Re: Report Sheet
I figured it out. Here's mine.
from, to and na are for the nurse i got them from, nurse i'm giving them to, and my na for the day
I have admission Hx and pmh separate. under admission hx, i put what brought them here. for ex
3.5-to ed w/ CPx3d, rad to back. 3.6 cath-3 vessel disease 3.7-cabgx3 3.8-to pcu (my floor)
i have rhythm, b/c we are a telemetry floor.
under the box "i&o, dw, accucheck" i circle it if they are i and o, or a daily weight, then circle accucheck and write in how often, achs and 2 for ex
tubes/wires/etc is b/c we often have pt's with chest tubes, blakes, peg's, pacing wires, etc.
elimination is where i write foley, colostomy, etc.
procedures is for the cath, cardiolite, cxr notes
then there is always "other" and "dont' forget" for other things i want to say.
room number is in bottom corner b/c when flipping thru my clipboard, i can easily come to the room i want
if you like it, lmk. if you don't say why. i am always up for improvements to my system.
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