Ameya Clinic

A Unit of Vartak Health Services Pvt RECOVERY ROOM TRANSFER SHEET

Ltd

Patient's Details
Patient's Name : Age/Sex:
Allergies □ Yes □ No Vulnerable Patient □ Yes □ No
PRN No.: Ward/Bed No.:
Doctor's Name : Date of admission:
Diagnosis :
Post Anesthesia Recovery Score (Aldrete Score)
Admission Order Shifting
Parameter Description of the Patient Score
DOCTOR DOCTOR DOCTOR
Moves all extremities voluntarily / on command 2
Activity Moves 2 extremities voluntarily / on command 1
Unable to move extremities 0
Breathes deeply and coughs freely 2
Respiration Dyspnoea or Limited Breathing 1
Apnoeic 0
Within 20% of Preoperative baseline 2
Vital Sings(BP
20% -40% of Preoperative baseline 1
& P)
>40% of Preoperative baseline 0
Full Awake 2
Consciousness Arousable on calling 1
Not responding 0
SpO2>92% on room air 2
Oxygenation Needs O2 to maintain SpO2>92% 1
SpO2>90% even with O2 supplementation 0
Maximum Total Score is 10 Total Score > 9 is required for
Total Score
discharge

Recheck before Shifting Patient (by Nurse)

Significant Surgical Bleeding absent □ Yes □ No
Pain relief adequate □ Yes □ No
Nausea / Vomiting absent □ Yes □ No
Eqidural catheter (if present) - site and dressing OK □ Yes □ No
Arterial line (if present)-removed □ Yes □ No
Central Line (if present)-Site and dressing OK □ Yes □ No
Urine Output - Adequate / Inadequate.
Increase abdominal girth Yes / No (In Case of Laparotomy).
If any of the above answer is no an / or Aldrete Score <9 Please inform recovery Room Consultant and await further
instructions for Discharge
Comment / Discharge Order :

Remarks

Name & Signature of anesthetist Date and Time

Version SRKH/001 Document Number SRKH/SOP/DPT/001

Effective Date 4 Sept 2018 Revision Date 3 Sept 2018