Title Page
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
-
S/S of infection
-
S/S include...
- Low grade Temp
- Fever >38.1
- Narrowed Pulse Pressure
- WBCs lower
- Hypothermia <36
- Heart Rate >90
- Acute confusion
- Acute change in LOC
-
Source of infection
- No Know Source
- PNU
- UTI
- Positive Blood Cultures
- Abdominal pain or distension
- Meningitis
- CVC or PICC
- Cellulitis
- Septic arthritis
- Infected wound
- Chemo
- Recent organ Transplant
-
Suspect Sepsis!
-
Severe Sepsis Screen
- None identified
- Systolic BP <90
- Cap refill >3 seconds
- Purpuric Rash
- Mottled
- Cold peripheries
- Lactate >2
-
Suspect Severe Sepsis!
-
Central Line
-
Indication
- Medication requires CVC
- CVP monitoring
- TPN
- Other
- Inapproprate line nurse to speak with dr to DC
-
Site
- WNL
- Reddened
- Swollen
- oozing
- Bleeding
- Pain/Tenderness
-
Dressing
- Clear Tagaderm
- Old CHG Impregnated
- Gauze
- CDI
- Dated and <7days old
- Not dated
- Outdated
- Saturated
- Dressing not intact
- needs to be changed
-
Biopatch
- Yes
- No
- Blue up
- Blue side down
- Slot aligned
- Slot NOT aligned or Sitting on top of catheter
- Saturated
- Needs to be changed
-
Foley
-
Indication
- Accurate I&Os
- Retention
- Neurogenic bladder
- Stage 4 healing wound
- Immobilization
- No appropriate indication nurse to DC
-
Foley WNL
-
Foley with issues
-
Foley Issues
- Below Bladder
- No securement device
- Hose with kink or loops
