LOG BOOK PRIVILEGING & CREDENTIALING (MEDICAL OFFICER) HOSPITAL TUANKU JA’AFAR SEREMBAN NEGERI SEMBILAN DARUL KHUSUS
LOG BOOK
PRIVILEGING &
CREDENTIALING
(MEDICAL OFFICER)
HOSPITAL TUANKU JA’AFAR
SEREMBAN NEGERI SEMBILAN DARUL KHUSUS
DEPARTMENT OF
ANESTHESIOLOGY
NAME : -------------------------------------------
DATE OF POSTING :---------------------------
DATE OF COMPLETION :--------------------- Approved by:............................................
Date : ........................................................
LIST OF PROCEDURES AND REQUIREMENTS
NO PROCEDURE OBSERVE CONDUCT
WITH ASSIST
PERFORM
1. ANAESTHESIA
a) Administration of general anaesthesia
10 10 10
b) Endotracheal intubation 10 10 10
c) Insertion of oropharyngeal airway 10 10 10
d) Insertion of laryngeal mask airway 10 10 10
e) Use of video laryngoscope (Glidescope)
10 10 10
f) Spinal anaesthesia 10 10 10
g) Peripheral intravenous cannulation
10 10 10
h) Arterial catheter cannulation 10 10 10
i) Central venous catheter cannulation
10 10 10
- femoral , external jugular,
Internal jugular and subclavian routes
j) Epidural anaesthesia 10 10 10
- Lumbar and caudal epidural
- Thoracic epidural to be done
by specialist
k) Combined spinal-epidural anaesthesia
10 10 10
l) Fibreoptic bronchoscopy and intubation requires supervision by specialists
10 10 10
m) Peripheral regional blocks requires supervision by specialists
10 10 10
n) Defibrillation and cardioversion 10 10 10
2. INTENSIVE CARE
a) Central Venous Access 10 10 10
b) Femoral line 10 10 10
c) External jugular line 10 10 10
d) Intra osseous cannulation 10 10 10
e) Endotracheal intubation 10 10 10
f) Insertion of oropharyngeal airway 10 10 10
g) Use of video laryngoscope (eg Glidescope)
10 10 10
h) Peripheral intravenous cannulation
10 10 10
i) Arterial catheter cannulation 10 10 10
j. Central venos catherer cannulation - femoral, external jugular, Internal jugular and subclavian routes
10
10
10
k. Use of various types of ventilators- high end, transport and portable
10
10
10
l) Insertion of haemodialysis
10 10 10
m) Defibrillation and cardioversion
10 10 10
n) Chest tube insertion
10 10 10
o) Pleural tap
10 10 10
p) Lumbar puncture
10 10 10
q) Fibreoptic bronchoscopy requires supervision by specialists
10 10 10
r ) Use of various types of ventilators-high end, low-end, transport and portable
10 10 10
s) Insertion of haemodialysis catheters
10 10 10
t) Defibrillation and cardioversion
10 10 10
u) Chest tube insertion
10 10 10
v) Pleural tap
10 10 10
w) Lumbar puncture
10 10 10
PROCEDURE NO 1 : ANAESTHESIA ( a) Administration Of General Anaesthesia
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (b) Endotracheal Intubation
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (c) Insertion Of Oropharyngeal Airway
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (d) Insertion Of Laryngeal Mask Airway
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (e) Use Of Video Laryngoscope (Glidescope)
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (f) Spinal Anaesthesia
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (g) Peripheral Intravenous Cannulation
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (h) Arterial Catheter Cannulation
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (i) Central Venous Catheter Cannulation
- femoral , external jugular, Internal jugular and subclavian routes
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (j) Epidural Anaesthesia
- Lumbar and caudal epidural - Thoracic epidural to be done by specialist
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (k) Combined Spinal-Epidural Anaesthesia
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (l) Fibreoptic Bronchoscopy And Intubation Requires Supervision By
Specialists
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (m) Peripheral Regional Blocks Requires Supervision By Specialists
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 1 : ANAESTHESIA (n) Defibrillation and Cardioversion
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (a) Central Venous Access
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (b) Femoral Line
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (c) External Jugular Line
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (d) Intra Osseous Cannulation
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (e) Endotracheal Intubation
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (f) Insertion of Oropharyngeal Airway
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (g) Use Of Video Laryngoscope (eg Glidescope)
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (h) Peripheral Intravenous Cannulation
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (i) Arterial Catheter Cannulation
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (j) Central Venous Catheter Cannulation
- Femoral , External Jugular, Internal Jugular And Subclavian Routes
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (k) Use Of Various Types Of Ventilators-High End, Low-End, Transport And Portable
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (l) Insertion of Haemodialysis Catheters
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (m) Defibrillation and Cardioversion
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (n) Chest Tube Insertion
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (o) Pleural Tap
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (p) Lumbar Puncture
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (q) Fibreoptic Bronchoscopy Requires Supervision By Specialists
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (r) Use Of Various Types Of Ventilators-High End, Low-End, Transport and
Portable
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (s) Insertion of Haemodialysis Catheters
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (t) Defibrillation and Cardioversion
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (u) Chest Tube Insertion
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (v) Pleural Tap
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10
PROCEDURE NO 2 : INTENSIVE CARE (w) Lumbar Puncture
NO
DATE
PATIENT NAME
NRIC / RN
COMMENTS OUTCOME
SUPERVISOR
1
OB
SE
RV
E
2
3
4
5
6
7
8
9
10
1
AS
SIS
TA
NC
E
2
3
4
5
6
7
8
9
10
1
PE
RF
OR
M
2
3
4
5
6
7
8
9
10