Chest Drain Checklist + Clinical Note Generator

Procedure Date:

Time:

Operator:

Assistant:

Supervisor:

Team members introduce themselves and allocate roles

Yes

Patient identity checked?

Yes

Appropriate consent completed?

Yes

Procedure + site confirmed by patient/consent?

Yes

Site marked & checked against imaging/consent?

Yes

Operator discussed plan (sedation/analgesia/FiO₂)?

Yes

Known drug allergies?

Yes No

Coagulopathy? (drugs/labs)

Yes No

Any contraindications?

Yes No

Verbal confirmation between team members before start

Yes

All team members happy with consent + planned procedure

Yes

All equipment available?

Yes

Is patient position optimal?

Yes

Operator to confirm guidewire removed

Yes N/A

Drain adequately secured?

Yes

Chest X-ray requested?

Yes

Drain connected to appropriate underwater seal?

Yes N/A

Drain placed below patient level?

Yes

Clamp available?

Yes

Suction required?

Yes No

Specimens labelled correctly?

Yes N/A

Post-procedure handover/plan completed?

Yes

Sharps disposed of safely?

Yes

Equipment issues reported?

Yes N/A

Chest Drain Checklist + Clinical Note Generator

BEFORE THE PROCEDURE

TIME OUT

SIGN OUT