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