Clinical Skills Ltd

Clinical Skills Ltd http://clinicalskills.net is a web-based learning programme and reference tool, regularly updated by our specialist authors and editors.

Anyone who is studying clinical skills will find that clinicalskills.net gives them invaluable help. This user-friendly set of illustrated clinical skills guidelines is a great reference tool. It will help you understand the principles of a particular skill, so that you make the most of your time in the skills lab. Those with more experience will want to check their practice against the evidence-b

ased best practice shown in clinicalskills.net. The package features a wide range of skills and all are regularly updated by our specialist authors and editors.

Updates to three guides in our Ear care category:https://app.clinicalskills.net/shared/category/13• Ear examination• Ins...
02/06/2026

Updates to three guides in our Ear care category:
https://app.clinicalskills.net/shared/category/13

• Ear examination
• Instillation of ear drops
• Basic hearing tests

These fully illustrated guides have been updated by the authors and have also been double-blind peer reviewed. The author for “Ear Examination” and “Instillation of ear drops” is Linda Mills, Independent Nurse Consultant (Ear Care) in South Yorkshire. The author for “Basic hearing tests” is Andrew Petty, NHS Emergency Nurse Practitioner.

Competency checklists accompany these guides. These can be used to assist with staff development and assessment.

– Ear examination

It is important to perform an ear examination if the patient complains of any otalgia (ear pain), otorrhoea (discharge) or hearing loss, and before performing microsuction, ear irrigation or any other interventions involving the use of instruments.

Healthcare professionals should be familiar with the basic anatomy and physiology of the ear, as described in this guide, before performing an ear examination.

This guide demonstrates how to perform an ear examination, including the observation and palpation of external structures (pinna, tragus and the mastoid area), and using an otoscope to examine the ear canal and the tympanic membrane.

The guide also describes some conditions that may be observed during the examination. The healthcare professional should manage any abnormal findings if competent to do so or escalate to an appropriate healthcare professional as needed.

– Instillation of ear drops

Ear drops can be used to treat ear infections or to aid in the removal of excess ear wax. They may also be used to soften ear wax in advance of irrigation.

This guide demonstrates the instillation of ear drops into a patient’s ears. The principles shown are also useful when explaining to patients how to self-administer ear drops.

– Basic hearing tests

Hearing loss may be sensorineural or conductive. This guide describes the causes of both types of hearing loss.

Three basic hearing tests are demonstrated in the guide. A simple whispered word test can be used to identify if one ear has reduced hearing compared to the other. The Weber and Rinne tests involve the use of a tuning fork.

All three tests, when used together, can aid the healthcare professional in determining which type of hearing loss is affecting the patient and whether the hearing loss is unilateral or symmetrical.

Routine hand hygiene – updated guidehttps://app.clinicalskills.net/shared/procedure/12This fully illustrated guide has b...
26/05/2026

Routine hand hygiene – updated guide
https://app.clinicalskills.net/shared/procedure/12

This fully illustrated guide has been updated by Satu Hakala, Senior Lecturer in Simulated Learning and Clinical Skills at Kingston University London. The guide has also been double-blind peer reviewed.

It is important for healthcare professionals to correctly decontaminate their hands, in order to break the chain of infection and thereby reduce the risk of healthcare-associated infections.

This guide discusses the critical points when hand hygiene should be performed and describes the correct technique for decontaminating your hands using either soap and water or an appropriate hand sanitiser. The guide also considers when hand sanitisers can be used and situations where they are not appropriate.

Performing regular hand hygiene can irritate the skin, so good skin care is important. The guide includes information on occupational dermatitis and the use of hand cream.

A competency checklist accompanies this guide, which can be used to assist with staff development and assessment.

Updates to four Venous Access Device guideshttps://app.clinicalskills.net/shared/category/23• Accessing and care of a pe...
19/05/2026

Updates to four Venous Access Device guides
https://app.clinicalskills.net/shared/category/23

• Accessing and care of a peripherally inserted central catheter (PICC)
• Accessing and care of a midline catheter
• Accessing and care of a skin-tunnelled catheter
• Accessing and care of a totally implanted venous access device

Peripherally inserted central catheters (PICCs), skin-tunnelled catheters and implanted ports provide central venous access, with the tip of the catheter sitting in the superior vena cava or the upper right atrium. With midline catheters, the tip remains in the peripheral vascular system.

These devices can all be used to administer medications and fluids, as well as to collect blood samples for diagnostic testing.

Each device has advantages and disadvantages, and the choice of device will also depend on the duration of its requirement. For example, midline catheters are typically in place for 1–4 weeks, whereas implanted ports can remain indefinitely.

These fully illustrated guides include details of the correct positioning of the different catheters, the indications for their use, flushing, anchoring and changing dressings.

Competency checklists accompany these guides. These can be used to assist with staff development and assessment.

Celebrating International Nurses Day 2026
12/05/2026

Celebrating International Nurses Day 2026

Equilibrium and venting methods for reconstituting powdered medications – updated guidehttps://app.clinicalskills.net/sh...
12/05/2026

Equilibrium and venting methods for reconstituting powdered medications – updated guide
https://app.clinicalskills.net/shared/procedure/396

This fully illustrated guide has been reviewed by Kathleen Greenway, Associate Professor in Adult Nursing at Oxford Brookes University. The guide has also been double-blind peer reviewed.

Always follow the manufacturer’s guidelines carefully when reconstituting medication, including the correct type and quantity of diluent, and ensure that the contents of the vial are fully dissolved in the diluent.

The guide demonstrates both the equilibrium and venting methods for reconstituting and drawing up medications that need to be stored in a powdered format. This update includes additional notes on how to draw up the reconstituted medication when the full amount of solution is not required (e.g., for multidose vials or when a specific volume is required).

The guide also illustrates how to label and store the vial and/or syringe if, for example, they contain multiple doses. If giving more than one medicine by injection, and if the syringe is put down between doses, it is important to label syringes clearly to reduce the risk of errors in administration.

Medication errors in children – NEW GUIDEhttps://app.clinicalskills.net/shared/procedure/611This fully illustrated guide...
05/05/2026

Medication errors in children – NEW GUIDE
https://app.clinicalskills.net/shared/procedure/611

This fully illustrated guide is by Alison Taylor, Senior Lecturer in Child Health Nursing, University of Brighton. The guide has been double-blind peer reviewed.

Children are a high-risk group for medication errors. Physiological factors such as variation in weight, body surface area, growth, organ maturity and fluid distribution increase the potential for harm.

Medication administration is the stage of the medication journey at which errors are most likely to occur. Nursing staff are the healthcare professionals who are most involved in this stage and are therefore often considered accountable, even when this accountability may be unjust.

Making a medication error can be a stressful and demoralising experience, especially when vulnerable children are involved. Employers should operate an open culture and encourage the reporting of incidents and near misses.

This guide covers:

• Factors that may contribute towards medication errors;
• Prescribing errors;
• Transcribing errors;
• Dispensing errors;
• Storage errors;
• Preparation and administration errors;
• Calculation errors;
• Identifying and reporting errors.

Update to two guides from our Diabetes Care category:https://app.clinicalskills.net/shared/category/39• Measuring waist ...
28/04/2026

Update to two guides from our Diabetes Care category:
https://app.clinicalskills.net/shared/category/39

• Measuring waist circumference:

Central obesity (excess fat around the abdomen) is a key risk factor in the development of type 2 diabetes and is a known risk factor for insulin resistance.

Waist circumference measures abdominal obesity and is a very useful tool to help determine a person’s risk of developing type 2 diabetes. It is also useful when giving advice to people who have been diagnosed with type 2 diabetes regarding weight loss. This fully illustrated guide shows how to use anatomical landmarks to correctly identify a person’s waist and record an accurate waist measurement. It also shows an alternative method to measure the waist circumference when it may be difficult to identify the landmarks (e.g., in overweight people, or when carrying out the measurement in a setting where there is limited privacy).

It also shows how to calculate the body mass index (BMI); an alternative method of calculating a person’s risk of developing type 2 diabetes and cardiovascular disease.

• Self-monitoring of capillary blood glucose

The aim of diabetes management and treatment is to maintain blood glucose levels within a particular range, to help prevent serious long-term complications. The target levels for blood glucose vary according to individual need; patients will have agreed these levels with the clinician providing their diabetes care but should aim for between 4–7 mmol/L 2 hours after a main meal.

Blood glucose readings can help to guide patients and healthcare professionals in making the right decisions regarding lifestyle and treatments and thus maintain blood glucose levels within the target range. Blood glucose testing can also help to improve the patient’s awareness of the impact of diet and exercise on blood glucose levels as well as symptoms of hypoglycaemia and hyperglycaemia.

This guide covers how to use a blood glucose monitor either to check the patient’s blood glucose level or to show the patient how to do so.

Competency checklists accompany these guides. These can be used to assist with staff development and assessment.

Active birth: Birthing positions – updated guide:https://app.clinicalskills.net/shared/procedure/490This fully illustrat...
23/04/2026

Active birth: Birthing positions – updated guide:
https://app.clinicalskills.net/shared/procedure/490

This fully illustrated guide has been updated by Sam Copping, Lecturer in Midwifery, University of Suffolk. This guide has been double-blind peer reviewed.

During every stage of labour, midwifery staff should encourage and support the woman/birthing person to be as mobile as possible by helping them to safely adopt a position that they find the most comfortable, and to change positions as frequently as they wish, depending on the clinical situation.

Empowering and supporting women to adopt a range of positions for labour and birth promotes physiological labour and the release of oxytocin.

It is common for women to give birth in supine positions. However, there are benefits for labour and birth that are associated with adopting upright positions, such as kneeling, standing or squatting.

This guide describes a variety of positions that women can adopt in labour. This guide also covers a variety of helpful aids that are available to support positions for active birth, such as a:

• Birthing pool;
• Peanut ball;
• Birthing ball;
• Birthing mat;
• Birthing bar;
• Rebozo;
• Birthing stool;
• Inflatable stool.

Updates to three guides in our Medicines Management category:https://app.clinicalskills.net/shared/category/9• Medicines...
21/04/2026

Updates to three guides in our Medicines Management category:
https://app.clinicalskills.net/shared/category/9

• Medicines administration Part 1: Prescribers and prescriptions

• Medicines administration Part 2: Pre-administration checks

• Medicines administration Part 3: Administering the medication

These fully illustrated guides have been updated by Edda Hensler, Senior Lecturer in Nursing, School of Education, Sport and Health Sciences, University of Brighton, and Martina O’Brien, Senior Lecturer in Nursing, Brunel University London. The guides have undergone double-blind peer review.

Patients use medication more than any other intervention to manage their medical conditions. The number of prescriptions, as well as the complexity of the medication regimens that patients take, has continued to rise with increasing life expectancy and the management of multiple conditions.

Nurses are at the centre of medicines management and are therefore in an ideal position to support the safe and cost-effective use of medication to achieve the greatest benefit for patients while minimising potential harm.

Medicines safety is a team effort; nurses, midwives and nursing associates all have an important role in ensuring that healthcare professionals work together effectively to achieve this.

The Nursing and Midwifery Council (NMC) states that staff who administer medicines are responsible for ensuring that prescribers adhere to the Royal Pharmaceutical Society’s competency framework for prescribers, and that patient safety is not at risk.

Part 1 of this series (Prescribers and prescriptions) covers:

• Patient specific directions, patient group directions and verbal orders;
• Paper-based and electronic prescribing and medication administration records;
• Types of prescribers.

Part 2 of this series (Pre-administration checks) outlines:

• Gaining informed consent;
• Pre-administration checks.

Part 3 of this series (Administering the medication) describes:

• The six rights of safe medicines administration;
• Administering the medicine;
• Monitoring the patient;
• Reporting adverse drug reactions;
• Safe disposal of medicines;
• Supporting adherence through patient education.

Three NEW guides in our Observations in Midwifery category:https://app.clinicalskills.net/shared/category/127– Measuring...
16/04/2026

Three NEW guides in our Observations in Midwifery category:
https://app.clinicalskills.net/shared/category/127

– Measuring oxygen saturation during the perinatal period

Oxygen saturation levels are used to support the detection and escalation of deteriorating maternal condition. They guide the use of oxygen therapy to maintain oxygen saturations in a normal range, thus correcting potentially harmful hypoxaemia.

Pulse oximetry is used to measure oxygen saturation.

This guide covers how pulse oximeters work and how to use them, including:

• Choosing the most appropriate probe site;
• Cleaning and preparing the probe site;
• Attaching the probe;
• Troubleshooting issues that may cause inaccurate readings.

– Recording temperature during the perinatal period

Maternal temperature is a vital sign that is routinely monitored during the intrapartum period and during admissions to hospital in the antenatal and postnatal periods.

Detecting changes in the maternal temperature, alongside clinical assessment, can provide an indication of the woman/birthing person’s condition and the severity of illness.
This guide covers how to use disposable single-use devices, electronic thermometers and tympanic thermometers to record temperature.

– Assessment of respiration during the perinatal period

The respiratory rate is an important vital sign. Abnormal values are often seen before changes to the other vital signs in a deteriorating person. Changes in respiratory rate are often the earliest warning of sepsis, shock and respiratory insufficiency, and require early and prompt escalation.

This guide covers:

• The function of the respiratory system;
• How to assess the depth, rhythm and pattern of breathing;
• Other important observations to consider, e.g., cyanosis, pain, confusion and restlessness.

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