MDList CXRForList FallHistoryList FallPreviousList SchmidMobList RestraintEvaluationList RestraintAlternativesList ObservationList RestraintTeachingList
Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names Long Names Short Names
Your Your ETT Placement ETT Yes w/in 3 Mo 25 No 0 Ambulates 0 Effective/Needed Needed All Alternatives All q 15 Min Check q 15 All Listed  All
Favorite Favor Line Placement Line No 0 Yes 5 Amb w/ Assist 1 Not Needed Not Comfort Measures Comfort q 30 Min Check q 30 Restraint Reason Reason
MD MD Feed Tube Place Fd Tube Unsteady gait 2 Diversion Divers q 5 Min Check q 5 Alternatives  Altern
Name Name R/O Pneumo Pneumo SecondaryDxList FallGaitStrengthList Unable to Amble 0 MDOrderList Lines/Tubes D/C D/C L&T Cont Observation Cont Risks / Benefits Rsk/Ben
Here Here R/O Tamponade Tampnde Long Names Short Names Long Names Short Names Long Names Short Names Frequent Checks ^Checks Remove Criteria Remove
Admission Admit Yes 15 No 0 SchmidMentList Order Current Current Frequent Toilet ^Toilet RestraintCondList Care/Monitor Care
MDNotifiedList Morning Morning No 0 Yes 3 Long Names Short Names Written Today Written Medications Meds Long Names Short Names
Long Names Short Names Post-op Post-op AAO x 4 0 MD Notify: Renew MD Not ModifyEnvironmnt Environ CSM+Skin Intact CSM/Skn TransferList  
Abnormal Labs Labs Pre-op Pre-op AmbAidList FallConfJudgeList Periodic Conf 1 Padded Rails Rails CSM Adequate CSM OK Long Names Short Names
Admission Admit Long Names Short Names Long Names Short Names Confusion 2 OnOffDCList Relax Techniques Relax Skin Intact Skin OK Emergency Dept E.D.
Adverse Reaction Reacte InvasiveTestList None 0 No 0 Coma/Unrespon 0 Long Names Short Names Relocation Reloc Wound Wound OR OR
Bleeding Bleedng Long Names Short Names Bedrest 0 Yes 5 On On Remind CallLight Call Lt Redness*/Remark Red PACU PACU
Chest Pain CP Bronchoscopy Bronch Wheelchair 0 SchmidEliminList Off Off Reorientation Reorient Swelling*/Remark Swell Clinic Clinic
CO/CI CO/CI Colonoscopy Colonsc Amb w/ Staff 0 FallMedsDizzyList Long Names Short Names D/C'd D/C'd Side Rails/ Alarms Rls/Alrm note:  ? Delete csm adequate and skin intact? Home Home
Demise Demise Endoscopy Endoscp Crutches 15 Long Names Short Names Independent 0 Family at BS Family Other ICU Bed ICU Bed
Discharge ADA ADA Sigmoidoscopy Sigmoid Cane 15 No 0 Freq or Diarrhea 1 ClinicalRationaleList Sitter Sitter RestraintInterventionList Med-Surg Med-Srg
Dysrhythmia Dysrhy Line Placement Line Walker 15 Yes 3 Needs Assistance 2 Long Names Short Names Long Names Short Names Other Kaiser Kaiser
Ectopy Ectopy Lumbar Puncture LP Furniture 30 Incontinent 0 Dislodge Risk Dislodg RestraintTypeList Hygiene Met/* Hyg Other Hospital OthHos
Fall Fall Paracentesis Paracen FallNocturiaList Agitated Agitate Long Names Short Names Hydration Met/* Hyd Hosp Morgue Morgue
Hemodynamic ^s Hemo ^s Percut Trach P Trach IVSalineLockList Long Names Short Names SchmidFallHistoryList Combative Combatv Mittens Mittens Nutrition Met/* Nut Morturary Mortura
Hypertension HTN Pericardiocent PerCard Long Names Short Names No 0 Long Names Short Names Confused Confuse Soft Limb SftLimb Elimination/* Eli Coroner Coroner
Hypotension Hypoten Plasmapheresis Plasma Yes 20 Yes 2 None 0 Disoriented Disort Vest Vest ROM Done/* ROM    
Incr. Agitation Agitate Thoracentesis Thoracn None 0 Unknown 1 Previous Falls Hx Fall Belt Belt Position Chang/* Pos HistoryList
GI Disturbance GI  TEE TEE FallArrythmiaList Fall this admit 2 Temp Immobility TempImm Side Rails SideRls Airway Met/* Air Long Names Short Names
Line Problem Line Burr Holes Burr FallsGaitList Long Names Short Names Prior Fall 1 Unsteady On Feet UnStead Chemical Chem Resp Adequate/* Res Known History Known
MD Visit MD Vist Long Names Short Names No 0 Hx Wandering Wander Safe Enclose Bed SafeBed All  All New, acute New
Medication/s Med/s OffUnitTestList Normal 0 Yes 2 SchmidMedsList Leather Leather ***************** *** Probable Hx Probabl
Neuro Change Neuro Long Names Short Names Bedrest 0 Long Names Short Names BehavioralRationaleList If Not Met add a . Suspected Hx Suspect
Pain Pain Cardiac Cath Lab CCL Immobile 0 FallVisionHearingList Anticonvulsants 2 Long Names Short Names LimbRestraintLocList Remark .. No History No Hx
Post-op ^s PostOp^ CT Scan Head CT Head Weak 10 Long Names Short Names Tranquilizers 2 Danger To Others Others Long Names Short Names Unknown Hx Unknown
Pt/Fam Update Pt/Fam CT Scan Chest CT Chst Impaired 20 No 0 Psychotropics 2 Danger To Self Self R/L Upper Extrem Bil UE PtResponseRestraintList
Pulses Pulses CT Scan Abdomen CT Abd Yes 1 Hypnotics 2 ^ Destructive Destrve R Upper Extrem RUE Long Names Short Names SeizurePrecautionsList
Resp Disturbance Resp Intrvnt Radiolgy IR MentalStatusList ^ Aggressive Aggress L Upper Extrem LUE Sleeping Asleep Long Names Short Names
Shivering Shiver MRI MRI Long Names Short Names TransferModeList   FallTeachList   Other R/L Lower Extrem Bil LE Calm Calm None None
Temperature Temp Nuclear Medicine NucMed Orient to Ablity 0 Long Names Short Names Long Names Short Names **************** ******* R Lower Extrem RLE Agitated Agitate Padded Rails Pads
Urine Output UOP Forgets Limits 15 Gurney Gurney Fall Prevention Prevent If a Behavioral  . L Lower Extrem LLE Restless Restlss   Other
CodeBlueStartStopList Bed Bed Interventions Interv reason chosen,  .. All Four Extrem All 4
NonInvasiveTestList Long Names Short Names AdverseReactionList Wheel Chair Wheel Chair Aides to Prevent Aides q 15 minute  … R Upper/ Lower RUE/RLE LabSpecimenSentList SuicidePrecautionsList
Long Names Short Names Start Start Long Names Short Names Ambulatory Ambulatory documentation …. L Upper/ Lower LUE/LLE Long Names Short Names Long Names Short Names
CXR A&P CXR Stop, Revived Revived Medication Med FallTeachingList required. ….. R Upper/ L Lower RUE/LLE Hematology Hematol Safe Environment SafeEnv
CXR Lateral CXR Lat Stop, Deceased Decease Blood Product Blood Long Names Short Names L Upper/ R Lower LUE/RLE Chemistry Chem Sitter Sitter
EKG 12 Lead EKG   Other Treatment Tx Call Bell Instruct CallBel RestraintRationalList Bi Upper/ R Lower BiU/RLE Drug Levels DrugLev One to One 1:1
EKG A-Wires A-Wires **************** . Family Instruct Family Long Names Short Names Bi Upper/ L Lower BiU/LLE Enzymes Enzymes None None
Echocardiogram Echo See Code Blue .. PronouncedList Lines Instruct Lines Unnecessary Safe Bi Lower/ R Upper BiL/RUE Multiple Lab Tests Labs…
EEG EEG Record. , Long Names Short Names Reminder Remind Risk Same Same Bi Lower/ L Upper BiL/LUE Blood Culture BloodCx SafetyOutcomeList
KUB KUB Pronounced By MD Pron MD Reorientation Reorien Extubation Risk ExtRisk Sputum Culture Sputum Long Names Short Names
Ultrasound Bladder US Blad ReturntoCVORList **************** .   Other Confusion w/Risk Confuse RestraintAlternativesList Urine Culture UrineCx Safe Safe
Ultrasound Abd US Abd Long Names Short Names Add a Remark .. Disoriented Disorie Long Names Short Names Wound Culture WoundCx Unsafe Unsafe
Bleeding Bleedng noting the time. … FallRiskInterventionList Pulling Tubes Pulling Companionship Sitter Catheter Tip Culture CathCx
MD2List R/O Tamponade R/O Tmp Long Names Short Names Fall Risk FallRsk Dirversion Diversn CSF Culture CSF Cx
Long Names Short Names Exploration Explore SecurityEventList Routine Observe Observe *=Call Supervisr -  -  -  - Freq Observation Observe CSF CSF
Academic Team/* Rounds Open Chest Open Long Names Short Names Freq Observation FreqObs *Agressive *Agress Lighting Adjust Light Tissue Biopsy Tissue
Anesthetist/* Anesth Close Chest Close Pt Missing Pt Gone Close Observatn COB *Destructive *Destru Medication Meds Multiple Cultures Cx's…
HBS/* HBS Remove VAD D/C VAD Family Violence FamVlnt Non-slip Socks NonSlip *Assaultive *Assult Lines/Tubes DC LinesDC Peritoneal Fluid Periton
Intensivist/* Intens Pt Violence PtVlnt Constant Sitter Sitter *Suicidal *Suicid Physiolo Interv Physiol Pleural Fluid Pleural
Internist/* Intern ReferralList Visitor Violence VisVlnt Bed Alarm BdAlarm *Imminent Danger *Danger Environs Altered Environ Stool Stool
Medical Resid/* Med Res Long Names Short Names Police Guard Police Restrained Restrnt Siderails Up Rails
Nephrologist/* Nephol Home Health Home H PT Consult PT SideRailsList Remind Call Light Remind RoundsList
Neurologist/* Neurol Dietician Diet Elimination q2H Elim q2 Long Names Short Names Relocation Relocat Long Names Short Names
Neurosurgeon/* N Surg Wd/Skin CNS Wd/Skin Bedside Commode BSC 2 Rails 2 Rails Reorientation Reorien Multidiscipline Multi
Nurse Practitn/* NP Physical Therapy PT Orthostaic Orthost 1 Rail 1 Rail Cardiology Cardio
Pain Team/* Pain Occupat Ther OT  Exercise Exercis 3 Rails 3 Rails Pulmonary Pulm
Pediatrician/* Pediat 4 Rails *Restraint 4 Rails* Medicine Medicin
Psychiatrist/* Psych Neurology Neuro
Psychologist/* Psychol RestraintTypesList Nephrology Nephr
PA/* PA  Long Names Short Names Surgical Surgery
Surgeon, CV/* CV Surg Soft Soft Teaching Teach
Surg, OB/GYN/* OB/GYN Leather, Plastic Hard Sign-off SignOff
Surgeon, Vasc/* Vasc S Waist Waist Morning Morning
Surgeon, Res/* S Resid Medication Meds Pharmacy Pharm
Surgeon, ENT/* ENTSurg Mittens Mittens Dietary Dietary
Urologist/* Urol Softx4 Softx4 Wound Care Wound
******************   Hardx4 Hardx4 Pain Management Pain
Document Name  .
of Staff notified  .. RestraintApplied ToList
with Add Remark … Long Names Short Names
Wrists Wrists
Wrist, R Wrist,R
Wrist, L Wrist,L
Legs Legs
Leg, R Leg R
Leg, L Leg L
Extremities 4 Extrem4
Extremities,R ExtremR
Extremities,L ExtremL
RestraintPtCheckList
Long Names Short Names
q15min q15min
q5min q5min
Continuous Cont
RestraintSitesCondList
Long Names Short Names
Skn Clear&Intact Skin OK
Skin Reddened Red
Skin Broken Broken