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ICU discharge audit 2016
Patient UR *
Your answer
ICU Transfer Checklist
Found in patient medical record
ICU discharge sticker present? *
Was "Observations breaching clinical review criteria" box ticked? *
Was "HMO aware" box ticked? *
Was "Observations breaching MET criteria" box ticked? *
Was "HMO aware" box ticked? *
Was "relatives informed of transfer" box ticked? *
Was "patient belongings/valuables and medications" box ticked? *
Was nurse name & signature present? *
Was nurse name & signature dated & timed? *
Was HMO name & signature present? *
Was HMO name & signature dated & timed? *
ICU Medical Discharge Summary
Was a discharge summary in the patient medical record? *
Were ICU issues identified on the discharge summary? *
Were LOMT identified on the discharge summary? *
MR 85
Was an MR 85 available in the patient medical record? *
If MR 85 indicates that the patient is not for intubation; has a referral to ACP been completed on Patient Flow? *
Medication Chart
Have APP electrolytes been ceased? *
Transfer Process
Date cleared for ward *
MM
/
DD
/
YYYY
Time cleared for ward *
Time
:
Was both time and date of clearance for ward documented on the obs chart? (on day of ICU discharge) *
Date bed allocated *
MM
/
DD
/
YYYY
Time bed allocated *
Time
:
Date bed available *
MM
/
DD
/
YYYY
Time bed available *
Time
:
Date patient left ICU *
MM
/
DD
/
YYYY
Time patient left ICU *
Time
:
Comments (particularly if sticker or summary missing)
Your answer
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