NMC Annexe B Procedures: A Student Nurse’s Checklist by Placement Area
How to target and evidence mandatory Annexe B clinical procedures across adult, surgical, critical care, and community placements.
Key Clinical Takeaway
NMC Annexe B lists 66 core nursing procedures divided into Part 1 (procedures for assessing needs) and Part 2 (procedures for planning, providing and evaluating care). Students should strategically align proficiencies with clinical placement settings: acute medical wards for venepuncture and ECGs; surgical units for ANTT wound care and urinary catheterisation; critical care for airway suctioning and arterial lines; and community settings for syringe drivers and palliative symptom control.
NMC Annexe B Procedure Targeting Across Core UK Placement Areas
| Placement Area | High-Priority Annexe B Procedures | Assessment Method in PAD | Supervisor Sign-Off Tip |
|---|---|---|---|
| Acute Medical Ward | Venepuncture (B2.1), 12-lead ECG (B1.11), blood glucose monitoring, subcutaneous insulin | Direct observation & clinical rationale discussion | Record baseline NEWS2 interpretation alongside ECG trace verification |
| General Surgery / Orthopaedics | Aseptic Non-Touch Technique (ANTT, B2.4), male & female catheterisation (B2.11), wound drains, IV fluids | Direct observation & post-op infection prevention reflection | Evidence adherence to epic3 catheter guidelines and aseptic field integrity |
| Critical Care (ICU / HDU / ED) | Oropharyngeal/tracheal suctioning (B2.8), pulse oximetry, arterial line sampling, blood transfusions | Direct observation & simulation where appropriate (ASPiH) | Highlight alarm recognition, respiratory rate assessment & rapid escalation |
| Community / District Nursing | Subcutaneous syringe drivers (McKinney), compression bandaging, leg ulcer assessment, enteral tube feeds | Holistic home assessment & patient education observation | Document environmental risk assessment and lone-working safety |
| Mental Health & CAMHS | Mental State Examination (MSE), metabolic monitoring for antipsychotics, de-escalation, suicide risk assessment | Reflective observation & multidisciplinary handover notes | Evidence parity of esteem by documenting physical health monitoring in MH |
1. Acute Medical and Assessment Units: Diagnostic & Baseline Proficiencies
Acute medical assessment units (AMU) and elderly care wards provide rapid opportunities to evidence Annexe B Part 1 diagnostic procedures.
Focus on: recording and interpreting a full 12-lead electrocardiogram (ECG, B1.11); performing venepuncture for diagnostic blood samples (B2.1); blood glucose monitoring and safe insulin administration; and comprehensive nutritional screening using the MUST tool (B1.6).
When evidencing these skills in your PAD, include your clinical reasoning: why was the ECG indicated, what baseline values were noted, and how did you escalate abnormal findings using NEWS2?
2. Surgical Wards: Invasive Procedures, ANTT, and Post-Operative Monitoring
Surgical placements are the primary environment for invasive procedural competencies, particularly urinary catheterisation (B2.11) and surgical wound care using the Aseptic Non-Touch Technique (ANTT, B2.4).
Ensure you gain experience in both female and male catheterisation under direct supervision, paying strict attention to sterile draping, local anaesthetic gel dwell time (5-10 minutes in males), and drainage bag positioning.
Surgical placements also provide essential opportunities to observe and manage wound drains, patient-controlled analgesia (PCA) pumps, and intravenous infusion maintenance.
3. Community and Primary Care: Chronic Disease & Palliative Interventions
Community and district nursing teams offer unique exposure to complex ongoing procedures delivered in patients’ homes.
Key Annexe B skills to target include: administration of continuous subcutaneous medications via syringe drivers (e.g., McKinley T34); percutaneous endoscopic gastrostomy (PEG) care and enteral feeding; compression therapy for venous leg ulcers; and diabetic foot risk stratification (NICE NG19).
Community documentation must reflect patient independence, consent, and adaptation of techniques to domestic home environments while maintaining strict infection prevention.
4. Critical Care, HDU, and Emergency: Advanced Airway & Deterioration
Emergency and critical care environments allow students to evidence proficiencies that cannot be safely achieved on general wards.
These include: shallow and deep oropharyngeal and nasopharyngeal airway suctioning (B2.8); application of non-invasive ventilation interfaces (CPAP/BiPAP); blood component transfusion monitoring; and Glasgow Coma Scale (GCS) neurological monitoring.
Where live clinical opportunities for rare emergency procedures are limited, check with your university whether simulated practice hours under ASPiH guidelines can be utilised.
Frequently Asked Questions
Can I be signed off for venepuncture and cannulation in Year 1?
Most UK universities restrict invasive vascular procedures to Part 2 (Year 2) or Part 3 (Year 3) after theoretical training and simulation have been passed. Check your course handbook for university-specific prerequisites.
What if my placement area does not offer opportunities for male catheterisation?
Discuss this early with your Practice Assessor and Practice Educator. You can arrange a "spoke" shift with the surgical admissions unit, urology day case, or the continence team, or complete approved university simulation under ASPiH standards.
Does observing a procedure count as achieving the Annexe B proficiency?
No. Observation (demonstrating understanding) is formative preparation. To achieve summative sign-off, you must demonstrate hands-on clinical competence under appropriate supervision in accordance with your university PAD grading criteria.
