08. Procedures – 101

The core competencies in this domain are:

  1. Demonstrates a wide range of procedural skills to a high standard and as appropriate to the community requirements.
  2. Refers appropriately when a procedure is outside their level of competence.

A generic approach to medical procedures involves several universal steps that healthcare providers typically follow to ensure safety, efficacy, and compliance with medical standards. This approach is designed to cater to a wide range of procedures from simple diagnostic tests to complex surgeries. Here’s an outline:

Assessment and Diagnosis

  • Patient Interview:
    • Gathering comprehensive patient history, including symptoms, medical history, allergies, and current medications.
  • Physical Examination:
    • Conducting a thorough physical check to assess the patient’s current health status.
  • Diagnostic Testing:
    • Utilise tests like swabs, blood tests, imaging and biopsies to confirm the diagnosis.

Planning

  • Scope of Competency:
    • Ensure that the procedure is within your scope of competency, covered by your medicolegal insurance, and not prohibited in your practice location
  • Treatment Planning:
    • Determining the most appropriate procedure or treatment based on the diagnosis.
  • Informed Consent:
    • Discuss the risks, benefits, alternatives, and obtaining consent from the patient or their legal representative.
  • Preparation:
    • Providing the patient with pre-procedure instructions (e.g., fasting, medication adjustments).

Execution

  • Patient Consent:
    • Ensure the correct patient, correct procedure, and continuing consent
  • Equipment Setup and the 5Ps:
    • Ensure all necessary equipment and personnel are ready.
    • Remember the 5Ps – Prior Preparation Prevents Poor Performance
  • SOAP – Suction, Oxygen, Airway, Pharmacology:
    • For certain procedures, emergency equipment should be available.
  • Hand-washing and PPE
    • Ensure hand washing for infection control
    • Use PPE such as gloves, masks and eye protection
  • Anesthesia:
    • Ensure adequate anaesthesia for the procedure.
    • This may include local anaesthetic, nitrous oxide or methoxyflurane (Green Whistle) in general practice.
    • This may include conscious sedation or formal anaesthesia in hospital-type environments.
  • Positioning and Lighting:
    • Ensure the patient is appropriately positioned to make the procedure easier.
    • Ensure adequate lighting is available so you can see what you are doing.
  • Sterile Preparation, Gloves and Drape:
    • Ensure the risk of infection is minimised.
    • Note that alcoholic skin preparations have completed their job when dry.
    • Note that water-based skin preparations take 5 minutes to work.
  • Procedure:
    • Perform the procedure with precision and care.
  • Monitoring:
    • Continuously monitoring vital signs and the patient’s status during the procedure.
  • If you are down a hole stop digging:
    • Sometimes, things go wrong
    • If this happens consider the wisdom of stopping the procedure, asking a colleague for help, or calling an ambulance.
    • If required, fall back onto the basics of DRS ABCDEFG.

Post-Procedure Care

  • Immediate Care:
    • Managing immediate post-procedure needs, such as pain relief and monitoring for any complications.
  • Instructions for Recovery:
    • Providing detailed post-procedure care instructions, including activity limitations, medication schedules, and signs of potential complications.
  • Follow-up Appointments:
    • Scheduling follow-up visits to monitor recovery and address removal of sutures, as well as discussing results and any residual issues.
  • Safety-Net:
    • Ensure patients know what to expect post-procedure and when to represent urgently.

Documentation and Reporting

  • Document the procedure:
    • Recording the major aspects of the procedure, findings, and any complications.
  • Reporting:
    • Fulfil any necessary reporting requirements to medical records, registries, or reporting systems.

Evaluation and Feedback:

  • Outcome Evaluation:
    • Assess the outcomes of the procedure to determine if the expected health benefits were achieved.
  • Patient Feedback:
    • Gather feedback from the patient regarding their experience and satisfaction.
  • Quality Improvement:
    • Use insights from the procedure and feedback to improve future care and procedures.

This generic approach ensures a standardized protocol is followed, reducing variability and increasing the safety and effectiveness of medical procedures. Each step is crucial and tailored to the specific needs of the procedure and the patient.