# NICU/PICU Daily Safety Checklist

| Form ID | FRM-SAF-001 | Revision | 1.0 |
|---------|-------------|----------|-----|

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## 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 | | | |

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*Form FRM-SAF-001 Rev 1.0*