nicu-picu/Forms/Patient-Safety/FRM-SAF-001-Daily-Safety-Checklist.md

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