PIVIE Prevention K-Card

HAC SPS Bundle Elements

Which department are you completing this survey for?

Name of the employee observed:

Patient MRN?

Was the PIV assessed and documented every 60 minutes?
Was the PIV site touched and validated as soft, warm, and dry?

Touch, Look, Compare Assessment
Was the PIV site uncovered, dry, and visible?

Touch, Look, Compare Assessment. No use of socks, mitts, excessive tape, circumferential tape, or other devices covering the PIV site
Were the extremities comparable in size?

Touch, Look, Compare Assessment.
Comments

If No is chosen, please provide more details.