Care category Intensive care Semi-Intensive care Highly dependent care Intermediate care Minimal care Color Index

Tab Specifications

Score (Based on rubric) More than 34 29-34 23-28 18-22 12-17

Color Index Tab for Student Endorsement Sheet Red Orange Yellow Light Green Light Blue

1. Cut colored paper into strips 12 cm x 3 cm (10 pcs/color). 2. Fill out data as shown below. 3. Apply double-sided tape or glue on the under surface when tagging endorsement sheet. 12 cm 3 cm
To be folded in half. Patient Initials: ____ Sex/Age: ____/____ Ward/Room No.: ____/____ Bed No.: ___ Hospital No.: ____________ Date: ______ Diagnosis: ______________ Date: ______

MAKATI MEDICAL CENTER COLLEGE OF NURSING DRUG STUDY SHEET

Name of Patient: ____________________ Date of Birth: __________ Age: ______ Sex: ______ Room No.: _____ Bed No.: _____ Hospital No.: _______________________ Date Admitted: _________ Admitting Diagnosis: ___________________ Diet: ________ Primary Nurse: _____________________ Charge Nurse: __________________________ Attending Physician: _______________ Doctors Order Drug Mechanism Special Adverse Nursing Classificatio of Action Precautions Reactions Responsibilities Physician: n (Correlate (Potential/Actu _______________ clinically) al) Date/Time: ______/_______ Brand Dosage: 1. 1. RIGHT DRUG Name: Absorption/ (Patient Chart Intake & Medication Administration Record) Verified: _______ 2. RIGHT DOSE (Calculated dosage)

Generic Name:

Route:

2.

Distributio n & Action

Indication(s) : 1.

Frequency : Drug Interactions (Correlate clinically)

3. Drug Metabolism

Verified: _______ 3. RIGHT PATIENT (Patient identifiers)

2. Preparatio n: (Dilution) a. b. 4. Pharmacy Stock Dose: c. d. 5. Toxicities 4. Elimination

Verified: _______ 4. RIGHT ROUTE

3.

5.

Verified: _______ 5. RIGHT TIME (Actual schedule)

e. Verified: _______ 6. RIGHT DOCUMENTATI ON

Patient/Caregiver Instructions Remarks on Medication Administration 1. 1. 2. 2. 3. 3. Name of Student: ______________________________ Year Level/Section/Group: ______/______/______ Clinical Instructor: ______________________________ Date/Time: ______/______ Clinical Area: __________

Verified: _______