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 done at the bedside


Was the PIV side uncovered, dry, and visible?

Touch, Look, Compare Assessment done at the bedside.

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 done at the bedside.


Comments

For any NO chosen above, please describe your findings