PTCS Supervision Form

• Date of supervision

  Date

• Name of observed Crew

• ID Number of Crew

• Clinical Supervisor

  Select

• Name of Clinical Supervisor

• Shift Location

  Select

• Base location?

  Select

• Type of shift

  Select

• What type of service provided?

• Start time of observation

  Date

• End time of observation

  Date

• Demonstrated effective verbal communication skills

  Yes

  No

• Demonstrated effective written communication skills

  Yes

  No

• Overcame communication barriers with others?

  Yes

  No

• Comments on Communication Skills

• Any media to include for Communication Skills?

  Media

• Choose N/A where the standard was not relevant (such as no equipment was needed)

• Patient informed of all moves

  Yes

  No

  N/A

• Consent gained for all moves

  Yes

  No

  N/A

• Safe appropriate use of equipment?

  Yes

  No

  N/A

• Effective team work and communication?

  Yes

  No

  N/A

• Any comments on Patient handling?

• Any media for Patient handling?

  Media

• Choose N/A where the standard was not relevant (such as no patient assessment was needed, or no Safeguarding concerns were present)

• Consent gained throughout?

  Yes

  No

• Provided Patient Centered care?

  Yes

  No

• Were Safeguarding concerns identified?

  Yes

  No

  N/A

• Safeguarding concerns managed appropriately?

  Yes

  No

• Appropriate patient assessments?

  Yes

  No

  N/A

• Effective handovers?

  Yes

  No

  N/A

• Patients escalated appropriately?

  Yes

  No

  N/A

• Identified any Red Flags

  Yes

  No

  N/A

• Recognises any patient deterioration

  Yes

  No

  N/A

• Management of conditions effective?

  Yes

  No

  N/A

• Comments on Patient care

• Any media for Patient care?

  Media

• Choose N/A where the standard was not relevant (such as no risks were present)

• Undertook Dynamic Risk Assessments

  Yes

  No

• Risks managed?

  Yes

  No

  N/A

• Used Safe Systems of Work?

  Yes

  No

  N/A

• Followed policy, procedure and guidance appropriately (inc reporting and escalating AINM?)

  Yes

  No

  N/A

• Comments on Health and Safety

• Any media for Health and Safety?

  Media

• Was the Crew driving during shift?

  Yes

  No

• Any issues or concerns with standard of driving?

  No

  Yes

• SDVI checks completed correctly?

  Yes

  No

  N/A

• Vehicle made ready for transport?

  Yes

  No

  N/A

• All Crew and Patients safe to transport?

  Yes

  No

• Comments on Vehicle use and driving

• Any media for Vehicle use and driving?

  Media

• Worked well in a team?

  Yes

  No

• Acted with Equality, Diversity, and Inclusion?

  Yes

  No

• Legible and accurate record keeping?

  Yes

  No

• Worked within Scope of Practice?

  Yes

  No

• Uses resources appropriately?

  Yes

  No

• Comments for other capabilities

• Any media for this section?

  Media

• Complete one Development section for each goal. A new Development goal can be added by using the green button at the bottom.

Development area

• What is the specific goal for the Crew member?

• How will we know if the goal has been achieved?

• How will the Crew member achieve the development goal?

• What are the suggested Timescales for the development?

• Any risks or safety concerns recorded here will be flagged to the management team automatically. Please ensure you also contact the management team to ensure they are aware.

• Were any critical risks identified during the observation?

  No

  Yes

• Is it safe for the Crew to remain operational?

  Yes

  No

• Has the Crew been informed they are no longer operational?

  Yes

  No

• Any comments on informing the Crew?

Declaration

• I have conducted this observation inline with BRC policy and procedure

  Yes

  No

• Please sign

  Sign