Procedure Preparation Checklist

Procedure Information

Date & Time of Procedure

Procedure Name

Patient Name

Supervising Instructor/Preceptor

Knowledge Review - BEFORE Procedure

Instructions: Complete BEFORE attempting the procedure. Knowledge review ensures you understand the what, why, and how of the procedure.

Step 1: Read Procedure Protocol

Protocol Review Checklist

Read facility procedure protocol OR textbook protocol

Understand each step and the rationale (why we do it this way)

Identify potential complications and warning signs

Understand safety precautions and infection control measures

Step 2: Watch Procedure Demonstration

Video/Demonstration Review

Watch procedure video OR demonstration by instructor (if available)

Note technique details - how hands are positioned, movements, timing

Note potential challenges and how to handle them

Prepare questions to ask instructor before performing

Step 3: Understand Indications & Patient Factors

Procedure Indication (Why is patient getting this procedure?)

Patient-Specific Considerations

Contraindications to Check

Patient Preparation

Step 4: Communication & Consent

Patient Communication Checklist

Explain procedure to patient in understandable, non-technical language

Explain WHY the procedure is being done

Tell patient approximately how long procedure will take

Explain what sensations patient may feel (pressure, discomfort, temperature)

Answer all patient questions honestly and completely

Obtain verbal consent (written consent per facility protocol if required)

Step 5: Physical Preparation

Patient Physical Preparation Checklist

Ensure privacy - close curtain/door

Position patient appropriately and comfortably for procedure

Drape patient appropriately to maintain privacy and modesty

Ensure good access to area for procedure

Offer comfort measures (pillows, blanket, pain relief if needed)

Ensure call bell is within reach

Supply & Environment Preparation

Step 6: Gather & Check Supplies

Supply Checklist

Know all supplies needed for procedure (review protocol)

Gather ALL supplies before beginning (don't stop mid-procedure)

Verify sterile supplies are unopened and within expiration date

Test equipment is functioning (lights, power cords, batteries)

Organize supplies within easy reach in order of use

Step 7: Prepare Environment

Environment Preparation Checklist

Ensure adequate lighting on procedure area

Set up work area (if sterile procedure, maintain sterile field)

Ensure comfortable room temperature

Ensure all supplies and equipment are within reach without contamination

Minimize interruptions - post sign if appropriate

Self Preparation

Step 8: Personal Preparation

Hand Hygiene & PPE Checklist

Perform hand hygiene (wash or hand sanitizer)

Put on non-sterile gloves if indicated

Don sterile gloves using proper aseptic technique if required

Put on gown/apron if needed to prevent contamination of clothes

Use mask/eye protection if risk of splashing

Take a moment - visualize the procedure, mentally practice steps

Procedure Execution

Step 9: Procedure Performance

CRITICAL DURING PROCEDURE: Follow steps in order per protocol. Maintain aseptic/sterile technique. Watch for patient reaction. Communicate throughout. Ask for help if needed.

During Procedure Checklist

Follow protocol steps IN ORDER - do not skip steps

Maintain aseptic/sterile technique throughout

Continuously watch for patient signs of distress or discomfort

Communicate with patient - reassure, explain what you're doing

Don't hesitate to ask for help if needed

Maintain control of sterile field and avoid contamination

Monitor time - ensure procedure isn't taking excessively long

Procedure Complications Observed (if any)

Post-Procedure Care

Step 10: Patient Assessment & Comfort

Post-Procedure Patient Care Checklist

Assess patient response to procedure - pain level, vital signs if needed

Address any discomfort - position changes, pain relief

Ensure patient is safe and in comfortable position

Redrap patient appropriately and help with positioning

Ensure call bell is within reach

Answer patient questions and address concerns

Step 11: Cleanup & Specimen Handling

Cleanup Checklist

Properly dispose of sharps in appropriate container

Dispose of contaminated supplies in biohazard if needed

Label any specimens correctly with patient identifiers

Clean and disinfect reusable equipment per protocol

Remove PPE/gloves properly and dispose appropriately

Perform hand hygiene after cleanup

Leave area clean, organized, and ready for next use

Step 12: Documentation

Documentation Checklist

Document IMMEDIATELY after procedure completion

Document what procedure was performed, date, time, location

Document findings, results, specimens obtained

Document patient response (pain level, vital signs if taken, complications)

Document patient education provided

Sign with initials and credentials

Reflection & Learning

Procedure Strengths - What went well?

Areas for Improvement - What could I do better next time?

Instructor/Preceptor Feedback

Learning Objectives Achieved

Procedure Practice Tips

Building Competence with Procedures

Practice on manikins/models FIRST before doing on real patients

Ask instructor/preceptor to supervise first few attempts on real patients

Develop muscle memory through repeated practice and repetition

Visualize procedure mentally before performing - build confidence

Practice with classmates (with safety parameters) to gain experience

Request specific feedback from instructor on technique and communication

Document procedure experience in clinical logs to track progression

Recognize proficiency develops with repetition - be patient with yourself

Documentation

Student Signature / Date

Instructor Signature / Date (Optional)

PROCEDURE PREPARATION & EXECUTION CHECKLIST