Practical clinical skills assessment checklist

Perioperative, Instrument and Circulating nursing

The Australian College of Perioperative Nurses (ACORN) would like to assist in the practical skill development of nurses who are
new to perioperative/perianaesthesia nursing. To this end the college has developed a ‘practical checklist’ of basic skills required for
safe practice of our ‘junior and novice nurses’ who are studying towards a graduate certificate or graduate diploma in
perioperative/perianaesthesia practice. This is not a definitive list, but is designed to assist in practical educational development of
novice perioperative nurses.

Students should have their skills assessed over the course of their studies whilst in the perioperative workplace. Preferably, the
Perioperative Clinical Educator will do this but, in the absence of this position, a senior perioperative nurse with at least five years’
experience would suffice.

Competency in these practical skills assumes that the perioperative student nurse has been assessed using the competency skills
assessment tools pertaining to their specific perioperative unit. It is implied that the assessment tools that are used adhere to
current ACORN standards or guidelines and other appropriate standards, as required (such as ANZCA PS08, National Quality
Standards, AS4187;2014).

Student name: .................................................................. Workplace: .........................................................................

© Australian College of Perioperative Nurses 2018

Approved by the ACORN board August 2017
Perioperative, Instrument and Circulating nursing practical clinical skills assessment checklist

The student will be competent in the following skills.

Correct wearing of perioperative attire and Personal Assessor’s name:

Protective Equipment (PPE) …………………
Date assessed Assessors’ signature:

Understanding and managing both standard and additional Assessor’s name:

infection control principles. …………………
Date assessed Assessors’ signature:

Assessor’s name:
Preparing for an operating theatre list and checking surgical
set-up. …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Complete the Surgical Safety Checklist and Team Time Out. …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Positioning the patient for surgery and pressure area care. …………………
Date assessed Assessors’ signature:

Assessor’s name:
Surgical hand antisepsis, gowning and gloving. …………………
Assessors’ signature:
Date assessed

2 © Australian College of Perioperative Nurses 2018

Approved by the ACORN board August 2017
Perioperative, Instrument and Circulating nursing practical clinical skills assessment checklist

Assessor’s name:
Sharps management. …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Creating and maintaining an aseptic field. …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Prepping the surgical site. …………………
Date assessed Assessors’ signature:

Assessor’s name:
Sterile/aseptic draping of the surgical site. …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Monitoring of asepsis during the surgical procedure. …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Managing accountable items during surgery and
procedures. …………………
Date assessed Assessors’ signature:

Assessor’s name:
Medication safety on the aseptic field. …………………
Assessors’ signature:
Date assessed

3 © Australian College of Perioperative Nurses 2018

Approved by the ACORN board August 2017
Perioperative, Instrument and Circulating nursing practical clinical skills assessment checklist

Assessor’s name:
Managing and handling graft and donor tissue. …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Managing and handling prostheses and implantable items
(if applicable). …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Specimen handling and management. …………………
Date assessed Assessors’ signature:

Knowledge and expertise of special populations as required Assessor’s name:

in each specific OR – for example paediatrics, ENT,
…………………
obstetrics, cardiac, neurosurgical, orthopaedic. Assessors’ signature:
Date assessed

Assessor’s name:
Laser and electrosurgical safety including smoke plume. …………………
Assessors’ signature:
Date assessed

Assessor’s name:
Radiation safety. …………………
Date assessed Assessors’ signature:

Assessor’s name:
Fire safety in the operating theatre. …………………
Assessors’ signature:
Date assessed

4 © Australian College of Perioperative Nurses 2018

Approved by the ACORN board August 2017
Perioperative, Instrument and Circulating nursing practical clinical skills assessment checklist

Assessor’s name:
Appropriate decontamination and reprocessing of
instruments. …………………
Assessors’ signature:
Date assessed

Understanding and managing perioperative complications

including (but not limited to) massive blood loss, conversion Assessor’s name:
from laparoscopic to open, malignant hyperthermia, …………………
Assessors’ signature:
anaphylaxis, lipid rescue and CPR in the OR. Date assessed

Assessor’s name:
Completion of perioperative paperwork. …………………
Date assessed Assessors’ signature:

Clinical handover of surgical procedure to PACU staff

including providing details of surgical procedure, dressing, Assessor’s name:
drain tubes, notable intraoperative events or complications …………………
and estimated blood loss. Assessors’ signature:
Date assessed

5 © Australian College of Perioperative Nurses 2018

Approved by the ACORN board August 2017