Tracheostomy Checklist + Clinical Note Generator

Procedure Date:

Time:

Operator:

Assistant:

Supervisor:

Have all team members introduced themselves & roles assigned?

Yes

Patient identity checked?

Yes

Appropriate consent completed?

Yes

Is all equipment available and checked (tracheostomy, bronchoscopy, reintubation)?

Yes

Is appropriate monitoring attached? (including EtCO₂)

Yes

Previous grade of intubation checked?

Yes

Is the patient optimised for the procedure?

Yes

Is there coagulopathy? (drugs / labs)

Yes No

Known drug allergies?

Yes No

Enteral feed stopped and NG tube aspirated?

Yes

Are spinal precautions required?

Yes No

Any difficulties anticipated?

Yes No

If yes, plans discussed?

Yes

Verbal confirmation between team members before start?

Yes

Patient on appropriate ventilator settings and 100% FiO₂?

Yes

Patient adequately sedated and paralysed?

Yes

Position optimal?

Yes

Tracheostomy position confirmed with bronchoscope?

Yes

Appropriate distance from carina in flexed/extended neck?

Yes

Guidewire removed?

Yes

Capnography in situ?

Yes

Ventilator settings reviewed post-procedure?

Yes

Tracheostomy secured?

Yes

Cuff pressure checked?

Yes

Sedation reviewed?

Yes

Sharps safely disposed?

Yes

Tracheostomy bedhead sign placed?

Yes

Tracheostomy Checklist + Clinical Note Generator

BEFORE THE PROCEDURE

TIME OUT

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