GUIDE FOR DOH NCP PROGRAM B.

NCPRNL3A02 – PG 3-4, 2/3 FOR VS

*OPERATING ROOM NURSING*
KRMM C1. PATIENTS NEEDS/ PREFERENCES
[ ] E1. RN NOTES
LEGENDS: [ ] E2. LAB RESULTS
C = CRITERIA, [ ] E3. DOCUMENTATION OF CONDITION
E = EVIDENCE AND REFERRAL VALUES
PG = PAGE COVERED
VS = VERY SATISFACTORY RATING C2. CO-MORBIDITIES AFFECTING
PFB = PERFORMANCE FEEDBACK FORM PROCEDURE
[ ] E1. RN NOTES
[ ] E2. LAB RESULTS (COMORBIDITY)
A. NCORNL3A01 – PG 2-3, 3/5 FOR VS [ ] E3. DOCUMENTATION OF CONDITION/
REFERRAL
C1. ASSESSMENT DATA FOR SURGICAL
PATIENTS C3. POSSIBLE COMPLICATIONS
[ ] E1. MED CERT, LAB RESUTS [ ] E1. CASE ANALYSIS
[ ] E2. MEDICAL HISTORY
[ ] E3. MEDICATION RECORDS
[ ] E4. PHYSICAL EXAMINATION C. NCORNL3A03 - PG 4-6

C2. UNIQUE EXPECTED PATIENT OUTCOMES AS SCRUB NURSE - 4-5/6 FOR VS

[ ] E1. MED CERT, LAB RESULTS
[ ] E2. MEDICAL HISTORY C1. SPONGE COUNT SHEET
[ ] E3. MEDICATION RECORD [ ] E1. SPONGE COUNT SHEET
[ ] E4. PSYCHOSOCIAL ASSESSMENT
C2. ASSISTS THE SURGEON ACCURATELY
C3. INDIVIDUAL PATIENT NEEDS [ ] E1. SPONGE COUNT SHEET
[ ] E1. MED CERT, LAB RESULTS
[ ] E2. MEDICAL HISTORY C3. ASEPTIC TECHNIQUE
[ ] E3. MEDICATION RECORDS [ ] E1. INFECTION CONTROL CHECKLIST
[ ] E4. PSYCHOSOCIAL ASSESSMENT
C4. ACCURATE COUNTING
C4. CO-MORBIDITIES [ ] E1. SPONGE COUNT SHEET
[ ] E1. MEDICAL HISTORY
[ ] E2. MEDICATION RECORD C5. DOCUMENT COMPLETENESS
[ ] E3. PYSCHOSOCIAL ASSESSMENT [ ] E1. SPONGE COUNT SHEET

C5. POSSIBLE OUTCOMES C6. SCIENTIFIC PRINCIPLES IN PLAN OF

[ ] E1. CASE ANALYSIS CARE
[ ] E1. CASE ANALYSIS
[ ] E2. INTERVIEW OF PATIENT USING
PREOP CHECKLIST
AS CIRCULATING NURSE – 3-4/5 FOR VS [ ] E2. NURSING CARE PLAN
[ ] E3. ENDORSEMENT SHEET
C1. INSPECTS EQUIPMENT AND MACHINES [ ] E4. MONITORING SHEET
[ ] E1. MACHINE/ EQUIPMENT MONITORING [ ]. E5. EVALUATION FORMS
FORM

C2. UPDATES RELATIVES ON STATUS OF E. NCORNL3B01 – PG 8, 2/3 FOR VS

PATIENT
[ ] E1. RN NOTES C1. HEALTH EDUCATION - PROVISION
[ ] E1. TEACHING PLAN/ TOOL
C3. OBSERVES ASEPTIC TECHNIQUE [ ] E2. RN NOTES
[ ] E1. DOCUMENTED ASEPTIC TECHNIQUE [ ] E3. SATISFACTION SURVEY/ ALAGANG
TAGUBILIN
C4. ACCURATE CUNTING OF INSTRUMENTS
[ ] E1. DOCUMENT CHECKLIST OF C2. HEALTH EDUCATION - DOCUMENTATION
INSTRUMENTS [ ] E1. TEACHING PLAN/ TOOL
[ ] E2. RN NOTES
C5. ADDITIONAL SURGICAL NEEDS (BLOOD, [ ] E3. SATISFACTION SURVEY/ ALAGANG
MEDS) TAGUBILIN
[ ] E1. DOCUMENTATION OF REFERRAL
[ ] E2. BLOOD TRANSFUSION/ IV INSERTION C3. EVALUATION OF PREOP EDUCATION
DONE
[ ] E1. EVALUATION FORM
D. NCORNL3A04 – PG 7, 3/4 FOR VS [ ] E2. RN NOTES

C1. INITIAL ASSESSMENT FOR POSSIBLE

INJURY F. NCORNL3C01 – PG 8-9, 2/3 FOR VS
[ ] E1. PERIOPERATIVE EVALUATION TOOL
[ ] E2. PROGRESS NOTES/ RN NOTES C1. DELIVER INFO ON PLAN OF CARE TO
PATIENT AND FAMILY
C2. INSPECTS CONTRAPTIONS [ ] E1. PATIENT FEEDBACK
[ ] E1. PREOP CHECKLIST [ ] E2. NURSING CARE PLAN
[ ] E2. RN NOTES [ ] E3. RN NOTES

C3. CONDITION PRIOR TO TRANSFER C2. ADDRESS INQUIRIES OF PATIENT AND

[ ] E1. MONITORING SHEETS FAMILY
[ ] E2. RN NOTES [ ] E1. PFB
[ ] E3. EVALUATION FORMS [ ] E2. RN NOTES

C3. PROVIDES SUFFICIENT INFORMATION

C4. COMMUNICATION WITH RECEIVING [ ] E1. PATIENT FEEDBACK
UNIT [ ] E2. RN NOTES
[ ] E1. RN NOTES
G. NCGENL3D01 – PG 10, 2/3 CRITERIA [ ] E2. DOCUMENTATION OF DISCUSSING
RIGHTS
C1. REFERS TO MEMEBERS OF
MULTIDISCIPLINARY TEAM I. NCGENL3F01 – PG 12, 2/3 CRITERIA
[ ] E1. RN NOTES
[ ] E2. NURSING CARE PLAN C1. AVAILABILITY/ FUNCTIONALITY OF
[ ] E3. RELATED FORMS EQUIPMENTS/ SUPPLIES
[ ] E1. INVENTORY REPORT
C2. DOCUMENTATION OF ATTACHMENTS/ [ ] E2. RIS OF STOCKS/ SUPPLIES
REFERRAL FORMS [ ] E3. OTHER DOCUMENTS
[ ] E1. RN NOTES
[ ] E2. INFORMED CONSENT FORMS C2. REGULAR CHECK UP OF FUNCTIONALITY
[ ] E3. OTHER MEANS AVAILABLE [ ] E1. JOB ORDER FOR MALFUNCTIONING
EQUIPMENTS
C3. ATTENDS TO NEEDS OF PATIENTS [ ] E2. MAINTENANCE LOG BOOKS
BASED ON THE REFERRAL [ ] E3. EQUIPMENT MONITORING TOOL
[ ] E1. RN NOTES [ ] E4. OTHERS
[ ] E2. NURSING CARE PLAN
[ ] E3. OTHER MEANS AVAILABLE C3. PREVENTIVE MAINTENANCE/
CALIBRATION
[ ] E1. CALIBRATION STICKERS
H. NCGENL3E01 – PG 11, 2/3 FOR VS [ ] E2. CALIBRATION LOG BOOKS
[ ] E3. OTHERS
C1. COMPLIES WITH SOP AND WIS ON
ETHICAL PATIENT CARE
[ ] E1. DOCUMENTED NURSING AUDIT J. NCGENL3G01 – PG 13-14, 2/3 FOR VS
[ ] E2. SUMMARY OF SATISFACTION SURVEY
[ ] E3. PERFORMANCE EVALUATION OF C1. RECORD MANAGEMENT
SUPERIOR [ ] E1. INQUIRY OF KNOWLEDGE ON
[ ] E4. PFB POLICIES (DATA PRIVACY)
[ ] E5. OTHER MEANS AVAILABLE [ ] E2. PFB
[ ] E3. NO INCIDENCE OF NON-COMPLIANCE
C2. DOCUMENTATION INVOLVING ETHICAL TO RECORD KEEPING POLICIES
DECISION MAKING [ ] E4. OTHERS
[ ] E1. RN NOTES
[ ] E2. PFB C2. ACCOMPLISHES ALL NECESSARY
[ ] E3. OTHER FORMS AVAILABLE RECORDS
[ ] E1. FILLS UP ALL CHART FORMS/
C3. NURSING INTERVENTIONS/ PATIENT SPECIAL AREAS
CARE RELATED TO ETHICAL PRINCIPLES [ ] E2. PFB
[ ] E1. DOCUMENTATION OF WITNESSING [ ] E3. RN NOTES
CONSENT [ ] E4. MONITORING RECORDS
[ ] E5. OTHERS
C3. COMPILES FORMS TO BE SUBMITTED TO C2. KNOWLEDGE ON INSTITUTIONAL
MEDICAL RECORDS PROCESSES THAT CHALLENGE COMPLIANCE
[ ] E1. RECEIVING LOG BOOK (ADMITTING) [ ] E1. ACTUAL CASE SCENARIO
[ ] E2. PFB [ ] E2. REFLECTION NOTES/ DIARY
[ ] E3. OTHERS [ ] E3. PFB
[ ] E4. OTHERS

K. NCGENL3A01 – PG 14-15, 2/3 FOR VS C3. BEST NURSING CARE IN LINE WITH
NATIONAL HEALTH GOALS
C1. PERFORMS ROLE IN CQI (ISO) [ ] E1. REFLECTION NOTES/ DIARY
[ ] E1. CQI MONITORING [ ] E2. PFB
[ ] E2. COPY OF MINUTES REGARDING ISO [ ] E3. FEEDBACK FROM PEERS
[ ] E3. PFB [ ] E4. OTHERS
[ ] E4. OTHERS

C2. NURSING SERVICE AUDIT M. NCGENL3J01 – PG 17-18, 2/3 FOR VS

[ ] E1. NURSING SERVICE AUDIT OR SIMILAR
RECORDS C1. IDENTIFIES NURSING PROBLEMS OR
[ ] E2. COPY OF MINUTES OF NURSING ISSUES
AUDIT [ ] E1. PROBLEM LIST FOR NURSING
[ ] E3. PFB RESEARCH
[ ] E4. OTHERS [ ] E2. RESEARCH INTENTION FORM
[ ] E3. REFLECTION NOTES
C3. ATTENDS TRAINGINS AND SEMINARS [ ] E4. OTHERS
INVOLVING CQI
[ ] E1. PROOF RELATED TO ATTENDANCE C2. PREPARES A STUDY PROTOCOL
[ ] E2. LIST OF TRAININGS/ SEMINARS [ ] E1. RESEARCH PROTOCOL
[ ] E3. POST ACTIVITY INSIGHTS (ORNAP)
[ ] E4. OTHERS
N. NCGENL3K01 – PG 18-20, 2-3/4 FOR VS

L. NCGENL3I01 – PG 16-16, 2/3 FOR VS C1. TASK FOR PATIENT CARE

[ ] E1. DAILY ASSIGNMENT SHEET
C1. RECOGNIZES POLICY INCONSISTENCY [ ] E2. OPERATING ROOM DAILY REPORT
[ ] E1. REFELCTION NOTES/ DIARY/ [ ] E3. PFB
COMMUNICATION LOG BOOK [ ] E4. FEEDBACK FROM PEERS
[ ] E2. ACTUAL SCENARION PRESENTATION [ ] E5. REFLECTION NOTES/ DIARY
[ ] E3. PFB [ ] E6. OTHERS
[ ] E4. PERFORMANCE EVALUATION
[ ] E5. OTHERS C2. STAFF-PATIENT RATIO BASED ON
PATIENT CLASSIFICATION SYSTEM
[ ] E1. DAILY ASSIGNMENT SHEET
[ ] E2. OPERATING ROOM DAILY REPORT
[ ] E3. PFB P. NCGENL3M01 – PG 22, 2/3 FOR VS
[ ] E4. PATIENT ASSIGNMENT BOARD/ OR
SIMILAR C1. POSITIVE WORK ATTITUDE
[ ] E1. COMMENDATION LETTER FROM
C3. IDENTIFIES NECESSARY COMPETENCIES PEERS/ SUPERVISOR
[ ] E1. ACTUAL CASE SCENARIO [ ] E2. FEEDBACK FROM OTHER PERSONNEL
[ ] E2. UNIT MANAGEMENT REPORT [ ] E3. CUSTOMER SATISFACTION
[ ] E3. ENDORSEMENT LOGBOOK [ ] E4.OTHERS
[ ] E4. PFB
[ ] E5. OTHERS C2. PUNCTUALITY
[ ] E1. NO ILL RECORD OF TARDINESS/
C4. COMMUNICATION OF DELEGATION ABSENCES
[ ] E1. DAILY ASSIGNMENT SHEET [ ] E2. PERFORMANCE EVALUATION
[ ] E2. PFB [ ] E3. FEEDBACK FROM PEERS/ SUPERIOR
[ ] E3. ENDORSEMENT/ DAILY REPORT [ ] E4. OTHERS
[ ] E4. REFLECTION/ DIARY
[ ] E5. OTHERS

O. NCGENL3L01 – PG 20-21, 2/3 FOR VS

C1. PARTICIPATION RELATED TO CPD

[ ] E1. TRAINING NEEDS ASSESSMENT FORM
[ ] E2. PERSONAL DEVELOPMENT FORM
[ ] E3. EMPLOYEE SATISFACTION SURVEY
[ ] E4. REFLECTION NOTES/ DIARY
[ ] E5. FEEDBACK FROM PEERS/ SUPERIORS
[ ] E6. OTHERS

C2. EXPLORES DEVELOPMENT

OPPORTUNITIES
[ ] E1. PERFORMANCE EVALUATION
[ ] E2. PERFORMANCE FEEDBACK
[ ] E3. OTHER PROOF OF PROFESSIONAL
DEVELOPMENTAL ACTIVITIES/ PROGRAMS
(ORNAP, GRAD SCHOOL)

C3. ACTIVE FEEDBACK

[ ] E1. REFLECTION NOTES
[ ] E2. SELF FEEDBACK
[ ] E3. COMMUNICATION WITH PEERS