IBA Tool

Intervention-Based Assessment (IBA) Tool
Endotracheal Intubation
Trainee: Training stage: S1 S2 S3 S4
Assessor: Training centre:
Clinical problem/diagnosis: Patient RN:
Date:
Case complexity: Straightforward Some complex features Complex
Score key: N = Not assessed, U = Unsatisfactory (unsafe, has to be corrected), S = Satisfactory (Tick as appropriate)
Competence and definitions Score Comments
Consent N U S
C1 Demonstrates knowledge of indications, contraindications, and
complications of emergency endotracheal intubation (and invasive
mechanical ventilation).
C2 Demonstrates awareness of sequelae of intubating versus not
intubating in this patient.
C3 Explains the process of intubation to the patient and/or patient’s
relatives, including the risks and benefits, and checks understanding.
C4 Demonstrates awareness that in life-threatening situation, it can be
performed as a life-saving procedure.
Deliberation (Pre-intubation planning) N U S
D1 Demonstrates recognition of a difficult airway.
D2 Reviews the patient’s co-morbidities, relevant blood investigations,
ECG and imaging that may influence the selection of premedications,
equipment and approach to the intubation.
D3 Demonstrates awareness about the strategies in optimizing selected
unstable patients prior to and during intubation process to minimize
risk of deterioration.
D4 Selects appropriate endotracheal tube size, premedication types and
doses and an airway rescue plan.
D5 Ensures that assisting team members are aware of the instituted
strategies and rescue plan.
Preparation N U S
P1 Prepares medications and checks equipment including rescue devices.
P2 Assigns roles to team members.
P3 Positions the patient appropriately.
P4 Ensures all necessary monitoring are connected including end-tidal CO2
detector.
P5 Optimises the respiratory and cardiovascular status of the patient prior
to induction of anaesthesia.
P6 Performs appropriate pre-oxygenation technique.
Intubation technique N U S
T1 Performs correct technique of laryngoscopy and endotracheal
placement.
T2 Appropriately confirms placement of endotracheal tube.
T3 Demonstrates awareness of pitfalls of various confirmation methods.
T4 Ensures the endotracheal tube is anchored securely using appropriate
method.
Intervention (Troubleshooting in the event of unsuccessful intubation) N U S
I1 Seeks help appropriately.
I2 Assists ventilation.
I3 Identifies the cause of difficult intubation.
I4 Executes airway rescue plan.
Post intervention management N U S
M1 Ensures patient continues to be adequately sedated post intubation.
M2 Demonstrates reassessment for complications following intubation.
M3 Ensures patient is monitored and vital signs are documented.
M4 Reviews chest radiograph post intubation.
M5 Documents clearly the intubation process including the level of
difficulty, complications, medications used and endotracheal tube size
and depth.
Global summary and feedback
Based on the assessment of the completed elements, how much supervision Tick as Feedback
does this trainee need? appropriate
Level 0 Insufficient evidence observed to support a judgement
Level 1 Unable to perform the intervention under supervision
Level 2 Able to perform the intervention under supervision
Level 3 Able to perform the intervention with minimal supervision
(will need occasional help)
Level 4 Competent to perform the intervention unsupervised
(could deal with complications)
Time spent observing: Time spent providing feedback: (minutes)
(minutes)
Assessor satisfaction with IBA: Trainee satisfaction with IBA:
(Low) 1 2 3 4 5 6 7 8 9 10 (High) (Low) 1 2 3 4 5 6 7 8 9 10 (High)
Assessor stamp and signature: Trainee stamp and signature:
Invasive Mechanical Ventilation Setting

Date:
Consent N U S
(Demonstration of consent is assessed in the IBA for endotracheal intubation)
Deliberation (Planning) N U S
D1 Demonstrates knowledge of the physiological changes with positive
pressure ventilation.
D2 Demonstrates knowledge of indications and contraindications for
invasive ventilation.
D3 Demonstrates knowledge of complications of different ventilator
settings (mode, volume, pressure, rate, VILI).
D4 Selects the appropriate ventilator settings according to the underlying
pathology and relevant investigations.
D5 Checks the patient’s underlying medical problem and organ function in
order to ensure the best ventilator setting.
Preparation N U S
P1 Ensure the ventilator is safe, clean and ready to to be used.
P2 Ensures that the correct tubing and filter is in place.
P3 Ensures that the ventilator is connected to the appropriate gas source.
P4 Ensures that the alarm settings are set to enable ventilation to occur.
P5 Set the appropriate initial ventilator setting (mode, pressures, tidal
volume, rate, FiO2).
P6 Ensures that the patient is adequately sedated +/- paralysed.
Technique N U S
T1 Connects the patient to the ventilator via the correct tubing and
connections.
T2 Ensures appropriate graphs (volume, pressure, end-tidal CO2) are
generated based on the settings.
T3 Titrates oxygen requirement to desired oxygen saturation.
Intervention (Troubleshooting) N U S
I1 Interprets ventilator waveforms and identifies any ventilation problems
(e.g. ventilator dyssynchrony, air trapping).
I2 Adjusts the ventilator settings to achieve desired tidal volume and
minute ventilation.
I3 Assesses and manages a desaturating patient.
I4 Manages haemodynamic instability by reviewing the ventilator settings
and ensuring that the patient’s volume status and vasopressor
requirements are optimised.

M1 Ensures continuous monitoring of the patient.
M2 Ensures all connections are secured in order to reduce the possibility
of disconnected ventilator.
M3 Orders for and interprets the arterial blood gas 20-60 minutes after
starting ventilation.
M4 Make appropriate changes to the ventilator settings depending on the
arterial blood gas.
M5 Documents clearly indication for invasive ventilation and ventilator
settings.
M6 Refers patient to appropriate teams for further management.
(minutes)
(Low) 1 2 3 4 5 6 7 8 9 10 (High) (Low) 1 2 3 4 5 6 7 8 9 10 (High)
Non-Invasive Ventilation Setting

Date:
Consent N U S
C1 Demonstrates knowledge of indications, contraindications and
complications of different settings of non-invasive ventilation (NIV).
C2 Demonstrates knowledge of the physiological changes with non-
invasive positive pressure ventilation.
C3 Explains the process of NIV to the patient and/or patient’s relatives,
including the risks and benefits, and checks understanding.
D1 Checks the patient’s history, physical examination and relevant
investigations including arterial blood gas to decide on the most
optimal ventilator setting.
D2 Decides on the target physiological and clinical parameters to be
achieved with the ventilator settings.
Preparation N U S
P1 Ensure the ventilator is safe, clean and ready to to be used.
P2 Ensures that the correct tubing and filter is in place.
P3 Ensures that the ventilator is connected to the appropriate gas source.
P4 Ensures that the alarm settings are set to enable ventilation to occur.
P5 Selects the appropriate mode of non-invasive mechanical ventilation.
P6 Selects the appropriate pressures or volume, FiO2, and PEEP.
P7 Ensures correct mask size for the patient and proper connection with
the ventilator.
Technique N U S
T1 Introduces and applies the mask to the patient’s face gently.
T2 Ensures appropriate graphs (volume, pressure) are generated based on
the settings.
T3 Ensures that the patient is able to tolerate the ventilator settings.
I1 Adapts the ventilator settings according to the patient’s response.
I2 Adapts the ventilator settings to achieve the desired tidal volumes and
minute ventilation.
I3 Titrates oxygen requirement to the desired oxygen saturation.

M1 Ensures continuous monitoring of the patient.
M2 Ensures all connections are secured in order to reduce the possibility
of disconnected ventilator.
M3 Orders for and interprets the arterial blood gas 20-60 minutes after
starting ventilation.
M4 Make appropriate changes to the ventilator settings depending on the
arterial blood gas.
M5 Documents clearly indication for invasive ventilation and ventilator
settings.
M6 Refers patient to appropriate teams for further management.
Time spent observing: (minutes) Time spent providing feedback: (minutes)
(Low) 1 2 3 4 5 6 7 8 9 10 (High) (Low) 1 2 3 4 5 6 7 8 9 10 (High)
Point of Care Ultrasound (POCUS)

Clinical problem/diagnosis: Dyspnoea Trauma Shock Patient RN:
Date:
Consent N U S
C1 Demonstrates knowledge of indications, roles and limitations of POCUS
in this patient.
C2 Explains the process of POCUS to the patient and/or patient’s relatives
and checks understanding.
D1 Considers the selection of transducer (frequency, depth of penetration
and footprint) based on scan site and purpose.
D2 Selects appropriate POCUS modalities (e.g. Echo, FAST, lung
ultrasound, etc.) based on the clinical problem.
Preparation N U S
P1 Demonstrates proper positioning and exposure of the patient
particularly in difficult body habitus.
P2 Ensures the ultrasound machine is prepared, connected to power
source and placed in ergonomic position for scanning.
P3 Ensures adequate availability of ultrasound gel and tissue paper.
P4 Ensures presence of a chaperone if indicated and maintains patient
privacy.
POCUS technique N U S
T1 Obtains optimal image by adjusting ultrasound settings (gain, depth,
focus point).
T2 Demonstrates dexterity in transducer handling (sliding, tilting,
rotating).
T3 Demonstrates adequate sono-anatomic knowledge of relevant
structures.
T4 Obtains all required windows for the ultrasound modality and ensures
relevant structures are visualised in each window.
T5 Exhibits appropriate posture when scanning.
T6 Recognises difficult visualization due to patient body habitus and
performs certain manoeuvers to obtain better image window.
POCUS interpretation N U S
I1 Identifies variations from normal.
I2 Interprets the findings in relation to the clinical problem.
I3 Integrates and correlates the sonographic findings with clinical data to
arrive to a diagnosis or a clinical syndrome.
Post POCUS management N U S

M1 Formulates the management plan based on the POCUS findings.
M2 Explains to the patient about sonographic findings and subsequent
management.
M3 Ensures proper care of the patient post procedure (wiping off gel,
covers up patient).
M4 Demonstrates proper care of the ultrasound machine post procedure.
M5 Documents clearly the sonographic findings.
(Low) 1 2 3 4 5 6 7 8 9 10 (High) (Low) 1 2 3 4 5 6 7 8 9 10 (High)
Procedural Sedation and Analgesia (PSA)

Date:
Consent N U S
complications of procedural sedation and analgesia (PSA).
C2 Demonstrates knowledge of the physiological changes associated with
the drugs chosen for PSA.
C3 Explains the process of PSA to the patient and/or patient’s relatives,
including the risks and benefits, and checks understanding.
D1 Performs risk assessment on patient using relevant classification
system (e.g. ASA status).
D2 Selects the appropriate sedative agent and/or analgesic agent based on
current diagnosis and co-morbidities.
D3 Decides on the intended level of analgesia and depth of sedation.
Preparation N U S
P1 Ensures that the patient is at a properly monitored area (cardiac
monitor, pulse oximeter, and end-tidal CO2 where available).
P2 Ensures the respiratory and cardiovascular status of the patient is
optimized prior to PSA.
P3 Ensures adequate number of assisting staff skilled in advanced life
support.
P4 Ensures standard precaution is adhered to.
P5 Ensures all rescue devices (e.g. resuscitation trolley) are prepared for
immediate use when needed.
P6 Ensures the correct drugs are prepared and the doses pre-calculated
for the patient.
P7 Ensures the pharmacologic antagonists for benzodiazepines and
opioids are immediately available in the procedural area.
Technique N U S
T1 Administers sedative/analgesic drugs in incremental doses, titrating to
the desired endpoints.
T2 Assesses the depth of sedation and degree of analgesia before the
intended procedure is performed.
T3 Demonstrates awareness of the onset and duration of action of the
drugs used.
T4 Checks for symptoms and signs of adverse effects e.g. anaphylaxis.
I1 In the event of airway and/or ventilation compromise during PSA:
- Encourages/physically stimulates patient to breathe deeply.
- Administers supplemental oxygen.
- Provides positive pressure ventilation (PPV) if spontaneous
ventilation is inadequate.
- Administers reversal agents when airway control, spontaneous
ventilation or PPV are inadequate.
I2 Manages haemodynamic instability appropriately with fluid if
indicated.
I3 Manages any adverse drug reactions (e.g. anaphylaxis) appropriately.
M1 Ensures regular monitoring of patient’s vital signs in an appropriately
staffed and equipped area until they return to baseline level of
consciousness and is no longer at risk for cardiorespiratory depression.
M2 Checks for side effects such as nausea and vomiting, and manages
appropriately.
M3 Ensures appropriate disposition plan and/or discharge advice for
patient.
Based on the assessment of the completed elements, how much Tick as Feedback
supervision does this trainee need? appropriate
(minutes)
(Low) 1 2 3 4 5 6 7 8 9 10 (High) (Low) 1 2 3 4 5 6 7 8 9 10 (High)
Peri-arrest and/or cardiac arrest management

Date:
Consent N U S
complications of intervention.
C2 Demonstrates awareness of sequelae of intervention and non-
intervention.
C3 Explains the process of intervention to the patient and/or patient’s
relatives, including the risks and benefits, and checks understanding.
C4 Demonstrates awareness that in life-threatening situation, it can be
performed as a life-saving procedure.
D1 Demonstrates recognition of the relevant physiological abnormalities
and co-morbidities that influence the decision for resuscitation.
D2 Reviews relevant investigation results.
D3 Selects appropriate medications (dose and route) and equipment.
D4 Considers the appropriate treatment algorithm.
Preparation N U S
P1 Checks and prepares monitoring and resuscitation equipment.
P2 Prepares team members.
P3 Prepares medications (dose and route).
P4 Positions the patient appropriately.
Technique (patient resuscitation) N U S
T1 Optimises airway, breathing and circulation.
T2 Administers analgesia and sedation as per clinical indication.
T3 Performs synchronised cardioversion correctly.
T4 Performs defibrillation correctly.
T5 Ensures high quality CPR.
T6 Looks for and treats reversible causes.
T7 Institutes appropriate intervention(s) for the reversible causes
identified:
Pathology 1:
Pathology 2:
Pathology 3:
T8 Ensures proper communication among team members.
T9 Ensures proper communication with patient’s relatives.
Intervention (Troubleshooting in complex cases) N U S

I1 Initiates appropriate alternative or escalation of treatment.
I2 Seeks help appropriately.
M1 Initiates post-resuscitation care.
M2 Ensures proper documentation.
M3 Ensures proper communication with patient’s relatives.
M4 Arranges for appropriate disposition.
(Low) 1 2 3 4 5 6 7 8 9 10 (High) (Low) 1 2 3 4 5 6 7 8 9 10 (High)
Trauma Management
Date:
Consent N U S
C1 Demonstrates knowledge of medicolegal aspects of trauma
management (principles of necessity in resuscitation, application of
implied consent vs need for written or verbal consent, indications for
consultant’s consent)
complications of the treatment for injuries in trauma.
complications of medications and blood transfusion including massive
transfusion protocol.
C4 Explains the diagnosis and the process of intervention to the patient
and/or patient’s relatives, including the risks and sequelae, and checks
understanding.
D1 Considers the teams to be alerted during trauma management, various
setups of trauma team and mechanisms for activation.
D2 Arranges for a suitable bay for trauma management.
D3 Considers the number of ED staff to be on standby and assigns team
member roles.
D4 Locates and checks equipment.
D5 Ensures relevant drugs and blood products are available and accessible.
Preparation N U S
P1 Activates trauma team.
P2 Prepares the ED team.
P3 Prepares all necessary equipment.
P4 Assesses and activates massive transfusion protocol.
P5 Alerts other relevant teams as and when the need arises or in
anticipation of necessity.
Technique (Primary Survey) N U S
T1 Assesses airway, breathing, circulation and disability, and exposes
patient appropriately.
T2 Uses appropriate adjuncts for assessment and interprets findings
correctly.
T3 Recognises life-threatening injuries.
Intervention (Primary Survey) N U S

I1 Selects appropriate intervention(s) for the pathology(ies) identified:
Pathology 1:
Pathology 2:
Pathology 3:
Technique (Secondary Survey) N U S
T4 Looks for hidden injuries and manages appropriately.
T5 Takes a complete targeted history and performs a complete
examination.
Intervention (Secondary Survey) N U S
I2 Selects appropriate intervention(s) for the pathology(ies) identified:
Pathology 1:
Pathology 2:
Pathology 3:
M1 Re-assesses patient’s condition and checks for complications.
M2 Documents findings and interventions.
M3 Ensures appropriate disposition of patient and appropriate handover
to relevant teams for definitive care.
(Low) 1 2 3 4 5 6 7 8 9 10 (High) (Low) 1 2 3 4 5 6 7 8 9 10 (High)

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IBA Tool

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Intervention-Based Assessment (IBA) Tool

Invasive Mechanical Ventilation Setting

Post intervention management N U S

Non-Invasive Ventilation Setting

Post intervention management N U S

Point of Care Ultrasound (POCUS)

Post POCUS management N U S

Procedural Sedation and Analgesia (PSA)

Peri-arrest and/or cardiac arrest management

Intervention (Troubleshooting in complex cases) N U S

Intervention (Primary Survey) N U S

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