The Skills Index and the Ten-Minute Sequence Drill

THE SKILLS INDEX

ASSESS

• Head-to-toe route .......... Same direction, every patient, every time .......... P3
• Technique order .......... Inspect, palpate, percuss, auscultate .......... P4
• The abdominal exception .......... Listen before you press, always .......... P4
• Region findings, normal against abnormal .......... Report the finding, do not name it .......... P3
• Vital sign technique .......... The method column is part of the value .......... P7
• Pain by age and cognition .......... Self-report first, then the right tool .......... P7

PROTECT

• Sterile field .......... One inch, one waist, one look away .......... P5
• Catheter insertion .......... Urine returns, advance, then inflate .......... P5
• Specimen collection .......... Right container, right timing, two identifiers .......... P8
• Wound culture .......... From the cleansed bed, never from drainage .......... P8

MAINTAIN

• Nasogastric insertion .......... Upright, nose to earlobe to xiphoid, mark it .......... P6
• Placement verification ⚑ .......... Radiograph before use; verify current guidance .......... P6
• Enteral feeding .......... No feeding without confirmed position .......... P6
• Tracheostomy care .......... Precut gauze, full spare set at bedside .......... P6
• Suctioning ⚑ .......... For an indication, no suction going in .......... P6
• Ostomy care .......... Cut just larger, empty at one third .......... P6
• Drains and dressings .......... Empty, measure, recompress the closed ones .......... P9

MOVE

• Body mechanics .......... Bed to waist, wheels locked, load close .......... P8
• Transfer .......... Chair on the stronger side, sit before standing .......... P8
• Positioning .......... Off the trochanter, heels off the bed .......... P8
• Elimination .......... Scan for retention before assuming no output .......... P8
• Sleep .......... Cluster care, protect the block .......... P8
• Sensory aids .......... Lower the pitch, do not raise the volume .......... P8

RECORD

• Documentation .......... Describe, time it, never obliterate .......... P10
• SBAR handoff .......... Name the ask and the time frame .......... P11
• Pressure injury staging ⚑ .......... Deepest visible tissue, never backward .......... P9
• The stop-and-call list ⚑ .......... Cover, position, call. Do not reinsert .......... P9
• End-of-life and postmortem care .......... Comfort, presence, then policy and law .......... P8

What this book compressed

Three areas could not be carried at full depth in fifteen pages. Medication administration technique lives with drug knowledge → BOOK 05. Respiratory therapies including oxygen delivery devices and chest tubes live with the respiratory system → BOOK 09. Specialty wound modalities such as negative pressure therapy are institutional protocol and are learned at the bedside from that protocol.

The ten-minute drill

• Minutes 1–2 — Walk the head-to-toe route aloud, stop by stop, without looking.
• Minutes 3–4 — State the technique order, then state the abdominal exception and the reason for it.
• Minutes 5–6 — Name the four sterile field boundaries and the four contamination events.
• Minutes 7–8 — Recite the six staging entries and the three staging rules.
• Minutes 9–10 — Build an SBAR aloud for any patient you can picture, and finish with a named ask and a time frame.

Cross-links

• Precautions and personal protective equipment .......... → BOOK 04
• Every range and reference value .......... → BOOK 07
• Every calculation .......... → BOOK 06
• Drug knowledge .......... → BOOK 05
• Delegation of skills .......... → BOOK 03
• What a finding means .......... → BOOKS 08–14
• The final countdown .......... → BOOK 16

Margin noteif you can say the order out loud, you own it.

TakeawayA skill is a sequence, and the exam scores the order far more often than it scores the definition.