INVASIVE PROCEDURE SAFETY CHECKLIST: ITU Intubation BEFORE THE PROCEDURE PREPARATION TIME OUT SIGN OUT Have all members of the team Verbal confirmation between team members before start of Yes No introduced themselves? procedure Is patient position optimised? Yes No Endotracheal position confirmed (EtCO2 Yes No trace)? Are spinal precautions required? Yes No Were difficult airway plans discussed? Yes No Tube depth checked (B/L Air entry)? Yes No Pre-oxygenate: 100% FiO2 for 3 mins Yes No Is senior help needed? Yes No ETT secured and cuff pressure checked? Yes No Are nasal cannulae for apnoeic Is role allocation clear? (intubator, drugs, Yes No ventilation needed? Yes No Nasal O2 Removed? Yes No assistant, cricoid, MILS) Is a Water’s circuit available and ready? Yes No Appropriate ventilator settings Is difficult airway anticipated? Yes No Yes No Is cricoid pressure considered and NGT confirmed? Any concerns about procedure? Yes No Yes No aspirated? Analgesia and sedation started? Yes No Post intubation sedation ready? If you had any concerns about the procedure, how were Yes No ICP optimisation required? D/W Yes No these mitigated? Neurosurgeon? EQUIPMENT & DRUGS Chest X-Ray required? Is monitoring attached ? (ECG, SpO2, BP Yes No Yes No on regular cycling, Hand over to nursing staff? Yes No Is suction ready? Yes No Is adequate venous access in place? Yes No Are working laryngoscope/s and bougie Signature of Yes No ready? responsible clinician Are endotracheal tube/s ready? Yes No completing the form Are oropharyngeal airways and iGels Yes No available? Is difficult airway trolley likely to be Yes No needed? Procedure date: Are drugs and vasopressors ready? Yes No Time: Any drug allergies known? Yes No Operator: TEAM Observer: Is senior help needed? Yes No Assistant: Is role allocation clear? (Intubator, drugs, Yes No assistant, cricoid, MILS) Level of supervision: SpR Consultant Is difficult airway anticipated? Equipment & trolley Yes No prepared:
INVASIVE PROCEDURE SAFETY CHECKLIST: ITU Intubation BEFORE THE PROCEDURE PREPARATION Have all members of the team introduced themselves? Yes No Is patient position optimised? Yes No Are spinal precautions required? Yes No Pre-oxygenate: 100% FiO2 for 3 mins Yes No Are nasal cannulae for apnoeic ventilation needed? Yes No Is a Water’s circuit available and ready? Yes No Is cricoid pressure considered and NGT aspirated? Yes No Post intubation sedation ready? Yes No EQUIPMENT & DRUGS Is monitoring attached ? (ECG, SpO2, BP on regular cycling, Yes No Is suction ready? Yes No Is adequate venous access in place? Yes No Are working laryngoscope/s and bougie ready? Yes No Are endotracheal tube/s ready? Yes No Are oropharyngeal airways and iGels available? Yes No Is difficult airway trolley likely to be needed? Yes No Are drugs and vasopressors ready? Yes No Any drug allergies known? Yes No TEAM Is senior help needed? Yes No Is role allocation clear? (Intubator, drugs, assistant, cricoid, MILS) Yes No Is difficult airway anticipated? Yes No TIME OUT Verbal confirmation between team members before start of procedure Were difficult airway plans discussed? Yes No Is senior help needed? Yes No Is role allocation clear? (intubator, drugs, assistant, cricoid, MILS) Yes No Is difficult airway anticipated? Yes No Any concerns about 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 Endotracheal position confirmed (EtCO2 trace)? Yes No Tube depth checked (B/L Air entry)? Yes No ETT secured and cuff pressure checked? Yes No Nasal O2 Removed? Yes No Appropriate ventilator settings confirmed? Yes No Analgesia and sedation started? Yes No ICP optimisation required? D/W Neurosurgeon? Yes No Chest X-Ray required? Yes No Hand over to nursing staff? Yes No Signature of responsible clinician completing the form
invasive_procedure_safety_checklist_-_itu_intubation_word_version.docx