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PCA (Anesthetic Assistant) Training Assessment Form
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Operating Theatre, North District Hospital
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Revised on 3 Jan 2022
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1. Excellent performance
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Name:
2. Good performance
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Rank:
3. Effective performance
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Date of Appointment:
4. Below-standard performance
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Rating ( √ as appropriate)
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Assessment areas1234N.A.
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1Familiar with O.T. environment and fire exit
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1.1 Functional areas
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1.2 Dirty and clean zones
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1.3 Traffic control
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comments:
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2Familiar with the use of telephone & intercom in O.T.
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2.1 Using group call & point to point contact
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2.2 Diversion of telephone line
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2.3 Paging Anesthetist and Surgeons
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comments:
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3Able to identify packing sterility
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3.1 Understand the different types of chemical indicator
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3.2 Expiry date & lot number
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3.3 Wet pack
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3.4 Integrity
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comments:
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3AAble to follow Aseptic Technique in:
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3a.1 Opening of sterile instrument set
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3A.2 Deliver sterile supply into sterile field
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3A.3 Maintain sterile field
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comments:
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4Able to prepare for IV infusion
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4.1 Common sizes of Angiocath
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4.2 IV infusion sets, blood giving set & CVP
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4.3 Infusion warmer
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comments:
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5Understand on difference type of fluid and solution
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5.1 Types of IV fluid
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5.2 Blood & blood products
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5.3 Checking of integrity
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comments:
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by Anaes		Able to prepare & assist procedure for GA
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6.1 Checking of anaesthesia machine
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6.2 Common sizes/types of endotracheal tube & airway
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6.3 Checking of laryngoscope
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6.4 Endotracheal tube intubation
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6.5 LMA insertion
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6.6 Awake Fibre Intubation
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6.7 Able to locate difficulty intubation trolley and familiar with its content.
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6.8 Use of airway exchange catheter
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6.9 Common Anaesthetic Drugs
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comments:
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7Able to perform after care on used anaesthetic equipment:
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7.1 Laryngoscopes & blades
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7.2 LMA
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7.3 Common airway gadgets
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comments:
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by Anaes		Able to prepare and assist procedure for SA/ Epidural
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8.1 Common sizes and types of spinal needles e.g. Quicke, Whitecare
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8.2 Epidural set/CSE set
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8.3 Position of patient during procedure
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comments:
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9Able to prepare procedure & assist for Foley catheterization
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9.1 Common sizes of Foley catheter
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9.2 Skin preparation solution
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9.3 Water for irrigation (balloon inflation)
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comments:
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by Anaes		Able to prepare procedure trolley for Central Line insertion
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10.1 Sizes of central line
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10.2 Skin preparation solution
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10.3 Use of related instrument tray
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comments:
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by Anaes		Able to assist patient positioning
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11.1 Supine position
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11.2 Lateral position
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11.3 Lithotomy position
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11.4 Prone position
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11.5 Types & application of positioning devices
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11.6 Lifting, turning & securing patients
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11.7 Apply proper manual handling techniques
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11.8 Handling of obese patient
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comments:
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12Able to set up monitoring for patient under GA/ SA/ LA procedure
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12.1 ECG
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12.2 BP
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12.3 SaO2
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12.4 Body temperature
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comments:
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13Familiar with location of all endoscopes trolleys
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13.1 Orthropaedic TV trolley
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13.2 Surgical TV trolley
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13.3 Anaesthetic TV trolley
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13.4 Gynaecological TV trolley
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comments:
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14Able to handle OT light
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14.1 Auto focus/manual focus
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14.2 Position for optimum light
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comments:
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15Able to set up Diathermy Machine