Special Care Baby Unit Handover Checklist (Daily)
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment Checklist
*
Rows
Yes
No
N/A
Transcutaneous Bilirubinometer is operational
All incubators are operational
Patient Monitor (uMec 12) is available and operational
Pulse oximeter/Sleep Apnea monitor is available and operational
Phototherapy lights are operational
Is neonatal ambubag available?
Is adult ambubag available?
Is a fully filled oxygen cylinder available?
Is a paediatric laryngoscope 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?
Paediatric stethoscope is available and operational?
Syringe and Infusion pumps are operational?
Glucose monitor is operational?
Vein Finder is operational?
Consumables Checklist
*
Rows
Yes
No
N/A
Any thoughts?
Oralpharyngeal airways available (Sizes 000 and 00)?
Endotracheal tubes available (Sizes 1.5, 2 & 2.5)?
Nasogastric tubes available (Sizes 6 & 8)?
Cotton wool available?
Disposable gloves available?
Neonatal oxygen mask available?
Sterile syringes available?
Suture materials available?
Methylated spirit available?
Blood sample collection bottles available?
How many patients are in the Special Care Baby Unit?
*
If any, then list their patient number and APGAR score
Patient in SCBU checklist
*
Rows
Yes
No
N/A
Has the Medical Officer or Paediatrician sent for the baseline investigations?
If there are any preterms, has the Ophthalmologist been informed about carrying out Retinopathy of Prematurity (ROP) ?
Has the APGAR Score for each patient been recorded for each patient?
Have any of the newborns been identified as perinatally HIV-exposed? And If so, has this been recorded on the EMR with the appropriate relevant patient tag?
Have any preterms been identified and recorded as such on the EMR using the relevant patient tag?
Are the patients vital signs being continuously monitored using the patient monitors and electrodes (If necessary)? And are these results being recorded on the EMR?
Have we taken the non-invasive Bilirubin reading using the Transcutaneous Bilirubinometer (normal reading is between 1.0-12.0 mg/dL)?
Has an umbilical (central) line been inserted into the newborn?
Is the newborn at risk of venous thrombosis?
If applicable, please list the patient number(s) for any identified 'perinatally HIV-exposed' patients
*
Paediatric Nurse/Nurse Handing Over
First Name
Last Name
Signature
Paediatric Nurse/Nurse Taking Over
First Name
Last Name
Signature
Submit
Submit
Should be Empty: