Lumiform / Templates / Record patient information with a nurse shift report sheet

Record patient information with a nurse shift report sheet

This Nurse Shift Report template can be used and customized to record vital patient information either in the ICU or virtually any other nurse’s station. Outgoing nurses use a nurse shift report to keep track of a patient's diagnosis, attending doctor, consults, critical lab values, and medication history and pass it on to the oncoming nurse. This digital template allows the attachment of photos, assignment of tasks, and digital sign-offs to help streamline the nurse shift reporting process.

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Record patient information with a nurse shift report sheet

Audit

General Information

Date of Birth

Sex

Admitted

Patient Report

Diagnosis

Procedure

Does the patient has allergies?

Please enter details

Patient medical history

Code status

Patient Monitoring - Vital Signs

Click + to add patient monitoring details

Time Check

Blood Pressure

Heart Rate

Temperature

Oxygen Saturation

Oxygen

Respiratory Rate

Pain

Blood Sugars

Are there dispensed medications?

Time of Med Pass

Intake

Breakfast

Lunch

Supper

Other

Output

Foley

Emesis

Drains

Tubes

Ostomy Bag

Labs and Needed Procedures

Labs

Needed Labs

Future Procedures

Other

Discharge Plan

Variance to Discharge Plan: Barrier

Resolution

Consults

Completion

Click + to add Nurse On Duty

Full Name and Signature of Nurse Attendee

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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.