DATE:__________________ EDC ROOM TO ROOM

NIGHTS
INITIALS:_______________
Nursing Unit/Room # Monitor Flow Meter Reg - SX Can - Tube Single Triple NOTES

TO BE CHECKED ON NIGHT SHIFT

OPNC UNIT (2) WHITE POLES W/ 3 IVACS, (5) SINGLE POLES W/ 1 IVAC, MONITOR, REGULATOR, SX CANISTER W/ TUBING
BAY 1
BAY 2
BAY 3
BAY 4
BAY 5
BAY 6
BAY 7
TOTAL ON UNIT:
CARDIAC CATH RECOVERY (FIRST FLOOR) (1) WHITE POLE W/ 3 IVACS (IN EACH BAY) , MONITOR, REGULATOR, SUCTION CAISTER WITH TUBING
BAY 2
BAY 3
BAY 4
BAY 5
CATH LAB 1 (2) WHITE POLES W/ 3 IVACS
REGULATOR
CAN ISTER & TUBING
CATH LAB 2 (2) WHITE POLES W/ 3 IVACS
REGULATOR
CAN ISTER & TUBING
XRAY SPECIALS (1) WHITE POLES W/ 3 IVACS
REGULATOR
CANISTER & TUBING

Date of Origin: 10/2015 blh

Revised: 8/2016 de,4/17ss,4.18ss; 12/18 de
 DATE:__________________ EDC ROOM TO ROOM
NIGHTS
INITIALS:_______________
Nursing Unit/Room # Monitor Flow Meter Reg - SX Can - Tube Single Triple NOTES
ED SOUTH (1) SINGLE POLE W IVAC, MONITOR, REGULATOR, SX CANISTER W/ TUBING
BAY 1
BAY 2
BAY 3
BAY 4
BAY 5
BAY 6
BAY 7
BAY 8
BAY 9
BAY 10
SOUTH LOBBY
DINAMAP X 2
PROCEDURE SPACE (1) SINGLE POLE W/ IVAC
DINAMAP X 1
REGULATOR X 1
TUBING X 1
CANISTER X 1
MAIN ED (FIRST FLOOR) EACH ROOM IVAC, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
TRAUMA #1 (1) TRIPLE IVAC, (1) SINGLE POLE W/ IVAC, 3 SUCTION REGULATOR, SX CANISTER WITH TUBING X3
TRAUMA #2 (1) WHITE POLE W/ 3 IVACS, (1) WHITE POLE W/ 2 IVACS, SINGLE POLE W/ 1 IVAC, 3 REGULATORS, SUCTION CANISTER WITH TUBING X3

TRAUMA #1
TRAUMA #2

OB ROOM #1
OB ROOM #2
RM1
RM2
RM3
RM4
RM5
RM6
RM7
RM8
RM9
RM10

Date of Origin: 10/2015 blh

Revised: 8/2016 de,4/17ss,4.18ss; 12/18 de
 DATE:__________________ EDC ROOM TO ROOM
NIGHTS
INITIALS:_______________
Nursing Unit/Room # Monitor Flow Meter Reg - SX Can - Tube Single Triple NOTES
RM11
RM12
RM13
RM14
RM15
RM16
RM17
ED NORTH-BEHIND CURTAIN (1) SINGLE POLE W/ IVAC
DINAMAP X 1
TREATMENT IN PROGRESS (LOBBY CHECK) (3) SINGLE POLE W/ IVAC
DINAMAP X 3
CONSULTATION ROOM (1) SINGLE POLE W/ IVAC
DINAMAP X 1
PACU
BAY1
BAY2
BAY3
BAY4
BAY5
BAY6
ENDO (EACH BAY) REGULATOR, CANISTER & TUBING
BAY 1
BAY 2
BAY 3
BAY 4
PROCEDURE ROOM #2
DINAMAP X 1
CARDIO PULMONARY (1) SINGLE POLE W/ IVAC
DINAMAP X 1
NUCLEAR MED (1) SINGLE POLE W/ IVAC
DINAMAP X 1

Date of Origin: 10/2015 blh

Revised: 8/2016 de,4/17ss,4.18ss; 12/18 de
DATE:__________________ EDC ROOM TO ROOM
NIGHTS
INITIALS:_______________

Date of Origin: 10/2015 blh

Revised: 8/2016 de,4/17ss,4.18ss; 12/18 de
DATE:__________________ EDC ROOM TO ROOM
NIGHTS
INITIALS:_______________

Date of Origin: 10/2015 blh

Revised: 8/2016 de,4/17ss,4.18ss; 12/18 de
DATE:__________________ EDC ROOM TO ROOM
NIGHTS
INITIALS:_______________

Date of Origin: 10/2015 blh

Revised: 8/2016 de,4/17ss,4.18ss; 12/18 de
 DATE:_________________ EDC ROOM TO ROOM
DAYS
NURSING
REG / SX Flow PT BED/
UNIT/RM MONITOR CAN / TUBE SINGLE
meter
SCD FEED W VAC ISO PCA EPI IV PAIN
ALARM
ARTIC ROHO
NUMBER

NEPHROLOGY CENTRAL (SECOND FLOOR) 1-SINGLE IVAC ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
SURGICAL CENTRAL ( THIRD FLOOR) 1-SINGLE IVAC ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
315
316
317
318
319
320
321
322
323
324
325
326

7
Date of Origin:3/2012 blh
Revised: 6/2013 blh: 10/2015 de,8/16ss:9/16ss,10/16ss; 2/17 de; 4/18 de
 DATE:_________________ EDC ROOM TO ROOM
DAYS
NURSING
REG / SX Flow PT BED/
UNIT/RM MONITOR CAN / TUBE SINGLE
meter
SCD FEED W VAC ISO PCA EPI IV PAIN
ALARM
ARTIC ROHO
NUMBER

PEDIATRIC UNIT (THIRD FLOOR) 1-SINGLE IVAC ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
301
302
303
304
305
306
307
308
309
310
PEDS OVER FLOW (THIRD SURG CENTRAL) 1-SINGLE IVAC ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
311
312
313
314
PEDS EXAM ROOM

STEP DOWN (THIRD FLOOR) 3-SINGLE IVAC, 3-REGULATORS, 3-SUCTION CANISTERS WITH TUBING
327
328
329
330
331
332
333
334
335
INTENSIVE CARE UNIT (FOURTH FLOOR) 1-SINGLE IVAC, 3-SINGLE IVACS ON WHITE POLE, 4-REGULATORS, 4 -SUCTION CANISTERS WITH TUBING
1
2
3

8
Date of Origin:3/2012 blh
Revised: 6/2013 blh: 10/2015 de,8/16ss:9/16ss,10/16ss; 2/17 de; 4/18 de
 DATE:_________________ EDC ROOM TO ROOM
DAYS
NURSING
REG / SX Flow PT BED/
UNIT/RM MONITOR CAN / TUBE SINGLE
meter
SCD FEED W VAC ISO PCA EPI IV PAIN
ALARM
ARTIC ROHO
NUMBER

4
5
6
7
8
9
10
11
12
13
14
MEDICAL CENTRAL (FOURTH FLOOR) 2-SINGLE IVACS ON POLE, SINGLE MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419

9
Date of Origin:3/2012 blh
Revised: 6/2013 blh: 10/2015 de,8/16ss:9/16ss,10/16ss; 2/17 de; 4/18 de
 DATE:_________________ EDC ROOM TO ROOM
DAYS
NURSING
REG / SX Flow PT BED/
UNIT/RM MONITOR CAN / TUBE SINGLE
meter
SCD FEED W VAC ISO PCA EPI IV PAIN
ALARM
ARTIC ROHO
NUMBER

CHILDBIRTH CENTER (FIFTH FLOOR) SINGLE MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
518
519
NURSERY IVAC X 3
CARDIOLOGY UNIT (FIFTH FLOOR) OVERFLOW (ROOMS 550-556-) 1-SINGLE IVAC ON POLE, MONITOR, REGULATOR, CANISTER WITH TUBING
550
551
552
553
554
555
556
CARDIOLOGY UNIT (FIFTH FLOOR) 2-SINGLE IVACS ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
557
558
559
560

10
Date of Origin:3/2012 blh
Revised: 6/2013 blh: 10/2015 de,8/16ss:9/16ss,10/16ss; 2/17 de; 4/18 de
 DATE:_________________ EDC ROOM TO ROOM
DAYS
NURSING
REG / SX Flow PT BED/
UNIT/RM MONITOR CAN / TUBE SINGLE
meter
SCD FEED W VAC ISO PCA EPI IV PAIN
ALARM
ARTIC ROHO
NUMBER

CARDIOLOGY UNIT (FIFTH FLOOR) 2-SINGLE IVACS ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
561
562
563
564
565
566
567
568
569
570
571
572
573
MEDICAL EAST (FOURTH FLOOR) 2-SINGLE IVACS ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467

11
Date of Origin:3/2012 blh
Revised: 6/2013 blh: 10/2015 de,8/16ss:9/16ss,10/16ss; 2/17 de; 4/18 de
 DATE:_________________ EDC ROOM TO ROOM
DAYS
NURSING
REG / SX Flow PT BED/
UNIT/RM MONITOR CAN / TUBE SINGLE
meter
SCD FEED W VAC ISO PCA EPI IV PAIN
ALARM
ARTIC ROHO
NUMBER

468
469
470
471
472
473
SURGICAL EAST (THIRD FLOOR) SINGLE IVAC ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373

12
Date of Origin:3/2012 blh
Revised: 6/2013 blh: 10/2015 de,8/16ss:9/16ss,10/16ss; 2/17 de; 4/18 de
 DATE:_________________ EDC ROOM TO ROOM
DAYS
NURSING
REG / SX Flow PT BED/
UNIT/RM MONITOR CAN / TUBE SINGLE
meter
SCD FEED W VAC ISO PCA EPI IV PAIN
ALARM
ARTIC ROHO
NUMBER

NEPHROLOGY EAST(SECOND FLOOR) SINGLE IVAC ON POLE, MONITOR, REGULATOR, SUCTION CANISTER WITH TUBING
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273

13
Date of Origin:3/2012 blh
Revised: 6/2013 blh: 10/2015 de,8/16ss:9/16ss,10/16ss; 2/17 de; 4/18 de