Procedure Checklists & Role-Based Instructions Bundle

1. Medication Preparation (Nurse / Pharmacist)

1. Confirm patient identity (2 identifiers) and indication. Verification: Name + DOB aloud.
2. Review medication order: drug, dose, route, rate, frequency, allergies, and interactions.
3. Select correct medication and check label against order. Verification: Read drug name and concentration aloud (two-person verification for high-risk meds).
4. Calculate dose and prepare using aseptic technique as required.
5. Inspect for clarity, particulate matter, expiration date, and correct diluent.
6. Label syringe/infusion bag with drug name, concentration, preparer initials, and time prepared.
7. Perform final bedside check before administration: patient identifiers, medication, dose, route, time, and documentation. Patient prompt: “I’m about to give you [drug name]. Do you have any questions or known allergies?”
8. Document administration and any patient response immediately.

Key safety notes: Use independent double-checks for high-risk medications (insulin, anticoagulants, chemo). When magnet or barcode scanning is available, require it for verification steps.

2. Central-Line Dressing Change (RN / Wound Care)

1. Explain procedure to patient and obtain verbal consent. Place patient in appropriate position and lighting.
2. Gather supplies on a sterile field; check expiration dates and integrity.
3. Perform hand hygiene and apply appropriate PPE (sterile gloves, mask, gown, eye protection as indicated).
4. Don sterile gloves and remove old dressing using aseptic technique; observe and note site condition (redness, drainage, tunneling).
5. Cleanse catheter site using recommended antiseptic (e.g., chlorhexidine) following manufacturer dwell and drying times. Verification: full 30-second scrub and dry.
6. Allow site to fully dry; apply barrier or antimicrobial dressing per protocol.
7. Secure catheter and ensure tubing is properly coiled or anchored to reduce tension.
8. Dispose of waste, remove PPE, perform hand hygiene, and document dressing integrity, findings, and patient education provided.

Patient prompt: “I’m going to change the dressing on your central line to lower infection risk. Tell me if you feel pain or see redness.”

Key safety notes: If signs of infection are present, stop and notify provider. Use checklist stop-points for sterile field breaches.

3. Intubation Tray Preparation (Respiratory Therapist / RN / Physician Assistant)

1. Confirm indication and anticipated difficulty; communicate plan with the team (role assignments: airway lead, medication nurse, equipment manager, recorder).
2. Gather and check equipment: laryngoscope (blade and handle), endotracheal tubes (various sizes), stylet, suction, bag-valve mask, oxygen source, capnography/circuit, tape/securement device, medications (sedative, paralytic, vasopressor), and backup airway devices (LMA, bougie).
3. Check functionality: laryngoscope light, suction, oxygen flow, and availability of backup devices. Verification: audible suction and light check aloud.
4. Prepare medications in labeled syringes and have reversal/adjunct medications available.
5. Place monitoring (pulse oximetry, ECG, capnography) and ensure suction is ready at bedside.
6. Brief the team with a two-minute airway timeout: patient status, plan A/B/C, confirmation method (capnography), and post-intubation order set.
7. Document pre-procedure checks and time-out completion.

Patient prompt (if awake): “We will place a breathing tube to help you breathe. I will explain each step.”

Key safety notes: Have difficult airway cart accessible and assign a team member to initiate emergency front-of-neck access if needed per local protocol.

4. Bedside Handoff (Nurse-to-Nurse / Interdisciplinary)

1. Conduct handoff at the bedside with both nurses and the patient/family present when possible.
2. Confirm patient identity (2 identifiers) with the patient and receiving clinician.
3. Use a short standardized framework (e.g., Situation-Background-Assessment-Recommendation): current problem, recent changes, critical tasks, outstanding orders, and anticipated events.
4. Verify lines/tubes/oxygen, infusion rates, pending labs/imaging, isolation status, and allergies.
5. Discuss safety risks (falls, pressure ulcers, infection risk) and mitigation actions taken.
6. Agree on 1–2 priority tasks to be completed within the next hour and document handoff completion.
7. Invite patient/family questions and confirm their understanding of the immediate plan.

Key safety notes: Always perform a physical tour of the bedside including checking drains, dressings, and devices; never rely solely on verbal summary.

5-Minute Observed-Competency Coaching Script

1. Introduce yourself and set a 5-minute expectation: “I’ll watch a single complete task and give two quick coaching points.”
2. Ask the clinician to perform the procedure at normal pace. Observe silently, noting critical verification steps and any deviations.
3. After completion, praise one specific action that met the standard.
4. Offer one focused corrective suggestion with demonstration if needed. Ask the clinician to repeat the missed step until performed correctly (micro-practice).
5. Confirm competency outcome (Pass / Needs Practice) and document date, coach initials, and any follow-up training required.

Passing criteria example: Completed all required verification steps, maintained aseptic technique where applicable, and communicated with patient appropriately. If any critical step missed, mark Needs Practice and schedule a second coached attempt within 24–72 hours.

Tailoring and Implementation Tips

• Customize wording to local role titles, medication names, equipment brands, and exact antiseptic dwell times per facility policy.
• Limit each checklist to essential safety steps and 6–10 items; consider a one-page pocket card for quick reference.
• Integrate with bedside barcode scanning, EHR order links, or the site’s observed-competency tracking when available.
• Run short simulation sessions using the 5-minute coaching script to build familiarity and acceptance.

Suggested KPIs and Audit Questions

• Percent of medication preparations with completed double-check for high-risk meds.
• Percent of central-line dressing changes meeting sterile checklist items on audit.
• Percent of bedside handoffs that included patient and verification of two identifiers.
• Audit question examples: Was antiseptic applied for the recommended dwell time? Was the final bedside verification performed and documented?

Documentation & Ownership

Assign a local owner (unit educator or clinical lead) for version control and regular review. Store the canonical checklist in your team’s domain so units can copy and adapt while preserving a central master version.

Accessibility & Training

Use laminated quick-reference cards, brief video demonstrations, and the 5-minute coaching script during onboarding. Encourage managers to schedule short observed-competency checks during the first week of new hires and quarterly thereafter.

Notes on Safety and Scope

These checklists are designed to support safe practice and consistent onboarding. They are not a substitute for facility policies, manufacturer instructions, or professional judgment. Always follow local protocols and escalation pathways for abnormal findings.