply nerve stimulator electrodes.

6.11 Competency Knows principles of nerve stimulation during local anaesthesiaKnowledge and Skills Indicators Date Performance


Nerve stimulators for locating nerves,insulated needles, principles of their use.Is able to assist the anaesthetist whenthis equipment is being used.

● Discuss the use of a nerve stimulator to locate nerves. (See also 3.7, 3.8, 3.9)

● Discuss available types of regional block needle.

● Discuss the importance of using the correct nerve stimulator.

● Demonstrate ability to correctly set the nerve stimulator with direction from

● anaesthetist.

● Discuss the need for patient cooperation.

page 70


6.12 Competency Can measure blood glucose and describe risks associated with abnormal valuesKnowledge and Skills Indicators Date Performance


Demonstrates ability to measure bloodglucose and describe risks associatedwith abnormal values.Can calibrate a blood glucose machine(using manufacturer’s guidelines).

● Demonstrate ability to correctly calibrate the blood glucose machine.

● Demonstrate ability to obtain a blood sample for testing.

● Interpret and discuss normal range of blood sugar levels.

● Discuss the significance of abnormal blood sugar results.

● Discuss management of abnormal glucose levels.

6.13 Competency Can safely apply a diathermy electrode and remove it when no longer requiredKnowledge and Skills Indicators Date Performance


Safe choice of site, skin inspection andpreparation, application of pad, cablesiting and final check.Removal and inspection.Understands basic principles ofelectrocautery.

● Discuss principles of electrocautery/diathermy.

● Demonstrate ability to select appropriate site for placement of diathermy

● electrode.

● Check skin to ensure satisfactory condition prior to electrode placement.

● Correctly site cable and connection to diathermy machine.

● Safely remove diathermy electrode following surgery.

● Check and document skin integrity for any signs of damage.

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6.14 Competency Can describe anaesthetic aspects of pacemakers and implantable cardiac defibrillators (ICDs)Knowledge and Skills Indicators Date Performance


Anaesthetic aspects of pacemakers and ICDs.Management of patients withpacemakers and ICDs.www.mhra.gov.uk/home/groups/dts-bi/documents/websiteresources/con2023451.pdf

● Discuss the use of pacemakers and implantable defibrillators.

● Discuss the effects diathermy may have on a pacemaker or ICD.

● Discuss the placement of diathermy electrode with regard to pacemaker or ICD.

● Recognise that patients with a demand type pacemaker or defibrillators may require reprogramming prior to surgery.

6.15 Competency Can assist with the positioning of nasogastric tubesKnowledge and Skills Indicators Date Performance


Shows ability to assist with thepositioning of nasogastric tubes inconscious or unconscious patients.

● Discuss the use of gastric tubes.

● Select and prepare an appropriate gastric tube.

● Secure tube in position.

● Attach suitable collection bag.

http://www.mhra.gov.uk/home/groups/dts-bi/documents/websiteresources/con2023451.pdf



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6.16 Competency Can prepare, apply and monitor the use of arterial tourniquet equipmentKnowledge and Skills Indicators Date Performance


Able to safely prepare, apply, andmonitor the use of arterial tourniquetequipment (including exsanguinators).Notifies surgical operator oftourniquet time.

● Select and apply appropriate cuff.

● Use exsanguinator as required.

● Select appropriate pressure for limb.

● Monitor tourniquet pressure.

● Record tourniquet start and finish time.

● Discuss the importance of time limitation.

● Regularly update team regarding tourniquet time.

● Discuss the implications of tourniquet pain in the anaesthetised patient.

● Discuss complications of tourniquets.

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page 74


Section 7 Participation in Intra-operative Patient Care (Including Transfer and Positioning)

7.1 Competency Knows principles of, and participates in, maintaining normothermia in an intra-operative patientKnowledge and Skills Indicators Date Performance


Patients at risk of hypothermia.Principles of heat loss in intra-operativepatient. Strategies for maintainingnormothermia.Implementation of these strategies.Prevention of inadvertent hypothermia.

● Discuss physiology and physical principles of thermoregulation.

● Discuss thermoregulation in relation to anaesthesia and surgery.

● Discuss patient groups at risk of hypothermia.

● Use strategies to maintain normothermia.

● Discuss temperature monitoring.

● Discuss risks and contraindications of patient warming devices.

● Discuss the significance of normothermia to postoperative recovery.

7.2 Competency Understands principles of, and participates in, maintaining fluid balance in an intra-operative patientKnowledge and Skills Indicators Date Performance


The principles of maintaining fluidbalance in intra-operative patient.Demonstrates ability to accuratelyrecord fluid balance, recording of fluidlosses and administration of IV andother fluids. (See 5.11)

● Discuss the physiology relevant to fluid balance.

● Discuss the clinical importance of maintaining fluid balance.

● Record urine output.

● Record administration of IV fluids.

Patient temperature

Fluid balance

page 75


7.3 Competency Can use the operating table and its attachmentsKnowledge and Skills Indicators Date Performance


Understands the features of theoperating table and its attachments,and has the ability to use them correctlyand safely.

● Discuss safety features of the operating table.

● Demonstrate ability to safely move the operating table.

● Identify and use appropriate operating table attachments.

● Return the operating table to a head down or level position in the event of an anaesthetic emergency.

7.4 Competency Knows anatomy relevant to, and shares knowledge of, the risks of patient positioningKnowledge and Skills Indicators Date Performance


Anatomy relevant to patientpositioning.The risks of patient positioning(including eye protection, nerveprotection and cardio-respiratoryconsequences of patient position,prolonged anaesthesia).

● Discuss the management and risks of patient positioning.

● Discuss risk assessment strategies for individual patient positioning.

Moving and handling: the Operating Table, Attachments and Patient Positioning

page 76


7.5 Competency Can position patients safely for surgery, including transfer to the operating table using appropriate equipmentKnowledge and Skills Indicators Date Performance


Able to position patients safely in awide range of positions.Satisfies requirements of movingand handling training (includingregular updates).

● Demonstrate ability to place the patient in a wide range of surgical positions.

● Demonstrate ability to use patient transfer equipment safely and appropriately.

7.6 Competency As part of the perioperative team, can safely return patient to supine or lateral decubitus positionKnowledge and Skills Indicators Date Performance


As part of the perioperative team is ableto safely return patient to supine orlateral decubitus position.

● Demonstrate ability to safely position the patient following surgery.

page 77


Deep Venous Thrombosis Risk / Pressure Area Care The AA has a role to play in pressure area care, should know a risk scoring system and should be able to demonstrate ability to reduce the risk.

7.7 Competency Understands the risks of deep venous thrombosis, the principles of prophylaxis and the equipment involvedKnowledge and Skills Indicators Date Performance


The risks of deep venous thrombosis,the principles of deep venous thrombusprophylaxis, assessment of risk foreach patient and implementation ofstrategies to reduce that risk includingequipment, which may be involved.The risks of compartment syndrome.Prolonged anaesthesia.

● Discuss the physiological process in the formation of a deep vein thrombus (DVT).

● Discuss factors which pre dispose patients to DVT.

● Discuss assessment strategies for DVT risk.

● Discuss the implementation of strategies to reduce the risk of DVT.

● Demonstrate use of equipment for the prevention of DVT.

● Discuss national and local guidelines for prevention of DVT www.sign.ac.uk/guidelines/fulltext/122/index.html

7.8 Competency Able to quantify tissue viability and can implement appropriate strategies to reduce riskKnowledge and Skills Indicators Date Performance


Assesses tissue viability using a currentscoring system. Describes, and implements strategies to reduce that risk. Understands the hospital team’s role in reducing the incidence of post-operative pressure sores in an increasingly elderly population.Increased risks with prolonged anaesthesia.

● Discuss risk factors associated with tissue viability.

● Demonstrate ability to use a tissue viability scoring system.

● Demonstrate ability to implement strategies to protect tissue viability.

http://www.sign.ac.uk/guidelines/fulltext/122/index.html

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● Clinical Supervision ● Literature Reviews ● Skills Lab/Simulator Training


● Documents – guidelines/protocols ● Diaries – learning log ● Critical incident analysis

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8.1 Competency Adheres to approved policies for the secure storage and management of medicines, including controlled drugsKnowledge and Skills Indicators Date Performance


Classes of drugs. Policies for the securestorage and management of medicines.Legal and practical issues relating to themanagement of Controlled Drugs.The AA’s role includes providing drugsto the anaesthetist without any unduedelay, from a registered ‘key holder’ ifrequired.

● Discuss the legal definition of drug classifications.

● Discuss national and local regulations regarding storage and management of medicines.

● Discuss national and local regulations regarding controlled drugs www.nmc-uk.org/Documents/Standards/nmcStandardsForMedicinesManagementBooklet.pdf and www.aagbi.org/sites/default/files/controlleddrugs06_0.pdf

● Discuss the recording of controlled drugs as per local hospital policy.

● Discuss the importance of having drugs immediately available.

● Provide drugs to the anaesthetist without undue delay.

8.2 Competency Understands principles of rotating drug stock to minimise wasteKnowledge and Skills Indicators Date Performance


Drug stock management. ● Discuss the importance of drug stock rotation.

● Adhere to local guidelines for drug storage.

● Discuss the implications of poor drug stock control.

● Demonstrate ability to order drugs.

● Demonstrate ability to receive, record and correctly store drugs.

Underpinning Knowledge

page 80


8.3 Competency Knows the hazards of anaesthetic agent pollutionKnowledge and Skills Indicators Date Performance


The hazards of anaesthetic agentpollution and importance ofscavenging.Routine monitoring of backgroundlevels of anaesthetic agents.Appropriate action in the event ofa spillage. (See also 5.1, 5.2 and 5.7)

● Discuss the risks of exposure to anaesthetic agents.

● Discuss gas scavenging systems.

● Discuss routine monitoring of anaesthetic agent pollution.

● Discuss local guidelines in the event of anaesthetic agent spillage, and know location of relevant spill kit equipment.

8.4 Competency Understands the clinical difference between crystalloids and colloidsKnowledge and Skills Indicators Date Performance


Pathophysiology of body fluidcompartments.Principles of fluid therapy.

● Discuss the pathophysiology of body fluid compartments.

● Discuss practical examples of fluid therapy.

● Discuss differences between crystalloids, colloids and the indications for use.

page 81


8.5 Competency Understands the principles involved in the safe administration of blood and blood products to adult patientsKnowledge and Skills Indicators Date Performance


Blood and blood products: clinicalaspects of therapy, checks, recognitionand management of transfusionreactions and clear documentation.Equipment for administration of bloodproducts. (See 6.7)www.aagbi.org/sites/default/files/bloodtransfusion06.pdf and www.aagbi.org/sites/default/files/red_cell_08.pdf

● Complete education pack for ‘Better Blood Transfusion’ www.learnbloodtransfusion.org.uk

● Demonstrate ability to check blood transfusion products in accordance with BTS and local policy.

● Follow documentation guidelines for blood product administration.

● Discuss blood transfusion thresholds.

● Discuss the importance of close patient monitoring to identify any blood product incompatibility at an early stage.

● Can identify signs of transfusion reaction.

8.6 Competency Can maintain clear, accurate and complete records of drug useKnowledge and Skills Indicators Date Performance


Able to maintain clear, accurate andcomplete records of drug use.

● Discuss guidelines for written records relating to the use of drugs.

● Use NMC / HPC guidelines for drug recording.

General Management of Drugs

http://www.learnbloodtransfusion.org.uk

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8.7 Competency Can calculate dosages and concentrations appropriate for clinical useKnowledge and Skills Indicators Date Performance


Able to calculate dosages andconcentrations appropriate for clinicaluse (as per local policy).The AA may usefully prepare drugs foradministration during emergencies,and must be familiar with safe practice.

● Demonstrate ability to calculate doses and prepare drugs following guidelines.

● Complete local Intravenous Drug administration study day and supervised practice.

● Use NMC / HPC guidelines for drug preparation www.nmc-uk.org/Documents/Standards/nmcStandardsForMedicinesManagementBooklet.pdf

8.8 Competency Understands basic pharmacological principlesKnowledge and Skills Indicators Date Performance


Basic pharmacology, including druginteractions and side effects.The AA must have a workingunderstanding of the pharmacology ofanaesthetic drugs.

● Discuss basic pharmacology of drugs used in anaesthesia.

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8.9 Competency Understands the clinical indications, storage requirements, clinical preparation, labelling and disposal

requirements of drugs relevant to anaesthetic practice

Knowledge and Skills Indicators Date Performance Criterion Achieved

Trainee Assessor

The clinical indications, storagerequirements, clinical preparation,labelling and disposal requirementsof current drugs in the followingcategories: volatile agents; anaestheticgases; intravenous induction agents;opioids; sedatives; suxamethonium;non-depolarising neuromuscularjunction blockers; neuromuscularjunction reversal agents including sugammadex; inotropes; pressor agents; vasodilators; anti-arrhythmics; anti-cholinergics; local anaesthetic agents; non-steroidal analgesics; anti-emetic agents; antacids; bronchodilators; respiratory stimulants;steroids; antibiotics; anticoagulants anddantrolene.

● Discuss local guidelines on the disposal of drugs.

● Demonstrates ability to safely dispose of unused drugs.

● Discuss classification and modes of use of the following drug groups: volatile agents; anaesthetic gases; intravenous induction agents; opioids; sedatives; suxamethonium; non-depolarising neuromuscular junction blockers; neuromuscular junction reversal agents including sugammadex; inotropes; pressor agents; vasodilators; anti-arrhythmics; anti-cholinergics; local anaesthetic agents; non-steroidal analgesics; anti-emetic agents; antacids; bronchodilators; respiratory stimulants; steroids; antibiotics; anticoagulants and dantrolene.

● Discuss national and local recommendations for drug / syringe labelling www.aagbi.org/sites/default/files/syringelabels(june)04.pdf and www.aagbi.org/sites/default/files/syringelabels03.pdf

http://www.aagbi.org/sites/default/files/syringelabels(june)04.pdf

page 84


Equipment associated with Drug Delivery

8.10 Competency Understands the principles of target controlled infusion anaesthesia and sedationKnowledge and Skills Indicators Date Performance


Principles of target controlled infusionalanaesthesia and sedation. Programming is responsibility of anaesthetist.

● Discuss the principles of target controlled infusion (TCI) anaesthesia and sedation. (See also 8.9)

● Discuss the advantages and disadvantages of this technique.

8.11 Competency Able to set up and manage target controlled infusion equipmentKnowledge and Skills Indicators Date Performance


Able to set up target controlled infusionequipment. Aware of safety features.

● Identify and prepare TCI equipment.

8.12 Competency Understands the principles of patient controlled analgesia (PCA)Knowledge and Skills Indicators Date Performance


Opioid pharmacology with respectto patient controlled analgesia,monitoring, hazards.

● Discuss the pharmacology of drugs used for PCA.

● Discuss monitoring of patients using PCA.

● Discuss NMC / HPC and National guidelines in maintaining written records relating to PCA.

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8.13 Competency Can set up patient controlled analgesia equipmentKnowledge and Skills Indicators Date Performance


Able to set up patient controlledanalgesia equipment, includingdocumentation. Aware of safetyfeatures. Responsibility for settingdosage, infusion rates and lockoutperiod lies with the anaesthetist.

● Discuss safety features of PCA equipment.

● Prepare PCA equipment following local guidelines.

8.14 Competency Can set up equipment to deliver nebulised drugsKnowledge and Skills Indicators Date Performance


Able to set up equipment to delivernebulised drugs (e.g. bronchodilators).

● Prepare equipment to deliver nebulised drugs.

8.15 Competency Can set up equipment for epidural infusionKnowledge and Skills Indicators Date Performance


Able to set up equipment designed todeliver drugs by epidural infusion.Aware of safety features.Knowledge of national guidelines for management of epidural infusions in the hospital setting.

● Discuss safety features of equipment for epidural infusion.

● Prepare equipment for epidural infusion.

● Use guidelines for the use of epidural infusion equipment.

● Discuss Association of Anaesthetists Guideline on Best Practice at www.aagbi.org/sites/default/files/epidural_analgesia_2011.pdf

http://www.aagbi.org/sites/default/files/epidural_analgesia_2011.pdf

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9.1 Competency Can handover a patient in recovery, summarising relevant clinical features of the patient’s

pre- and intra-operative careKnowledge and Skills Indicators Date Performance


Effectively communicates all relevantdetails to the recovery staff.

● Demonstrate ability to prioritise information and communicate to the recovery staff.

9.2 Competency Can systematically assess the patient in recovery using the ABC headings and appropriate monitoringKnowledge and Skills Indicators Date Performance


Can assess a patient with respectto: airway adequacy, respiratorysufficiency, and cardiovascular function.Can summarise the assessment.

● Prepare recovery area for patients’ arrival.

● Discuss common postoperative complications.

● Demonstrates ability to support and maintain the patients’ airway in the immediate postoperative period.

● Establish oxygen therapy.

● Apply routine monitoring and interpret values.

● Chart accurately using standard symbols and recognise significant trends.

● Describe patients’ condition to the anaesthetist.

● Assess patient for signs of surgical complications.

● Discuss national and local recovery guidelines www.aagbi.org/sites/default/files/postanaes02.pdf (under review) and www.sign.ac.uk/guidelines/fulltext/77/index.html

Routine Care of the Post-operative Patient

page 88


9.3 Competency Can assess post-operative painKnowledge and Skills Indicators Date Performance


Demonstrates ability to assess thenature and severity of post-operativepain. (See 3.7)

● Discuss physiology of acute pain.

● Use pain assessment tools.

● Discuss strategies for managing postoperative pain.

● Discuss national and local pain guidelines.

9.4 Competency Can assess post-operative nausea and vomitingKnowledge and Skills Indicators Date Performance


Demonstrates ability to assess post-operative nausea and vomitingand arrange appropriate action inadherence with local protocols.

● Recognise signs of nausea.

● Record nausea score.

● Initiate treatment in the event of nausea or vomiting.

● Record accurate fluid balance.

● Discuss national and local post operative nausea and vomiting guidelines.

page 89


9.5 Competency Understands the important conditions which must be met before a patient can be discharged

on the day of anaesthesiaKnowledge and Skills Indicators Date Performance


Knows the medical and social factorsinvolved in the early discharge ofpatients who have had general or localanaesthesia.

● Discuss criteria for safe discharge on the day of anaesthesia.

● Discuss the content and importance of discharge instructions.

● Follow local guidelines for discharge medication and documentation.

● Discuss the factors that may prevent the patient going home on day of surgery.

● Discuss national and local early discharge from recovery guidelines www.onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2011.06651.x/pdf

9.6 Competency Can insert an oropharyngeal airway when indicated and confirm its effectivenessKnowledge and Skills Indicators Date Performance


Recognises the indications forinsertion of an oropharyngeal airway.Able to insert it safely, and confirm itseffectiveness.

● Discuss signs of upper airway obstruction.

● Recognise upper airway obstruction.

● Demonstrate ability to maintain patients’ airway.

● Select and insert an oropharangeal airway and confirm its effectiveness.

page 90


9.7 Competency Can remove a laryngeal mask airwayKnowledge and Skills Indicators Date Performance


Able to remove laryngeal maskairway safely.

● Discuss principles of safe removal of a LMA.

● Demonstrate ability to remove a LMA.

9.8 Competency Can assist in the removal of endotracheal tubeKnowledge and Skills Indicators Date Performance


Understands the principles of safeendotracheal tube removal and canassist in endotracheal tube removal.Is aware of extubation guidelines for patients with difficult intubations

● Discuss principles of safe removal of an ET tube.

● Demonstrate ability to remove an ET tube according to local protocol.

● Discuss the extubation guidelines from the Difficult Airway Society www.das.uk.com/content/das-extubation-guidelines

http://www.das.uk.com/content/das-extubation-guidelines

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page 92


Section 10 Involvement in Emergency Management

Role of AA in emergenciesEmergencies can occur during the conduct of anaesthesia. The anaesthetist may need the AA to recognise and respond to a rapidly changing situation. The anaesthetist may ask the AA to get help or it is possible that the anaesthetist may be taken ill while caring for a patient. Skilled help must be called for without delay, and the AA may be required to manage the situation until help arrives.

The AA must also familiarise themselves with the surgical emergencies that are likely to present for surgery in the specialties in which they work. The nature of these may have great significance for the anaesthetic techniques employed and appropriate monitoring.

10.1 Competency Knows how to contact senior anaesthetic staff for assistanceKnowledge and Skills Indicators Date Performance


Knows how to contact senior anaesthetic staff for assistance.

● Discuss how to contact appropriate senior nursing / anaesthetic / medical help.

10.2 Competency Understands the principles of managing the shocked patientKnowledge and Skills Indicators Date Performance


Types of shock, grades of shock, theirsignificance, and the principles ofmanaging them.Anaphylactic Shock Managementguidelines published by the Associationof Anaesthetists.

● Discuss types of shock.

● Recognises the significance and implications of shock.

● Discuss the principles for managing shock.

● Discuss Association of Anaesthetist guidelines for Anaphylaxis www.aagbi.org/sites/default/files/ana_web_laminate_final.pdf

Knowledge of Relevant Emergency Conditions

page 93


10.3 Competency Understands management of: cyanosis, stridor / laryngeal spasm, bronchospasm, cardiac dysrhythmias,

pneumothorax, masseter muscle spasmKnowledge and Skills Indicators Date Performance


The significance, possible causes of, and management of: cyanosis; stridor / laryngeal spasm; bronchospasm; cardiac dysrhythmias; pneumothorax; masseter muscle spasm.

● Discuss causes of cyanosis.

● Discuss causes and management of stridor.

● Discuss causes and management of bronchospasm.

● Discuss causes and management of pneumothorax.

● Discuss causes and management of cardiac dysrhthmias.

● Discuss the significance of masseter muscle spasm.

10.4 Competency Can implement local protocol for management of sudden life-threatening haemorrhageKnowledge and Skills Indicators Date Performance


Local protocol for management ofsudden life-threatening haemorrhageincluding use of rapid infusors/warmersand cell salvage where available.

● Discuss the principles for managing haemorrhage.

● Demonstrate ability to source equipment and drugs to manage haemorrhage. (See also 7.2, 5.11)

● Discuss national / local guidelines for management of haemorrhage www.aagbi.org/sites/default/files/massive_haemorrhage_2010_0.pdf www.aagbi.org/sites/default/files/cell%20_salvage_2009_amended.pdf

http://www.aagbi.org/sites/default/files/massive_haemorrhage_2010_0.pdf

http://www.aagbi.org/sites/default/files/cell%20_salvage_2009_amended.pdf

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10.5 Competency Can describe detailed management of patient with latex allergyKnowledge and Skills Indicators Date Performance


Pathophysiology and clinicalmanagement of latex allergy.Setting up a tray with equipment thatis safe for use in patients with latexallergy.Local protocols for management ofthese patients.

● Discusses pathophysiology of latex allergy.

● Discuss risk factors.

● Discuss management of latex allergy.

● Demonstrate ability to source latex free equipment and drugs required to treat patient.

● Demonstrate ability to implement national / local guidelines for management of latex allergy www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Product-specificinformationandadvice-G-L/Latexreactions(allergies)andmedicaldevices/index.htm and www.nrls.npsa.nhs.uk/resources/?entryid45=59791

http://www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Product-specificinformationandadvice-G-L/Latexreactions(allergies)andmedicaldevices/index.htm




http://www.nrls.npsa.nhs.uk/resources/?entryid45=59791

page 95


10.6 Competency Understands Malignant HyperpyrexiaKnowledge and Skills Indicators Date Performance


The clinical features and principlesof patient management in malignanthyperpyrexia.Guidelines published by the Associationof Anaesthetists.Adheres to local protocols.Knows location of dantrolene, ice andlocal policy for obtaining more stocksas needed.

● Discuss malignant hyperpyrexia (MH). ● Awareness that masseter muscle spasm may be first clinical indication of MH. ● Discuss the management of MH. ● Discuss the complications of MH. ● Discuss national / local guidelines for management of Malignant Hyperpyrexia www.aagbi.org/sites/default/files/MH%20task%20allocations%20for%20web.pdf and www.aagbi.org/sites/default/files/MH%20guideline%20for%20web%20v2.pdf and www.aagbi.org/sites/default/files/MH%20recommended%20contents%20for%20web.pdf

● Demonstrate ability to source equipment and drugs.

● Utilise risk management strategies for a known MH patient coming to theatre.

10.7 Competency Can perform Immediate Life SupportKnowledge and Skills Indicators Date Performance


Can perform Immediate Life Support.Attendance at local course: ILSResuscitation Council (UK).Knows local protocols for access anduse of defibrillators and support.

● Complete ILS/equivalent local training programme and yearly updates.

● Discuss national guidelines for immediate life support www.resus.org.uk/pages/guide.htm

● Demonstrate ability to perform immediate life support.

● Discuss local guidelines regarding use of defibrillators.

http://www.aagbi.org/sites/default/files/MH%20task%20allocations%20for%20web.pdf

http://www.aagbi.org/sites/default/files/MH%20task%20allocations%20for%20web.pdf

http://www.aagbi.org/sites/default/files/MH%20guideline%20for%20web%20v2.pdf

http://www.aagbi.org/sites/default/files/MH%20guideline%20for%20web%20v2.pdf

http://www.aagbi.org/sites/default/files/MH%20recommended%20contents%20for%20web.pdf

http://www.aagbi.org/sites/default/files/MH%20recommended%20contents%20for%20web.pdf

http://www.resus.org.uk/pages/guide.htm

page 96


10.8 Competency Can set up an underwater drain for the treatment of pneumothoraxKnowledge and Skills Indicators Date Performance


Able to set up an underwater drain(or flutter valve) for the treatment ofpneumothorax.

● Prepare and assemble all equipment required for chest drain insertion and intrapleural draningage

10.9 Competency Knows how to recognise a clinical incident or near miss and follow local reporting mechanismsKnowledge and Skills Indicators Date Performance


Critical incidents: definition, action,worked examples.

● Discuss definition and provide examples of critical incidents.

● Demonstrate ability to follow local reporting procedures.

● Discuss importance of informing/updating line manager.

● Discuss the role of agencies supplying hazard / incident notifications to NHSScotland www.hfs.scot.nhs.uk/online-services/incident-reporting-and-investigation-centre-iric/

page 97


10.10 Competency Understands importance of being familiar with specialism specific emergency conditions and has a

systematic approach to thisKnowledge and Skills Indicators Date Performance


A systematic approach to developinga good working understanding of themanagement of important problemsspecific to the specialties in which theAA practices (e.g.penetrating eye-injury surgery; orthopaedic cementhypotension; TURP syndrome).

● Discuss the unique challenges that individual surgical specialities can present for anaesthesia. See also specialty-specific competencies in Part B

10.11 Competency Can describe the principles of safe transfer of patients for investigations or treatment within the hospitalKnowledge and Skills Indicators Date Performance


The principles of adult patientpreparation and stabilisation prior totransfer. (See also 20.1)

● Demonstrate the ability to prepare for and transfer an adult patient within the hospital. www.aagbi.org/sites/default/files/interhospital09.pdf

● Discuss the importance of airway equipment during transfer.

● Discuss the importance of monitoring equipment during transfer.

● Discuss drugs applicable to transfer.

● Discuss the importance of co-ordination of transfer between portering staff, other department /unit staff, etc

http://www.aagbi.org/sites/default/files/interhospital09.pdf

page 98


10.12 Competency Can assist the anaesthetist in the management of an emergency thoractomyKnowledge and Skills Indicators Date Performance


The use and placement of double lumen tubes and anaesthetic aspects of one lung anaesthesia. (See also 14.1 and 14.3)

● Discuss the pathophysiology of one lung anaesthesia

● Discuss the management of one lung anaesthesia

● Discuss the types of tubes and blockers used for lung isolation.

● Demonstrate ability to assist the anaesthetist to check the position of a double lumen tube

● Discuss the management of hypoxia during one lung ventilation

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page 100


Notes

page 102

To practise independently, AAs must have all of the knowledge and skills described in Part A. In addition, they must have all of the knowledge and skills described in Part B, which apply to specialities in which they practise.

An AA who does not possess the appropriate Part B knowledge base and competencies for a speciality must be supervised when working in that speciality.

Section 11 Obstetrics

11.1 Competency Awareness of physiological effects of pregnancy and labourKnowledge and Skills Indicators Date Performance


Physiological effects during pregnancy and labour with particular reference to cardiorespiratory changes. Basic lifesupport in the pregnant patient.

● Describe normal labour and delivery.

● Discuss the common complications of pregnancy.

● Discuss the physiological changes in pregnancy.

● BLS in the pregnant patient.

Portfolio of Core Competencies for Anaesthetic Assistants Part B: Specialism Specific Competencies

page 103


11.2 Competency Analgesia in LabourKnowledge and Skills Indicators Date Performance


Effects of epidurals, systemic and epidural opioids, equanox (Entonox) analgesia, PCA and PCEA and use of 15° lateral wedge.

● Discuss techniques for analgesia in labour.

● Demonstrate competency in relation to epidural / spinal anaesthesia as defined in Section 3. (See 3.7, 3.8, 3.9)

● Discuss the management of an epidural in labour and its complications.

● Discuss local guidelines regarding epidural in labour.

● Demonstrate competency in relation to the use of controlled drugs as defined in Section 8. (See 8.1, 8.6, 8.7, 8.8, 8.9)

● Discuss the systemic, epidural and spinal effects of opioids.

● Discuss equanox and its use in labour.

● Discuss local hospital guidelines regarding the use and administration of equanox.

● Discuss the use of PCA and PCEA (See 8.13 and 8.15)

● Demonstrate and discuss the principles of reducing pressure from the pregnant uterus on the inferior vena cava.

page 104


11.3 Competency Antacid prophylaxis in the pregnant patient and drugs acting on the uterusKnowledge and Skills Indicators Date Performance


Pharmacology and physiology of drugsin the pregnant patient, includingantacid prophylaxis, clinicalpharmacology of oxytocic, tocolytic and vasopressor drugs.

● Demonstrate competency in relation to the use of drugs as defined in

● Section 8 specific to obstetrics. (See 8.8, 8.9)

● Discuss antacid prophylaxis.

● Identify and discuss any local guideline / protocol for the use of antacids.

● Discuss the pharmacological action of oxytocic drugs.

● Identify and discuss any local guideline / protocol for the use of oxytocic drugs.

● Discuss the pharmacological action of tocolytic drugs.

● Identify and discuss any local guideline / protocol for the use of tocolytic drugs.

● Discuss the pharmacological action of vasopressor drugs

● Identify and discuss any local guideline / protocol for the use of vasopressor drugs.

11.4 Competency Obstetric operative delivery under spinal, epidural and combine spinal epidural anaesthesiaKnowledge and Skills Indicators Date Performance


Anaesthetic aspects of obstetric operative delivery under spinal, epidural or combined spinal epidural anaesthesia. Anaesthesia for forceps / ventouse assisted delivery. Use of 15° lateral wedge in operative delivery.

● Demonstrate competency in relation to spinal, epidural or combined spinal epidural anaesthesia as defined in Section 3. (See 3.7, 3.8, 3.9)

● Discuss management of spinal, epidural or combined spinal epidural anaesthesia

● For lower section Caesarean section (LSCS) and operative delivery.

● Discuss anaesthetic complications and their management.

page 105


11.5 Competency Obstetric operative delivery under general anaesthesia including rapid sequence inductionKnowledge and Skills Indicators Date Performance


Anaesthetic aspects of obstetricoperative delivery under generalanaesthesia. Knowledge of rapid sequence induction. Awareness of increased incidence of failed intubation and knowledge of specific equipment used in obstetric practice.

● Discuss patient care issues as detailed in Section 2 in relation to obstetric surgery. (See 2.2, 2.3, 2.4)

● Participates in Rapid Sequence Induction.

● Discuss risk of regurgitation and its management.

● Discuss use of muscle relaxants in the obstetric patient.

● Can set up difficult intubation trolley (See 4.9)

● Knows protocol for unexpected difficult intubation and failed intubation drill (See 4.10)

11.6 Competency Indications for urgent deliveryKnowledge and Skills Indicators Date Performance


Indications for urgent deliveryincluding foetal distress, antepartumhaemorrhage, prolapsed cord andmalpresentation. Knowledge of classification of urgent delivery (I-IV) and importance of decision to delivery time.

● Discuss indications for urgent delivery.

● Demonstrate ability to prepare for obstetric emergency. (See Common Theme 2, 10.1).

● Discuss foetal distress and its implications.

● Discuss antepartum haemorrhage.

● Discuss prolapsed cord and malpresentation.

● Discuss classification of urgent delivery and relevance of decision to delivery time

page 106


11.7 Competency Pregnancy induced hypertension /eclampsiaKnowledge and Skills Indicators Date Performance


Anaesthetic aspects of pregnancyinduced hypertension / eclampsia.

● Discuss pregnancy induced hypertension /eclampsia their implications and management.

11.8 Competency Management of obstetric haemorrhageKnowledge and Skills Indicators Date Performance


Local protocol for management of sudden life threatening major obstetric haemorrhage including the use of invasive monitoring, rapid infusion devices, warming devices and cell salvage equipment when available.

● Can implement local protocol for management of sudden life-threatening haemorrhage (See 10.4)

11.9 Competency Anaesthesia for other obstetric interventions such as cervical suture insertion, management of 3rd and 4th

degree tears, evacuation of vulval haematoma and manual removal of placenta.Knowledge and Skills Indicators Date Performance


Anaesthetic management for other obstetric inverventions using epidural, spinal or general anaesthetic techniques.

● Discuss indications for spinal, epidural and general anaesthesia for common obstetric interventions

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page 108


Section 12 ENT

12.1 Competency Can describe the anaesthetic management of the shared airway including the surgical use of lasersKnowledge and Skills Indicators Date Performance


The anaesthetic management of theshared airway. Awareness of shared airway techniques used locally. Surgical use of lasers (See Section 5.13)

● Discuss the anatomy and physiology relevant to ENT anaesthesia.

● Demonstrate ability to set up and prepare anaesthetic room for ENT procedures.

● Discuss importance of airway protection where the airway is shared by both surgeon and anaesthetist.

● Discuss endotracheal tubes commonly used in ENT including NIM® tubes for thyroid surgery.

● Discuss use of throat pack.

● Discuss contamination of the shared airway.

● Discuss the use of LASER in the airway.

● Discuss types of tubes used in LASER surgery.

● Demonstrate ability to support and clear patient’s airway following ENT procedures.

12.2 Competency Can describe the features, mode of use and complications associated with the Boyle-Davis gagKnowledge and Skills Indicators Date Performance


Features, mode of use, andcomplications associated with theBoyle-Davis gag.

● Discuss features and use of the Boyle-Davis gag.

● Can describe the anaesthetic management of tonsillectomy, including the use of the Boyle Davis gag and the vCJD infection risk

page 109


12.3 Competency Can describe the anaesthetic management of tracheostomy, including the features of cuffed / uncuffed

tracheostomy tubesKnowledge and Skills Indicators Date Performance


The anaesthetic management oftracheostomy, including the features ofcuffed / uncuffed tracheostomy tubes.

● Discuss the anaesthetic management of a patient undergoing tracheostomy.

● Discuss the main features of tracheostomy tubes and their uses.

12.4 Competency Can describe the anaesthetic aspects of laryngeal surgery, including Montandon tubesKnowledge and Skills Indicators Date Performance


Laryngectomy resections, neck dissections and Montandon tubes.

● Discuss the anaesthetic challenges of laryngeal surgery.

● Demonstrate competency in relation to airway management as defined in

● Section 4 specific to laryngectomy. (See 4.6, 4.10, 4.13, 4.14)

● Discuss challenges of changing tubes.

● Discuss the management of patients with supraglottic, glottic and infraglottic lesions including those causing airway obstruction.

page 110


12.5 Competency Can set up equipment for minor laryngeal surgery (laryngoscopy and biopsy)Knowledge and Skills Indicators Date Performance


Able to set up equipment for laryngoscopy and biopsy. Understands the features of this equipment

● Discuss Microlaryngeal tubes.

● Demonstrate ability to set up and check equipment

● Discuss ventilation during bronchoscopy and laryngoscopy

12.6 Competency Can describe anaesthetic aspects of middle-ear and endoscopic sinus surgeryKnowledge and Skills Indicators Date Performance


Anaesthetic aspects of middle-ear surgery and endoscopic sinus surgery.

● Discuss anaesthetic aspects of middle-ear surgery including induced hypotension and eye protection

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page 112


Section 13 Cardiac

13.1 Competency Knows anaesthetic aspects of cardio-pulmonary bypassKnowledge and Skills Indicators Date Performance


Anaesthetic aspects ofcardio-pulmonary bypass.

● Discuss the clinical principles for cardio-pulmonary bypass.

● Discuss the role of the anaesthetist and anaesthetic assistant in procedures requiring bypass.

● Discuss role of cardiac pump technician in bypass procedure.

● Discuss patient care issues as detailed in Section 2. (See 2.2, 2.3, 2.4) in relation to cardiac surgery and cardio-pulmonary bypass.

13.2 Competency Describe the therapeutic/diagnostic techniques used where applicable, e.g. transoesophageal

echocardiography, intra-aortic balloon counterpulsation therapyKnowledge and Skills Indicators Date Performance


Principles of therapeutic / diagnostic techniques.

● Discuss the indications for and the use of transoesophageal echocardiography

● Discuss the indications for and the use of aortic balloon counterpulsation therapy.

page 113


13.3 Competency Can describe the features and management of major arrhythmiasKnowledge and Skills Indicators Date Performance


The features and management of majorarrhythmias.

● Demonstrate ability to recognise sinus rhythm and common arrhythmias.

● Discuss management of common arrhythmias.

13.4 Competency Can describe invasive monitoring for cardiac surgeryKnowledge and Skills Indicators Date Performance


Principles of invasive monitoring forcardiac surgery. Select appropriatetype/size of device in relation topatient’s condition and medical needs.

● Demonstrate ability to position patient correctly and support as appropriate throughout procedure.

● Demonstrate ability to remove failed device, apply pressure over puncture

● site and apply dressing if required. (See Competency 3.4)

page 114


13.5 Competency Can describe the principles of anticoagulation during cardiac surgery, including monitoring and reversalKnowledge and Skills Indicators Date Performance


The principles of anticoagulation duringcardiac surgery, including monitoringand reversal.

● Discuss importance of anticoagulation during surgery.

● Discuss normal and optimal activated clotting times (ACT).

● Discuss the importance for regular monitoring of the ACT and subsequent requirement for additional heparin if required.

● Discuss the importance of pH, oxygenation and restoration of normal temperature to ensuring successful restart of the heart to sinus rhythm.

13.6 Competency Can outline anaesthetic aspects CAVG, valve surgery and transplant surgeryKnowledge and Skills Indicators Date Performance


Anaesthetic aspects of CAVG, valvesurgery, transplant surgery.

● Discuss the anaesthetic aspects of CAVG, valve surgery and transplant surgery.

● Discuss the premedication, induction, maintenance, restoration of heartbeat and termination of bypass in surgery requiring bypass.

● Discuss the postoperative management of cardiac patients.

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page 116


Section 14 Thoracic

14.1 Competency Can describe anaesthetic aspects of one lung anaesthesiaKnowledge and Skills Indicators Date Performance


Anaesthetic aspects of one-lunganaesthesia.

● Discuss the pathophysiology of one lung anaesthesia.

● Discuss the management of one lung anaesthesia.

● Discuss patient care issues as in relation to thoracic surgery and one lung anaesthesia. (See 2.2, 2.3, 2.4)

● Discuss the types of tubes used for lung isolation.

● Demonstrate ability to assist the anaesthetist to check the position of a double lumen tube.

● Discuss the management of hypoxia during one lung ventilation.

14.2 Competency Can describe anaesthetic aspects of thoracic analgesia, e.g. epidural, paravertebral and intercostal blocksKnowledge and Skills Indicators Date Performance


Anaesthetic aspects of thoracicanalgesia.

● Discuss thoracic analgesia.

● Demonstrate competency in relation to thoracic analgesia management. (See 3.7, 3.8 and 3.9)

page 117


14.3 Competency Can identify and describe the features of a variety of commonly used double-lumen tubes and specialist

equipment required for endobronchial intubationKnowledge and Skills Indicators Date Performance


Is able to identify, and describe the features of a variety of commonly used double lumen tubes and other specialist equipment

● Select and prepare a suitable double lumen tube.

● Discuss and describe the features of double lumen tubes and methods of checking position

● Select and prepare a suitable bronchial blocker

● Discuss and describe the features of a bronchial blocker and their use.

14.4 Competency Describe techniques and equipment required for minor thoracic surgery, e.g. rigid bronchoscopyKnowledge and Skills Indicators Date Performance


Implications of undertaking minorthoracic surgery such as venturiprinciple, mode of ventilation andabsence of airway monitoring.

● Discuss bronchoscopy.

● Discuss thoroscopy.

● Discuss mediastinoscopy.

● Discuss ventilation during rigid bronchoscopy.

● Discuss venturi principle in relation to ventilation.

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page 119


Section 15 Neurosurgery

15.1 Competency Can describe principles involved in raised ICP managementKnowledge and Skills Indicators Date Performance


Principles involved in raised ICPmanagement.

● Discuss anatomy and physiology of central nervous system.

● Discuss the pathophysiology of intracranial pressure control

● Discuss the management of raised intracranial pressure.

● Discuss patient care issues in relation to neurosurgery. (See 2.2, 2.3, 2.4)

15.2 Competency Can describe the prevention of secondary injury to the brainKnowledge and Skills Indicators Date Performance


Strategies for the prevention ofsecondary injury to brain.

● Discuss the anaesthetic management required for a patient with raised ICP.

● Discuss the role of Intensive Care Unit (ICU) in management of raised ICP

● Discuss the clinical principles of prevention of secondary injury to the brain

● Discuss the role of Intensive Care Unit (ICU) in longer-term management of secondary brain injury

page 120


15.3 Competency Can describe anaesthetic issues relevant to intracranial surgeryKnowledge and Skills Indicators Date Performance


Knowledge of basic neuroanaesthetic techniques and strategies in the management of possible complications during neurosurgery.

● Discuss options for anaesthetic technique and rationale for choice and its influence on cerebral physiology .

● Discuss the use of invasive monitoring and additional monitoring that may be required e.g. facial nerve monitor, depth of anaesthesia monitor

● Discuss the risk of air embolism, its diagnosis and management

● Discuss specific patient positioning issues relevant to neurosurgery – sitting, semis-sitting, park bench and prone

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page 122


Section 16 Paediatrics

16.1 Competency Understands paediatric aspects of airway managementKnowledge and Skills Indicators Date Performance


Management of the Difficult PaediatricAirway. Clinical management, protocolsand guidelines relating to paediatricairway management.

● Demonstrate competency in relation to the management of the paediatric airway as defined in Section 4 across a range of age groups. (See 4.1– 4.12, 4.14, 4.16, 4.17)

● Discuss national and local protocols / guidelines relating to paediatric airway management

– www.resus.org.uk/pages/PCAequip.htm– www.nda.ox.ac.uk/wfsa/html/u10/u1007_01.htm ● Has completed Paediatric Advanced Life Support (PALS).

16.2 Competency Understands paediatric aspects of anaesthetic machineKnowledge and Skills Indicators Date Performance


Understands the principles of use of:the Ayres T-Piece. Understands thefeatures of, and principles of use of,paediatric ventilators.

● Discuss principles, features and uses for the Ayres T-Piece circuit www.nda.ox.ac.uk/wfsa/html/u08/u08_008.htm

● Discuss features required on a ventilator in order to safely and effectively ventilate a child.

● Discuss the principles of use for paediatric ventilators.

Paediatric anaesthesia differs from adult anaesthesia in many ways and is a major anaesthetic sub-specialty. Many of the competencies in Part A include paediatric aspects – which all anaesthetic assistants must know. This section includes specific competencies which are required for assistance of the paediatric anaesthetist.

http://www.resus.org.uk/pages/PCAequip.htm

http://www.nda.ox.ac.uk/wfsa/html/u10/u1007_01.htm

http://www.nda.ox.ac.uk/wfsa/html/u08/u08_008.htm

page 123


16.3 Competency Understands paediatric aspects of monitoring (including patient temperature)Knowledge and Skills Indicators Date Performance


Can select appropriate sized appliedparts (e.g. blood-pressure cuffs).Can set up, and understandsclinical reasons for, oesophagealor precordial stethoscopes. Knowsnormal monitoring values in paediatricpatients of different ages. Candescribe techniques for maintainingnormothermia in neonates.

● Select appropriately sized applied apparatus taking notice of child’s age / physical size.

● Discuss the clinical need for temperature monitoring and maintenance in children.

● Select appropriately sized oesophageal or precordial stethoscope.

● Discuss normal monitoring parameters in children of different ages.

● Demonstrate ability to ensure normothermia in neonates.

16.4 Competency Understands clinical aspects of fluid management in paediatric patientsKnowledge and Skills Indicators Date Performance


Use of burettes. Risk of over-transfusion.Routine anti-hypoglycaemic fluidregimes.

● Demonstrate the correct use of locally available burette systems.

● Discuss risks associated with over transfusion.

● Discuss why all paediatric intravenous fluids need to contain a minimum of 5% glucose.

● Discuss why hypoglycaemia is problematic in children.

page 124


16.5 Competency Understands anaesthetic aspects of specific neonatal surgical emergency conditionsKnowledge and Skills Indicators Date Performance


Can describe basic principles ofmanagement of neonatal emergencies(including Pyloric Stenosis, tracheo-oesophageal fistula and exomphalos).

● Discuss the need for prompt surgical intervention in a variety of neonatal emergencies.

● Discuss the potential complications involved in delayed surgical intervention of neonatal emergencies.

● Demonstrate ability to assist the anaesthetist in optimising the patient’s condition prior to surgery.

16.6 Competency Can set up equipment for paediatric bronchoscopy/microlaryngoscopyKnowledge and Skills Indicators Date Performance


Able to set up equipment for paediatricbronchoscopy. Understands thefeatures of this equipment.

● Demonstrate ability to set up and check equipment.

● Discuss ventilation during bronchoscopy.

● Discuss microlaryngoscopy and microlaryngeal tubes.

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Section 17 Anaesthesia in Remote Locations (Interventional Radiology (a) and ECT (b))

17.1 Competency Can describe the problems associated with anaesthesia in an isolated siteKnowledge and Skills Indicators Date Performance


The problems associated withanaesthesia in an isolated site.

● Discuss national and local guidelines for the provision of anaesthesia in remote sites www.rcoa.ac.uk/node/766

● Discuss the need to ensure remote sites are adequately equipped.

● Demonstrate the ability to prepare for anaesthesia in a remote site.

● Discuss importance of local orientation of staff to remote site areas.

● Discuss storage, provision and management of drugs in remote site areas.

● Demonstrate knowledge of local procedure for summoning assistance.

17.2 Competency Can describe the difficulties of perioperative care in isolated sitesKnowledge and Skills Indicators Date Performance


The problems associated with perioperative care in an isolated site.

● Discuss safe transfer of patients to, within and from isolated sites. (See Section 20)

● Discuss the provision of waiting facilities for patients transferred to isolated sites.

● Discuss the provision of recovery facilities in isolated sites.

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17.3 Competency Aware of increased risk to patient in remote areas with regard to oxygen supplyKnowledge and Skills Indicators Date Performance


Aware of use of oxygen providedby cylinders alone in the absence ofpipeline supply. Understand necessity for immediate back-up supply of oxygen.

● Discuss potential risks associated with cylinder only oxygen supply.

● Discuss the use of cylinder oxygen and oxygen gas pressures indicating volume remaining.

● Demonstrate awareness regarding location of back up oxygen supply.

17.4 Competency Can describe the principles of anaesthesia for MRI imagingKnowledge and Skills Indicators Date Performance


The principles of anaesthesiafor MRI imaging. Guidelines for anaesthesia in MRI units from AAGBI.

● Discuss national and local guidelines for the provision of anaesthesia in MRI suites www.aagbi.org/sites/default/files/magnetic_resonance_unit_2010.pdf

● Discuss the need for restricted access and specific training for personnel working in the MRI suite.

● Complete local training regarding MRI safety procedures.

● Discuss rationale for restriction on magnetic objects in the scanner room.

● Discuss the requirement to utilise MRI compliant monitoring and its limitations.

● Discuss the implications that poor access to the patient may present.

● Comply with local workplace precautions and safe systems of work

http://www.aagbi.org/sites/default/files/magnetic_resonance_unit_2010.pdf

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17.5 Competency Can describe principles of safety during X-ray proceduresKnowledge and Skills Indicators Date Performance


The principles of safety during X-rayprocedures.

● Discuss national and local guidelines for safety during X-ray/CT procedures www.hse.gov.uk/radiation/ionising/index.htm Discuss types of procedure undertaken under anaesthesia in radiology department.

● Discuss the implications that poor access to the patient may present.

● Comply with local workplace precautions and safe systems of work.

● Understands principles of safe sedation and monitoring during procedures in X-ray department. (See 3.5 and 3.6)

17.6 Competency Is aware of the Mental Health (Care and Treatment) (Scotland) Act 2008Knowledge and Skills Indicators Date Performance


Voluntary patient, consenting.Detained patient, consenting.Detained patient, not consenting.Ability to treat once with ECT under theAct as an emergency. Aware of patientsrights when incapacitated or detained.www.scotland.gov.uk/Publications/2008/09/24090333/0

● Discuss issues of consent.

● Discuss patient’s rights.

● Respect patient confidentiality.

● Discuss potential for physical violence due to psychosis.

This section has been added to reflect the unique challenges of anaesthesia for ECT, which in many regions is performed away from the main theatre areas and therefore additional backup. It is considered good practice to obtain two Psychiatrists’ opinions pending opinion of Psychiatrist from the Mental Welfare Commission.

http://www.hse.gov.uk/radiation/ionising/index.htm



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17.7 Competency Understands the physical risks for a patient receiving ECTKnowledge and Skills Indicators Date Performance


Aware of risks of ECT to tongue, lipsand teeth, neck, vertebrae and limbs.

● Discuss risk to dentition and use of bite guard during masseter spasm on electrical stimulus.

● Discuss the need to support neck and jaw during stimulus and gentle restraint of upper and lower limbs.

● Discuss the need for muscle relaxation and general anaesthesia.

17.8 Competency Understands physiological response to ECT treatmentKnowledge and Skills Indicators Date Performance


Aware of autonomic effects of ECT onblood pressure and heart rate.Aware of requirement to have atropine,glycopyrrolate and short acting betablocker drugs available.

● Discuss physiological response to ECT stimulus.

● Discuss possible arrhythmias that may result from ECT.

● Discuss drugs utilised in ECT.

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17.9 Competency Demonstrate awareness of Scottish ECT Accreditation Standards (SEAN)Knowledge and Skills Indicators Date Performance


Aware of Scottish ECT AccreditationNetwork (SEAN) Standards.

● Discuss the SEAN standards and understand their importance particularly when working in a remote site in a Psychiatric Hospital without General

● Hospital back-up. www.sean.org.uk

http://www.sean.org.uk

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Section 18 Maxillo-facial Surgery

18.1 Competency Knows relevant anaesthetic aspects of facial injury surgeryKnowledge and Skills Indicators Date Performance


Anaesthetic aspects of facial injurysurgery.

● Discuss importance of airway protection where the airway is shared by both the surgeon and anaesthetist.

● Demonstrate ability to set up and prepare anaesthetic room for oral and maxillofacial procedures.

● Discuss the importance of oral pathology and preoperative airway assessment, and its influence on choice of anaesthetic technique, e.g. awake fibreoptic intubation, inhalational induction.

● Discuss endotracheal tubes and airway adjuncts used in anaesthesia for oral and maxillofacial surgery.

● Have knowledge of the indications for the use of a throat pack, and commonly used strategies to ensure its removal.

● Be aware of airway abnormalities, including contamination and blood, which have significance for anaesthesia for OMFS procedures, and the shared airway.

● Discuss the fact that patients are at increased risk of aspiration due to airwaycontamination, and the significance of jaw wiring postoperatively.

● Discuss the potential role of hypotensive anaesthesia in major head and neck surgery.

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Section 19 Burns

19.1 Competency Can describe the patho-physiology of burns (including smoke inhalation)Knowledge and Skills Indicators Date Performance


The pathophysiology of burns(including smoke inhalation).

● Discuss the effects of burns on the patients respiration.

● Discuss the implications of smoke inhalation to the provision of adequate ventilation.

● Discuss strategies to improve ventilation.

● Discuss hypothermia in the burns patient. (See 7.1)

● Discuss the challenges to patient handling and tissue viability. (See 7.5, 7.6, 7.8)

19.2 Competency Understands the principles of delivering analgesia to burns patientsKnowledge and Skills Indicators Date Performance


The principles of delivering analgesiato burns patients.

● Discuss and utilise established national and local pain control

● protocols / guidelines to ensure patient comfort. (See 9.3, 9.4)

● Discuss and utilise pain assessment tools.

● Demonstrate ability to asses and manage the effects of:

– patient controlled analgesia;

– continuous opiate infusion.

● Demonstrate ability to provide effective control of post operative nausea and vomiting utilising recognised national and local guidelines. (See 9.4)

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19.3 Competency Can describe the principles of fluid management in burns patientKnowledge and Skills Indicators Date Performance


The principles of fluid management inburns patient.

● Discuss the need to replace fluid to offset rapid fluid shift.

● Discuss the need for insertion of large bore venous access.

● Prepare for blood transfusion if large areas of burn tissue are to be excised. (See 5.11, 6.6, 6.7, 8.5)

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Section 20 Inter-hospital and Intra-hospital Adult Patient Transfer

The anaesthetic assistant may be required to assist the anaesthetist in preparing an adult patient for inter-hospital transfer and the safe transfer of patients for investigation or treatment within the hospital. The assistant must be familiar with the principles involved. Guidelines are available from the Association of Anaesthetists of Great Britain and Ireland at www.aagbi.org/sites/default/files/interhospital09.pdf

20.1 Competency Can describe principles of adult patient preparation and stabilisation prior to transferKnowledge and Skills Indicators Date Performance


The principles of adult patientpreparation and stabilisation prior totransfer.

● Demonstrate the ability to prepare for and transfer an adult patient within the hospital.

● Discuss the importance of drugs, monitoring and airway equipment during transfer.

● Discuss the importance of co-ordination of transfer between portering staff, other department / unit staff, etc.

● Demonstrate ability to assist the anaesthetist during preparation and stabilisation of the patient.

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20.2 Competency Can describe principles and difficulties of monitoring the critically ill adult patient during inter-hospital

and intra-hospital transferKnowledge and Skills Indicators Date Performance


The principles and difficulties ofmonitoring the critically ill adult patientduring inter-hospital and intra-hospitaltransfer.

● Demonstrate ability to attach patient to portable monitoring devices and discuss the need for monitoring.

● Ensure all cables are free from obstruction during transfer.

● Discuss the consequences of accidental disconnection of arterial, CVP or peripheral lines during transfer.

● Ensure all invasive lines can be visibly monitored for disconnection during transfer.

● Ensures portable monitoring equipment has sufficient battery power for transfer.

20.3 Competency Can describe anaesthetic principles of patient transfer by roadKnowledge and Skills Indicators Date Performance


Anaesthetic principles of patienttransfer by road, including role ofpolice escort.


● Discuss the importance of co-ordination of transfer between ambulance staff and police.

● Demonstrate ability to assist the anaesthetist during road transfer of the patient.

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20.4 Competency Can describe anaesthetic principles of patient transfer by airKnowledge and Skills Indicators Date Performance


The anaesthetic principles of patienttransfer by helicopter and fixed-wingaircraft.


● Ensures mechanical ventilator has sufficient functions to ensure adequate ventilation:

– variable tidal volume;

– variable rate;

– has low and high-pressure alarms;

– provides PEEP (0– 20 cm H2O);

– has a demand valve and monitors airway pressure.

● Discuss the possibility that standard oxygen cylinders may not be permitted on aircraft, dependent on transfer altitude.

● Ensure aircraft has sufficient oxygen supply.

● Recognise caustic materials will not be permitted on aircraft (e.g. soda lime).

● Discuss the importance of co-ordination of transfer between ambulance staff, airport authorities and aircraft pilot.

● Demonstrate ability to assist the anaesthetist during air transfer of the patient.

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20.5 Competency Understands importance of communication associated with inter-hospital patient transferKnowledge and Skills Indicators Date Performance


Communication associated with inter-hospital patient transfer.

● Discusses the importance of co-ordination of transfer between, ambulance staff, portering staff, other department / unit staff, etc.

● Clearly and precisely relays verbal information to relevant members of the team involved in transfer.

● Demonstrates ability to maintain clear and accurate records of patient care during transfer.

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Portfolio of Core Competencies for Anaesthetic Assistants Appendix 1

The Scottish Credit and Qualifications Framework (SCQF)

The SCQF is central to all external accreditation activity for NHSScotland. It has been devised to:

● provide a national framework for recognising all learning, provided it can be subject to valid, reliable and quality-assured assessment;

● clarify relationships between different Scottish qualifications, and between Scottish qualifications and those of the rest of the UK, Europe and beyond;

● enhance flexibility by building more credit links between different kinds of qualifications;

● provide a common means of describing and recording all individual learning achievements.

This descriptive framework is based on a 12-level scale that reflects the current Scottish system of education and training. Levels 2 –12 each have a descriptor, which sets out their general outcomes under five headings:

● knowledge and understanding;

● applied knowledge and understanding (practice);

● cognitive skills – evaluation and critical analysis, for instance;

● communication, numeracy and IT skills;

● autonomy, accountability and working with others.

The SCQF assists staff to plan, with their manager or supervisor, a learning path that will meet their needs and minimise the prospects of duplication of learning. Any short programme or work-based learning activity, provided it is appropriately assessed, will have the potential to be incorporated into the framework.

www.scqf.org.uk/The%20Framework/

Appendix 1

Qualification Framework

http://www.scqf.org.uk/The%20Framework/

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Appendix 2

Glossary of Abbreviations

AA Anaesthetic Assistant

AAGBI Association of Anaesthetists of Great Britain and Ireland

ACT Activated Clotting Time

AfPP Association for Perioperative Practice

ASA American Society of Anaesthesiologists

BMI Body Mass Index

BP Blood Pressure

BTS Blood Transfusion Service

CAVG Coronary artery vein graft

CO2 Carbon Dioxide

CODP College of Operating Department Practitioners

CPD Continuous Professional Development

CVP Central Venous Pressure

DLT Double lumen tube

ECG Electrocardiogram

ET Endotracheal

HCP Healthcare Practitioner

HE Higher Education

HIS Healthcare Improvement Scotland

HIV Human Immunodeficiency Virus

HSE Health and Safety Executive

I:E ratio Inspiratory Expiratory ratio

ICP Intra Cranial Pressure

ICU Intensive Care Unit

ILS Immediate Life Support

IPPV Intermittent Positive Pressure Ventilation

IT Information Technology

IV Intravenous

KSF Knowledge Skills Framework (Agenda for Change)

LA Local Anaesthesia/Anaesthetic

LMA Laryngeal Mask Airway

MRI Magnetic Resonance Imaging

MRSA Methicillin Resistant Staphylococcus Aureus

N2O Nitrous Oxide

NES NHS Education Scotland

NIBP Non-invasive blood pressure

NMC Nursing and Midwifery Council

NMJ Neuromuscular junction

O2 Oxygen

ODP Operating Department Practitioner

OSCE Objective Structured Clinical Examination

PALS Paediatric Advanced Life Support

PCA Patient Controlled Analgesia

PEEP Positive End Expiratory Pressure

PPE Personal Protective Equipment

RAE Ring, Adair Elwin (type of Endotracheal Tube)

RCA Royal College of Anaesthetists

RCN Royal College of Nursing

SCQF Scottish Credit and Qualifications Framework

SIGN Scottish Intercollegiate Guideline Network

SMAAD Scottish Multidisciplinary Anaesthetic Assistants Development Group

SMASAC Scottish Medical and Scientific Advisory Committee

SpO2 Oxygen saturation

TCI Target Controlled Infusion

Portfolio of Core Competencies for Anaesthetic Assistants Appendix 2