Please ensure the following elements are completed when rounding on patients.

Which department are you completing this survey for?

Name of the employee observed:

select

Is the code sheet posted with correct weight?

Is patient’s whiteboard filled out with current nurse and POC (plan of care)?

Has the hourly rounding tool been updated?

Hourly rounding (DAYs) Bi-hourly rounding (NIGHTs) on Pain, Pumps, Potty and Position are being completed

Is the emergency equipment set up or stocked and sealed in appropriate area?

Is the room clutter free so there is easy access to patient’s bed, sink and bathroom?

Are IVF bags and tubing properly labeled and within date range (not expired)?

Is the bed free of left over medical equipment (ie: blue caps, CHG wipes or wrappers)?

Is the patient wearing ID band on extremity or central line (ID band not attached to bed, crib, wall or parent)?

For CA7 only: Go to the charting. In the past 24 hours, were the daily 1, 2, 3’s were completed and charted on A&I flowsheet?

x1- Bath, CHG, and Linen change

x2 Teeth Brush and Lip Balm

x3 Oral Rinse

For all other units: Go to the charting. In the past 24 hours, were the following completed and charted on the A&I flowsheet

Daily Bath or bath per infant guidelines

CHG wipe if appropriate

Daily linene change

Oral care as appropriate for age/population

If the room has a med cart, cart is clutter free and clean

Are extremities free of tourniquets that could have been left on the patients?

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