Regulating doctors, ensuring good medical practice

Tomorrow's Doctors: Appendix 1 - Practical procedures for graduates

Diagnostic procedures

Procedure  Description in lay terms 
1. Measuring body temperature ... using an appropriate recording device. 
2. Measuring pulse rate and blood pressure ... using manual techniques and
automatic electronic devices.
3. Transcutaneous monitoring of oxygen saturation Applying, and taking readings from, an
electronic device which measures the
amount of oxygen in the patient’s blood.
4. Venepuncture Inserting a needle into a patient’s vein
to take a sample of blood for testing,
or to give an injection into the vein.
5. Managing blood samples correctly Making sure that blood samples are
placed in the correct containers, and
that these are labelled correctly and
sent to the laboratory promptly and in
the correct way. Taking measures to
prevent spilling and contamination.
6. Taking blood cultures Taking samples of venous blood to test
for the growth of infectious organisms
in the blood. Requires special blood
containers and laboratory procedures.
7. Measuring blood glucose Measuring the concentration of glucose
in the patient’s blood at the bedside,
using appropriate equipment and
interpreting the results.

8. Managing an electrocardiograph (ECG) monitor

 Setting up a continuous recording of the
electrical activity of the heart. Ensuring
the recorder is functioning correctly, and
interpreting the tracing.
9. Performing and interpreting a 12-lead electrocardiograph Recording a full, detailed tracing of the
electrical activity of the heart, using a
(ECG) machine recorder (electrocardiograph).
Interpreting the recording for signs of
heart disease.
10. Basic respiratory function tests Carrying out basic tests to see how well
the patient’s lungs are working (for
example, how much air they can
breathe out in one second).
11. Urine multi dipstick test Testing a sample of urine for abnormal
contents, such as blood or protein. The
urine is applied to a plastic strip with
chemicals which change colour in
response to specific abnormalities.
12. Advising patients on how to collect a mid-stream urine specimen Obtaining a sample of urine from a
patient, usually to check for the presence
specimen of infection, using a method which
reduces the risk of contamination
by skin bacteria.
13. Taking nose, throat and skin swabs Using the correct technique to apply
sterile swabs to the nose, throat and skin.
14. Nutritional assessment Making an assessment of the patient’s
state of nutrition. This includes an
evaluation of their diet; their general
physical condition; and measurement of
height, weight and body mass index. 

15. Pregnancy testing

 Performing a test of the urine to detect
hormones which indicate that the
patient is pregnant.

Therapeutic procedures

Procedure   Description in lay terms
16. Administering oxygen Allowing the patient to breathe a higher concentration of oxygen than normal,
via a face mask or other equipment.
17. Establishing peripheral intravenous access and setting up an infusion; use of infusion devices Puncturing a patient’s vein in order to
insert an indwelling plastic tube (known as
a ‘cannula’), to allow fluids to be infused
into the vein (a ‘drip’). Connecting the
tube to a source of fluid. Appropriate
choice of fluids and their doses. Correct
use of electronic devices which drive and
regulate the rate of fluid administration.
18. Making up drugs for parenteral administration Preparing medicines in a form suitable for
injection into the patient’s vein. May
involve adding the drug to a volume of
fluid to make up the correct concentration
for injection. 
19. Dosage and administration of insulin and use of sliding scales Calculating how many units of insulin a
patient requires, what strength of insulin
solution to use, and how it should be given
(for example, into the skin, or into a vein).
Use of a ‘sliding scale’ which links the
number of units to the patient’s blood
glucose measurement at the time.
20. Subcutaneous and intramuscular injections  Giving injections beneath the skin
and into muscle.
21. Blood transfusion Following the correct procedures to give
a transfusion of blood into the vein of a
patient (including correct identification of
the patient and checking blood groups).
Observation for possible reactions to the
transfusion, and actions if they occur.
22. Male and female urinary catheterisation Passing a tube into the urinary bladder to
permit drainage of urine, in male and
female patients.
23. Instructing patients in the use of devices for inhaled medication Providing instructions for patients about
how to use inhalers correctly, for example,
to treat asthma.
24. Use of local anaesthetics Using drugs which produce numbness and
prevent pain, either applied directly to the
skin or injected into skin or body tissues.
25. Skin suturing Repairing defects in the skin by inserting
stitches (normally includes use of local
anaesthetic).
26. Wound care and basic wound dressing  Providing basic care of surgical or
traumatic wounds and applying dressings
appropriately.
27. Correct techniques for 'moving and handling', including patients Using, or directing other team members
to use, approved methods for moving,
lifting and handling people or objects, in
the context of clinical care, using methods
that avoid injury to patients, colleagues,
or oneself. 

General aspects of practical procedures

Aspect   Description in lay terms
28. Giving information about the procedure, obtaining and
recording consent, and ensuring appropriate aftercare		 Making sure that the patient is fully
informed, agrees to the procedure
being performed, and is cared for
and watched appropriately after the
procedure.
29. Hand washing
(including surgical ‘scrubbing up’)		 Following approved processes for
cleaning hands before procedures or
surgical operations.
30. Use of personal protective equipment (gloves, gowns,
masks)		 Making correct use of equipment
designed to prevent the spread of
masks) body fluids or cross-infection
between the operator and the patient.
31. Infection control in relation
to procedures		 Taking all steps necessary to
prevent the spread of infection
before, during or after a procedure. 
32. Safe disposal of clinical waste, needles and other ‘sharps’ Ensuring that these materials are
handled carefully and placed in a suitable
container for disposal.