Wellington ICU forms libraryWellington ICU

Forms & Protocols

Online Library

These resources are for the use of staff in Wellington ICU. They are used to improve the safety and care we provide to our patients. All forms are available in PDF format for download & printing. The online versions available here will always supercede any other.

Clinical Videos

The staff of Wellington ICU have developed clinical training videos, accessible below.

Serial Data

Bedside serial blood gas, haematology & biochemistry sheet

ICU Trauma

Standardised assessment & documentation of all ICU trauma patients

Allow A Natural Death

Checklist to improve the quality of end-of-life care in ICU

Tracheostomy Emergency

Emergency tracheostomy management poster for bedside display

Spinal Clearance

Stickers to clarify need for spinal precautions in patients with traumatic injury


Stickers to standardise ward review of patients seen by the ICU Tracheostomy Review And Management Service

Tracheostomy Checklist

Checklist for use in the insertion of percutaneous tracheostomies in the ICU

Intubation Checklist

Safety checklist for use prior to any planned intubation in the ICU

Above Cuff Vocalisation

Protocol for enabling speech in patients with Portex Suctionaid tracheostomies

Subglottic Secretion Aspiration

Protocol for aspiration of subglottic secretions in patients with Portex Suctionaid tracheostomies

COVID-19 Intubation Checklist

See Videos page for demonstration

Modified intubation checklist for suspected or confirmed COVID-19 patients in ICU

ICU Handover

Standardised tool to improve accurate structured information exchange

ICU Treatment Goals

Document to assist with alignment of ICU treatments and patients' known wishes, to prevent unnecessary treatments that are neither wanted nor warranted

ICU Insulin Sliding Scale

Insulin sliding scale protocol for hyperglycaemic ICU patients. Includes pathway for transition to hospital insulin chart. Not for use in DKA or HHS.

Difficult Airway Poster

Poster to display at the bedside of patients who are known to have a difficult airway. Includes emergency contact details.

ICU Drug Manual

Complete PDF of monographs for all medication used in Wellington ICU with extensive appendices

v3a 2020

Early Warning Score System

The Capital Coast DHB EWS system (including all vital sign chart variants) has its own dedicated website.


All forms are © Wellington ICU. They are made available here as a central resource for staff use to improve the quality of care we provide for our patients. If you wish to adapt any document for local use within your institution, please use the contact link to the right for enquiries. All editable master copies only exist as Apple Pages documents; converting to Word breaks most things so please don't ask.

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