Sync template from atomicqms-style deployment
This commit is contained in:
138
Forms/Patient-Safety/FRM-SAF-001-Daily-Safety-Checklist.md
Normal file
138
Forms/Patient-Safety/FRM-SAF-001-Daily-Safety-Checklist.md
Normal file
@@ -0,0 +1,138 @@
|
||||
# NICU/PICU Daily Safety Checklist
|
||||
|
||||
| Form ID | FRM-SAF-001 | Revision | 1.0 |
|
||||
|---------|-------------|----------|-----|
|
||||
|
||||
---
|
||||
|
||||
## Patient Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Patient Name | |
|
||||
| MRN | |
|
||||
| Location | |
|
||||
| Date | |
|
||||
| Shift | [ ] Day [ ] Night |
|
||||
|
||||
## Patient Identification and Communication
|
||||
|
||||
- [ ] Patient armband in place and accurate
|
||||
- [ ] Allergies documented and displayed
|
||||
- [ ] Code status clearly posted
|
||||
- [ ] Isolation precautions posted (if applicable)
|
||||
- [ ] Bedside safety brief completed with team
|
||||
|
||||
## Airway and Respiratory
|
||||
|
||||
- [ ] ETT secured and position marked/documented
|
||||
- [ ] ETT depth verified and matches previous
|
||||
- [ ] Ventilator settings match orders
|
||||
- [ ] Oxygen delivery device appropriate
|
||||
- [ ] Suction equipment at bedside and functioning
|
||||
- [ ] Ambu bag with appropriate mask at bedside
|
||||
- [ ] Inline suction system functioning (if applicable)
|
||||
|
||||
## Vascular Access
|
||||
|
||||
- [ ] All IV sites assessed for infiltration/infection
|
||||
- [ ] Central line dressing clean, dry, intact (date: ______)
|
||||
- [ ] PICC line secured, dressing intact
|
||||
- [ ] Umbilical lines secured (if applicable)
|
||||
- [ ] All IV infusions verified against MAR
|
||||
- [ ] IV pump alarms functional
|
||||
- [ ] Flushing protocol followed per policy
|
||||
|
||||
## Medications
|
||||
|
||||
- [ ] High-alert medications double-checked
|
||||
- [ ] Infusion pump rates verified
|
||||
- [ ] Vasopressor/inotrope concentrations verified
|
||||
- [ ] Sedation/analgesia infusions verified
|
||||
- [ ] Insulin infusion verified (if applicable)
|
||||
- [ ] Heparin infusion verified (if applicable)
|
||||
- [ ] Smart pump drug library enabled
|
||||
|
||||
## Monitoring and Alarms
|
||||
|
||||
- [ ] Cardiac monitor leads in place
|
||||
- [ ] Monitor alarm limits set appropriately
|
||||
- [ ] SpO2 probe positioned correctly
|
||||
- [ ] Blood pressure cuff size appropriate
|
||||
- [ ] Temperature monitoring functioning
|
||||
- [ ] All alarms audible and enabled
|
||||
|
||||
## Feeding and Nutrition
|
||||
|
||||
- [ ] Feeding tube position verified before use
|
||||
- [ ] Enteral feeding pump rate matches order
|
||||
- [ ] Breast milk/formula labeled correctly
|
||||
- [ ] Feeding advancement per protocol
|
||||
- [ ] Aspiration precautions in place
|
||||
- [ ] Head of bed elevated (if not contraindicated)
|
||||
|
||||
## Infection Prevention
|
||||
|
||||
- [ ] Hand hygiene performed
|
||||
- [ ] Central line bundle elements met (if applicable)
|
||||
- [ ] Hand hygiene
|
||||
- [ ] Chlorhexidine bath (if >2 months)
|
||||
- [ ] Line necessity assessed
|
||||
- [ ] Dressing intact
|
||||
- [ ] VAE prevention bundle (if ventilated)
|
||||
- [ ] HOB elevated 30 degrees (unless contraindicated)
|
||||
- [ ] Oral care performed
|
||||
- [ ] Sedation vacation/assessment
|
||||
- [ ] Contact isolation for MDRO (if applicable)
|
||||
|
||||
## Skin Integrity
|
||||
|
||||
- [ ] Skin assessment completed
|
||||
- [ ] Pressure areas assessed and repositioned
|
||||
- [ ] Medical device-related pressure injury prevention
|
||||
- [ ] Diaper area assessed
|
||||
- [ ] Ostomy sites intact (if applicable)
|
||||
|
||||
## Safety Equipment
|
||||
|
||||
- [ ] Bed in lowest position when not at bedside
|
||||
- [ ] Side rails up appropriately
|
||||
- [ ] Call bell within reach (if age-appropriate)
|
||||
- [ ] Fall risk assessment completed
|
||||
- [ ] Restraints (if used) appropriate and documented
|
||||
|
||||
## Family-Centered Care
|
||||
|
||||
- [ ] Family updated on plan of care
|
||||
- [ ] Family presence encouraged
|
||||
- [ ] Parent questions addressed
|
||||
- [ ] Developmental care practices implemented
|
||||
- [ ] Quiet time/minimal handling respected
|
||||
|
||||
## Documentation
|
||||
|
||||
- [ ] I&O documented accurately
|
||||
- [ ] Weight documented (if scheduled)
|
||||
- [ ] Vital signs documented per protocol
|
||||
- [ ] All medications documented in MAR
|
||||
- [ ] Care plan updated
|
||||
|
||||
## Issues Identified
|
||||
|
||||
**Issues requiring follow-up:**
|
||||
|
||||
|
||||
|
||||
**Actions taken:**
|
||||
|
||||
|
||||
|
||||
## Signature
|
||||
|
||||
| Role | Name | Signature | Date/Time |
|
||||
|------|------|-----------|-----------|
|
||||
| RN | | | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-SAF-001 Rev 1.0*
|
||||
Reference in New Lab Ticket
Block a user