Nursing discharge project ischemic stroke power point due 3/02/21

PATIENT HAND-OFF “SHARE” FORM (complete only what applies) Sending Unit

___________ Time: ____________ Transferring RN: __________________

Receiving Unit ___________

Date: ____________ Receiving RN: ____________________ RM#:______________

Allergies: S

SITUATION

DIAGNOSIS: Name: ___________________________________________ Age: _________ Physician/Surgeon: ________________________________________________ Reason for Admission/Transfer: ______________________________________ _________________________________________________________________ _________________________________________________________________ ED Admits: Did patient meet Sepsis Criteria: ___ Yes ___ No If yes, was the fluid bolus and antibiotics given: ___ Yes ___ No (If no, to be addressed in ED) Procedures: ______________________________________________________

H HISTORY

HISTORY: Pertinent History: _________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Meds: Code Status:

A ASSESSMENT

PERTINENT ASSESSMENT: V.S. ___________________________________________________________________________________ Neuro: _________________________________________________________________________________ Cardio/Vasc: _____________________________________________ Phase 2:_______________________ Skin: __________________________________________________________________________________ Respiratory: _____________________________________________________________________________ GI: ____________________________________________________________________________________ GU: ___________________________________________________________________________________ Pain: _________________________________ / Intervention + / - __________________________________

I/O: ___________________________________________________________________________ Drains/Tubes/Foley: ______________________________________________________________ Dressings: ___________________________________ Other: ____________________________ O2: ________________________________________ IV’s: __________________________________________________________________________

R REQUIREMENTS

REQUIREMENTS: Isolation: ______________________________________________________________________________ Fall Risk: ______________________________________________________________________________ Restraints: _____________________________________________________________________________ Other: _________________________________________________________________________________

E EVALUATE

THINGS TO EVALUATE NEXT INTERVAL CARE (if applicable): Tests: __________________________________________________________________________________ Labs: __________________________________________________________________________________ Other: _________________________________________________________________________________ _______________________________________________________________________________________

______________________________________________________________________________

CORE MEASURES

Core Measures (check if applicable – tell what interventions completed): __Chest Pain Protocol ____________________ __HF _______________________________________ __Pneumonia _______________________ __ Stroke Protocol ____________________________ __SCIP-Pre-op Initial Antibiotic Time Given ____________ Surgery End Time ________________________

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PATIENT STICKER: PATIENT HAND-OFF “SHARE” FORM

Chart Forms 6700.146 (04/06/10) *1UTF*