NHS Safety Thermometer Audit (test tool only)

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Ward details

• Ward name

• Date & Time

  Date

Demographics

• Bed number

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
  • 32
  • 33
  • 34
  • 35

• Age

  <18

  18-70

  >70

• Gender

  Male

  Female

Pressure Ulcers

• Please record the Category of the patients WORST Old and New pressure ulcers

• Old pressure ulcers: developed within 72 hours of admission to Trust

  None

  Category 2

  Category 3

  Category 4

  Not recorded

• Old pressure ulcer photo

  Media

• New pressure ulcers: developed 72 or more hours after admission

  None

  Category 2

  Category 3

  Category 4

  Not recorded

• New pressure ulcer photo

  Media

Falls

• Record the severity of any fall that the patient has experienced in previous 72 hours in a care setting (this includes at home if on a district nursing caseload)

• Falls severity

  Select No fall No harm Low Moderate Severe Death Not recorded

  • No fall
  • No harm
  • Low
  • Moderate
  • Severe
  • Death
  • Not recorded

Urinary tract infections

• Select OLD UTI if treatment began before admission - or NEW if after admission

• OLD or NEW urinary infection

  None

  Old UTI

  New UTI

  Not recorded

• If patient has had a urinary catheter during the last 72 hours, select the number of days it was in place

• Number of days catheter in place

  None

  1-28 days

  >28 days

  Not known

  Not recorded

VTE assessment and management

• Has a VTE Assessment been done?

  Yes

  No

  N/A

• Has VTE prophylaxis started if at risk?

  Yes

  No

  N/A

• VTE Treatment - if the patient is being treated for VTE, choose type of VTE (Old categories for VTE before admission)

  Select None Old DVT Old PE Old Other New DVT New PE New Other Not recorded

  • None
  • Old DVT
  • Old PE
  • Old Other
  • New DVT
  • New PE
  • New Other
  • Not recorded