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Initial Assessment of Documentation in First 24 Hours Medication Blood & Components Patient Pressure

Patient Ward In
Nursing / Doctor (Yes/ No) Error Transfusion Fall Ulcer
Start/ Start / Doctor Nursing
Name, Age/ Room no, Sex, UHID/ Date/Type & Doctor Nutrition Prescribed/Transfusion/
S. No. Finish T2/ Finish T3/ Care Care Yes/ No Yes/No Yes/No
Provisional Diagnosis Time (T1) Sign. screening Reaction
T2-T1 T3-T1 Plan Plan
Catheterisation Surgical Site Type of High risk
Ward Out Ventilation Central Vein Remarks
CA-UTI Infection incident medication
Date / Type / Out time T5 / Near
Date /Days of Associated Date /Days of DOS/ SSI / Yes Yes or No /
S. No. Advised Time T5-T4/Stay Days reintubation Miss / Room No / others
insertion/Infection Pneumonia insertion/Infection Yes or No /No Reaction
T4 Days Sentinel

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