Annexe B: Nursing Procedures, Steps and Safety Checks

Scope and weight

Seven questions on procedures is a small share, but the topics overlap with Platforms 3, 4 and 6, so the same skills are tested from several angles. The question style is usually one step of a procedure: what to check before, what to do during, what to do if something goes wrong, or what to document after. The Standards of proficiency list the procedures in Annexe B, and the exam draws on that list.

What is tested

• Observations. Accurate measurement of pulse, respiration, blood pressure, temperature and SpO2, plus neurological observations and the Glasgow Coma Scale.
• Blood and tests. Venepuncture, cannulation and blood sampling, 12-lead ECG and cardiac monitoring, blood glucose and ketone monitoring, and specimen collection for urine, sputum, stool, wound swab and blood cultures.
• Elimination and wounds. Urinary catheterisation and bladder irrigation, wound dressing with aseptic technique, stoma care and continence care.
• Airway, breathing and feeding. Oxygen delivery, inhalers, nebulisers and suction; nasogastric tube insertion and position checking.
• Injections and blood. Subcutaneous and intramuscular technique and the blood component transfusion procedure.
• Personal care and mobility. Hygiene, oral and eye care, pressure area care, repositioning, and moving and handling equipment.
• End of life and emergencies. Last offices, verification of death, basic life support and AED use.

Local points to anchor your answers

• Aseptic technique. In UK practice this means ANTT, the aseptic non-touch technique. Key parts and key sites are protected, and hand hygiene comes before and after.
• NG tube position. Aspirate pH of 5.5 or below, or X-ray when pH is not available. Misplaced NG tube feeding is a Never Event. Confirm at source.
• Transfusion. Bedside identity check using the wristband and compatibility label, baseline observations before the transfusion, then at 15 minutes and at least hourly, with each unit completed within 4 hours of removal from controlled storage. Confirm at source.
• Basic life support. Compressions at 100 to 120 per minute, depth of at least 5 cm and not more than 6 cm, 30 compressions to 2 breaths, call 999, use an AED early. Checked on the Resuscitation Council UK 2025 guideline.
• Glasgow Coma Scale. Eye 1 to 4, verbal 1 to 5, motor 1 to 6, total 3 to 15. A total of 8 or below indicates severe impairment and airway risk. Confirm at source.
• Verification of death and last offices. Follow local policy and respect the person's cultural and religious needs. Verification is by a competent professional as policy allows.
• Moving and handling. Assess the load, the person and the environment first, use equipment, and do not lift manually if an aid is available.

Three typical traps

1. Skipping identity or consent checks. Procedure questions often include a distractor that begins the task straight away. Confirm identity, explain the procedure and gain consent first.
2. Forgetting position checks. Before using an NG tube for feeding or medicines, the position must be confirmed by the approved method. "The tube was placed an hour ago" is not a check.
3. Mistaking technique for sterility. ANTT does not always mean sterile gloves. The level of protection depends on the procedure and the risk to key parts. Read the question for the key part and key site.

How the questions are framed

Annexe B stems ask about a stage of a procedure. Before a blood transfusion, what must be checked at the bedside? After a urinary catheter is inserted, what should be documented? What is the first action if a patient becomes breathless during a transfusion? A patient with an NG tube has just vomited, so what must be done before the next feed? What finding on a wound dressing change should be escalated? The marks come from knowing the standard order and the stop-and-escalate points.

What the exam asks about each group

• Observations. Choose the right technique, apply a consistent method, repeat an unexpected value and record accurately. Link results to NEWS2 and escalate.
• Sampling and testing. Label at the bedside, use the correct container, avoid contamination and send promptly. Blood cultures are taken before antibiotics where possible and without delaying treatment in sepsis.
• Catheters, wounds and stomas. Use ANTT, maintain a closed drainage system, observe the skin and document appearance, output and patient comfort.
• Respiratory procedures. Match the delivery device to the need, use the correct inhaler or nebuliser technique, and suction only when needed and for the shortest time.
• Feeding tubes. Confirm position by the approved method before every use, and stop and escalate if the check fails.
• Transfusion and injections. Check identity and compatibility at the bedside, monitor at the set intervals, and stop the transfusion and escalate at the first sign of a reaction.
• Care of the person. Provide hygiene, oral care, pressure area care and repositioning with dignity, privacy and attention to skin.
• Emergencies and death. Start BLS without delay, use an AED early, and carry out last offices with respect for the person's beliefs and in line with policy.

If a stem describes a sign of harm during a procedure, stopping and calling for help comes before continuing, documenting or reassuring.

How to revise it

1. Write each procedure as five lines: prepare and check identity, consent, perform, document, and what to escalate.
2. Know the safety checks that stop a procedure: wrong patient, wrong site, abnormal pH, signs of reaction.
3. Practise observations accurately. Recheck an abnormal value before acting, and know the NEWS2 consequence.
4. Rehearse BLS aloud with the numbers until fluent.
5. Watch procedures in practice if you can, since the OSCE will test the same steps physically.

Pair with Platform 4 for clinical context, Platform 6 for infection control, and the CBT compared with the OSCE for how skills carry into the practical part.