Labour Zone/Midwifery Handover Checklist (Daily)
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment Checklist
*
Rows
Yes
No
N/A
CTG is operational
ECG is operational
Patient Monitor is available and operational
Fetal Monitoring device is available and operational
Labour ward/zonal beds are operational
Is neonatal ambubag available?
Is adult ambubag available?
Is a fully filled oxygen cylinder available?
Are both the adult and paediatric laryngoscopes available?
Is neonatal ventilator available and operational?
Is mosquito net available for newborn child?
Thermometer available and operational?
Blood pressure apparatus is available and operational?
Both adult and paediatric stethoscopes are available and operational?
Consumables Checklist
*
Rows
Yes
No
N/A
Any thoughts?
Delivery pack is sterilised and available?
Sanitary Pad available?
Olive oil available?
Cotton wool available?
Disposable gloves available?
Neonatal oxygen mask available?
Sterile syringes available?
Suture materials available?
Methylated spirit available?
Blood sample collection bottles available?
Are Endotracheal tubes available (Sizes 1.5, 2, 2.5 & 7.5)?
Are orapharyngeal airways available (Sizes 000, 00 and 3)?
How many patients are in labour?
*
If any, then list their patient number, current stage of labour and early warning score
*
Patient in labour checklist
*
Rows
Yes
No
N/A
Has a partogram been documented for each patient?
Has Fetal Monitoring been documented and is it currently being performed for each patient?
Has an Early Warning Score been recorded for each patient?
Have any identified high risk pregnancy patients been recorded on the EMR with the appropriate relevant patient tag?
Are both mother and fetus vital signs being continuously monitored using patient monitor, blood pressure apparatus and CTG/Fetal monitoring device? And are these results being recorded on the EMR?
If applicable, please list the patient number(s) for any identified 'high risk pregnancy' patients
*
Have any patients been asked to maintain/record a kick count chart?
Are any patients having induction/augmentation of labour?
*
Please Select
Yes
No
If so, what are the results of the non-stress test (NST)
*
Please Select
Reactive
Non-reactive
Midwife/Nurse Handing Over
First Name
Last Name
Signature
Midwife/Nurse Taking Over
First Name
Last Name
Signature
Submit
Submit
Should be Empty: