Room Number __________ RN _________________________

Time 0700 0730 To Do Obtain report from RN-0700 Check MAR (put meds and times on med sheet) Meds Due: Y/N H-T assessment Accu-Checks: Y/N New Orders: Y/N instructions from instructor Chart This VS/Pain Time: __________ Assessment time: _________ Pain Intake ________ Output ________ Meds Check (incl narc count) IV site check New Orders Notes/Meds Given PRN meds given last night: 1. 2. 3. 4. 5.

0800 0830

Breakfast-make sure pt gets tray (if not NPO) Meds Due: Y/N (see med sheet) New Orders: Y/N Accu Check: Y/N

Breakfast: I: _______ O: _______ % of breakfast eaten __________ Chart in Computer (Assess-Nutrition) New Orders Accu Check Level

0900

Meds Due: Y/N (see med sheet) Vitals check with/update instructor IV site check

Chart Vitals/Pain Meds Given New Orders IV site check

1000

Meds Due: Y/N (see med sheet) Give bath and do bed changes-earlier if possible Weight (if needed) Wt: ________ Check for orders Chart H-T assessment in daily record

Meds Given bath and bed change new orders head to toe findings

1100

Accu-Check: Y/N Meds due (Give before lunch if Appropriate) Vitals/Pain Assessment check with/update instructor

VS/Pain Time: __________ Chart VS Chart Pain IV site check

1200 1230

Assessment Lunch-make sure pt get tray (if not NPO) Lunch I&O (+ anything since breakfast) Meds Due: Y/N (see med sheet) Accu Check: Y/N New Orders: Y/N

Assessment Time: ________ % of lunch eaten _________ Lunch: I: __________ O: __________

Room Number __________ RN _________________________

1300 Accu Check: Y/N Meds Due: Y/N Vitals check with/update instructor meds given vitals/ pain new orders

1400

new orders: Y/N Meds Due: Y/N Nurses notes/charting Accu Check: Y/N

new orders meds given Accu Check level

1500

check with/update instructor nurses notes charting care plan work { if applicable} meds due: Y/N Vitals

meds given Vitals

1600

meds due: Y/N Accu Check: Y/N care plan work {make sure all information needed for care plan has been collected} Nurses Notes

Meds given Accu Check Level

1700

Check for Dr orders Meds Due/Accu Check Vitals Check with instructor for charting Corrections and further instructions Report off to nurse by 1600 Report given to:

Vitals Meds given Accu Check Level