Daily Log Sheet printable pdf download

Date ______Student’s Name ___________________Pt Initials____Dx________________Age_____

Daily Log Sheet

The daily log was developed to help you organize your day, provide safe patient care, document

according to hospital policy, and meet your school of nursing objectives. Complete this log each clinical

day and give to your clinical instructor at the end of your shift. Check each activity that was completed.

Write NA if not applicable to your patient. Fill in blanks as requested. If you need more space, use back

of paper.

Safe Environment/Initial Care

Read patient’s entire chart summary, noting questions you may have?

Reviewed your patient’s history and progress notes from the previous day?

*Washed your hands before and after entering the patient’s room every time?

*Reminded others as needed to wash hands?

Introduced yourself to the patient and family?

Used universal precautions when handling any body fluids?

Give an example:

Followed isolation policy when caring for patient?

Type of isolation/protective equipment required:

Checked patient’s ID and allergy band? Location of each on patient:

*Second patient identifier used:

Noted patient’s allergies?

List allergies:

Checked IV fluids hanging, matched with IV fluids and rate ordered?

Checked to see if your patient’s IV tubing was labeled?

Expiration date:

Located the following at patient’s bedside: code sheet, ambu with correct size mask, suction

set-up including suction catheter?

Location of code sheet:

Documentation/Cerner/Clinview

Every AM, from task list documented:

*Humpty Dumpty/Heinrich scale (fall risk)

Score:

*Braden Scale (skin breakdown risk)

Score:

Pain Scale appropriate for developmental age

Score:

Scale used:

VS/I & O tab documented:

Vitals as ordered or indicated by acuity. (acute q8h, prog q4h, critical q2h)

Continuous infusions.

Accurate intake, including fluids and solid intake.

Accurate output.

Safety tab documented:

Safety checks (q12h) (includes suction set-up, ambu bag and mask, code sheet)

ADL’s (daily bath/shower, mouth care daily/q4h for patients NPO, daily linen change)

Trachs, trachcare (Q12h) with AM assessment.

IV site checks (hourly)

Cardiac/Apnea, Pulse Oximetry monitors (hourly, if ordered)

Biox probe sites(check q4h; change location q4h infant, q8h other pediatric pts)

Daily Log Sheet

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