Dd Form 2552 - Workload Management System For Nursing - Psychiatric Worksheet
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WORKLOAD MANAGEMENT SYSTEM FOR
NURSING - PSYCHIATRIC WORKSHEET
ENTER
DATE, RN
INITIALS,
AND LAST
ENTER DATE, RN INITIALS,
FOUR SSN
AND LAST FOUR SSN
ACUITY
POINT
ACUITY
POINT
SECTION I - CRITICAL INDICATORS
SECTION I - CRITICAL INDICATORS (Continued)
CODE
VALUES
CODE
VALUES
1. VITAL SIGNS (Manual TPR, BP)
5. TREATMENTS/PROCEDURES/MEDICATIONS
100
Vital signs qid or less
1
117
Start IV/Ace wraps/Tube care
2
101
Vital signs q4h or x 6
2
118
Dressing - simple 5-7 mins x 2
2
102
Vital signs q3h or x 8
3
Dressing - complex 30 mins x 1
119
4
103
Vital signs q2h or x 12
4
120
Lab tests performed/collected on the unit x 3
2
104
Vital signs q1h or x 24
8
121
Do EKG
2
105
Tilt test q4h or more
2
122
Venipuncture, arterial puncture x 2
2
2. MONITORING
123
Medications - exclude IV - 3-11 trips or q3h - q8h
2
106
Intake and output q8h
2
Medications - exclude IV - 12 trips or more or
124
4
107
Circulation checks q2h or x 12
2
q2h
125
Restraints, 2 point, 4 point, Posey
2
108
Patient checks q30 minutes x 8
8
109
Patient checks q15 minutes x 8
16
126
New admission - assessment and orientation
12
Transfer - between psychiatric units
110
Neuro checks q4h or x 6
3
127
4
(receiving units only)
3. ACTIVITIES OF DAILY LIVING
128
Accompany patient off unit - 15 minutes
2
111
Care - age 6 or more - Self/Minimal
2
129
Accompany patient off unit - 30 minutes
4
112
Care - age 6 or more - Assisted
6
130
Accompany patient off unit - 45 minutes
6
113
Care - age 6 or more - Complete
14
131
Other activities - 15 minutes
2
4. FEEDING
132
Other activities - 30 minutes
4
114
Spoon feed or 1:1 at meals tid
6
133
Other activities - 45 minutes
6
115
Tube feed - bolus q4h or x 6
5
134
Each hour requiring continuous staff attendance
8
116
Escort patient to dining hall x 1
2
0
0
0
0
0
0
0
0
0
0
SUBTOTAL A POINT VALUE
SUBTOTAL B POINT VALUE
DD Form 2552, FEB 92
Replaces DD Form 2552 TEST, NOV 89, which may be used.
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