Appendix 2: Checklists – Summary and Links
Chapter 1
Checklist 1: Routine Practices
Checklist 2: Five Key Moments in Hand Hygiene
Checklist 3: Hand Hygiene with ABHR
Checklist 4: Hand Hygiene with Soap and Water
Checklist 5: Applying and Removing Non-Sterile Gloves
Checklist 10: Surgical Hand Scrub with Medicated Soap
Checklist 11: Donning Sterile Gloves
Checklist 12: Preparing a Sterile Field
Chapter 2
Checklist 13 Health History Checklist
Checklist 16: Head and neck / Neurological assessment
Checklist 17 Chest / Respiratory Assessment
Checklist 18 Cardiovascular (CV) Assessment
Checklist 19 Abdominal / Gastrointestinal Assessment
Checklist 20 Genitourinary Assessment
Checklist 21 Musculoskeletal Assessment
Checklist 22 Integument Assessment
Checklist 23 Quick Priority Assessment
Chapter 3
Checklist 24 Risk Assessment for Safer Patient Handling
Checklist 25 Moving a patient from bed to stretcher
Checklist 26 Bed to Wheelchair Transfer – one person assist
Checklist 27 Moving a patient up in bed
Checklist 28 Positioning a Patient to the Side of the Bed
Checklist 29 Assisting a Patient to a Sitting Position
Checklist 30 Assisting to ambulate using a gait belt / transfer belt
Checklist 31 Ambulating with a walker
Checklist 32 Ambulating with crutches
Checklist 33 Ambulating with a cane
Checklist 34 Lowering a Patient to the Floor
Chapter 4
Checklist 35 Simple Dressing Change
Checklist 36 Wet to moist dressing changes
Checklist 37 Wound Irrigation and Packing
Checklist 38 Intermittent Suture Removal
Checklist 40 Emptying a Closed Wound Drainage System
Chapter 5
Checklist 42 Applying and Titrating Oxygen Therapy
Checklist 43 Oral Suctioning with Yankeur suction tip
Checklist 44: Oropharyngeal suctioning
Chapter 6
Checklist 45: Administering Medication by Mouth
Checklist 46: Administering Medication via a Gastric Tube
Checklist 47: Medication Administered Rectally
Checklist 48: Medication Administered Vaginally
Checklist 49: Instilling Eye (Ophthalmic) Medications
Checklist 50: Instilling Ear (Otic) Medications
Checklist 51: Instilling Nasal Medications
Checklist 52: Medication by Small-Volume Nebulizer
Checklist 53: Medication by Metered Dose Inhaler (MDI)
Checklist 54 Medication by Dry Powder Inhaler (DPI)
Checklist 55: Applying a Transdermal Patch
Checklist 56: Applying Topical Creams, Lotions, and Ointments
Chapter 7
Checklist 57: Administering an Intradermal (ID) Injection
Checklist 58: Subcutaneous Injections
Checklist 59: Administering a Z track Intramuscular Injection
Checklist 60: Administering medications IV Direct into a Locked / Capped IV
Checklist 61: Administering Medication IV Direct into an Infusing IV with Compatible Solution
Checklist 62 Administering IV Direct into an Infusing IV with Incompatible IV Solution
Checklist 63: Administering an Intermittent IV Medication by a Minibag (inital dose)
Chapter 8
Checklist 65: Assessing an IV System
Checklist 66: Priming IV Tubing
Checklist 68 Changing IV Tubing
Checklist 69: Flushing a PVAD – short Saline Lock
Checklist 70: Flushing a CVAD (PICC and Percutaneous Non hemodialysis)
Checklist 71: Removing a PVAD – short cannula / Peripheral Midline Catheter
Checklist 72: Removing a Percutaneous Non hemodialysis CVC/ PICC
Checklist 73: Changing an IV site dressing – no additional securement devices
Checklist 74: Changing an IV site dressing involving a securement device
Checklist 75 Pretransfusion Preparation
Checklist 76 Transfusion of Blood and Blood Products
Checklist 77: Managing a Blood or Blood Product Transfusion Reaction
Checklist 78: PN Administration
Chapter 9
Checklist 79: Blood Glucose Monitoring
Chapter 10
Checklist 80: Inserting a Nasogastric Tube – Adult
Checklist 81: Removal of an NG Tube
Checklist 82: Insertion of an Intermittent or Indwelling Urinary Catheter
Checklist 83: Removing an Indwelling Catheter
Checklist 84: Tracheal Suctioning – open method
Checklist 85: Replacing and Cleaning an Inner Tracheal Cannula
Checklist 86: Cleaning Stoma and Changing a Sterile Dressing
Checklist 87: Replacing Tracheostomy Ties (Velcro or Twill Tape)
Checklist 88: Care and management of a Closed Chest Tube Drainage System
Checklist 89: Changing an Ostomy Appliance (flange and pouch)
