INVASIVE PROCEDURE SAFETY CHECKLIST: Chest Drain Equipment & trolley BEFORE THE PROCEDURE prepared: Indication e.g. Pneumothorax, Pleural Effusion… TIME OUT Verbal confirmation between team members before start of Patient identity checked as procedure Yes No correct? Is patient on adequate Yes No Does the procedure need to ventilator SIGN OUT be Yes No settings and 100% FiO2? Sutures, tubing and dressing performed ASAP? Is patient adequately sedated Yes No Yes No secured? Appropriate consent completed? Yes No and Patient advised about care Is suitable drain and paralysed? and equipment available? Is position optimal? Yes No Yes No not elevating drain above the Yes No (including ultrasound All team members identified Yes No chest? guidance) and Analgesia prescribed? Yes No Confirm site of clinical roles assigned? In effusion, confirm no more Yes No abnormality Yes No Any concerns procedure? than 500ml is drained in the Correlates clinical signs with Yes No If you had any concerns about the procedure, how were first 1 hour or no more than Yes No CXR? these mitigated? 1500mls in the first 24 hours? Medicines and coagulation Yes No Request X-ray to confirm checked? Yes No position? Any drug allergies Known? Yes No Verbal handover to Nurse Safe site of drain insertion Yes No responsible Yes No identified? for patient? Are there any concerns about Yes No this procedure for the patient? Names and registering body numbers of clinicians Signature of responsible for the procedure responsible clinician 1. completing the form Procedure date: 2. Time: 3. Operator: Observer: Assistant: Level of supervision: SpR Consultant
INVASIVE PROCEDURE SAFETY CHECKLIST: Chest Drain BEFORE THE PROCEDURE Indication e.g. Pneumothorax, Pleural Effusion… Patient identity checked as correct? Yes No Does the procedure need to be performed ASAP? Yes No Appropriate consent completed? Yes No Is suitable drain and equipment available? (including ultrasound guidance) Yes No Confirm site of clinical abnormality Yes No Correlates clinical signs with CXR? Yes No Medicines and coagulation checked? Yes No Any drug allergies Known? Yes No Safe site of drain insertion identified? Yes No Are there any concerns about this procedure for the patient? Yes No Names and registering body numbers of clinicians responsible for the procedure 1. 2. 3. TIME OUT Verbal confirmation between team members before start of procedure Is patient on adequate ventilator settings and 100% FiO2? Yes No Is patient adequately sedated and paralysed? Yes No Is position optimal? Yes No All team members identified and roles assigned? Yes No Any concerns procedure? Yes No If you had any concerns about the procedure, how were these mitigated? Procedure date: Time: Operator: Observer: Assistant: Level of supervision: SpR Consultant Equipment & trolley prepared: SIGN OUT Sutures, tubing and dressing secured? Yes No Patient advised about care and not elevating drain above the chest? Yes No Analgesia prescribed? Yes No In effusion, confirm no more than 500ml is drained in the first 1 hour or no more than 1500mls in the first 24 hours? Yes No Request X-ray to confirm position? Yes No Verbal handover to Nurse responsible for patient? Yes No Signature of responsible clinician completing the form
invasive_procedure_safety_checklist_-_chest_drain_word_version.docx