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 6: Donning PPE

Checklist 7: Doffing PPE

Checklist 8: BBF Exposure

Checklist 9: Entering the OR

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 14: Pain Assessment

Checklist 15: Vital Signs

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 39 Staple Removal

Checklist 40 Emptying a Closed Wound Drainage System

Checklist 41 Drain Removal

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)

Checklist 64: Administering an Intermittent IV Medication by a Minibag using an Existing Secondary Line.

Chapter 8

Checklist 65: Assessing an IV System

Checklist 66: Priming IV Tubing

Checklist 67: Changing an IV

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)


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Clinical Procedures for Safer Patient Care Copyright © 2018 by Thompson Rivers University is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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