Bm Tracking Sheet
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1BM TRACKING SHEET
Month:_____________________________
Clients Name:_________________________________________
Medication
DS Dulc. Suppository
Consistency: Type 1, 2, 3, 4, 5, 6, or 7 per
Size:
S - small
Given
FE Fleets enema
Bristol Stool Formation Scale on
M- medium
(Just PRN)
MOM Milk of Magnesia
reverse side.
L- large
MC Mag Citrate
XL – X Large
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Days
Eves
Nights
Number
of Days
No BM
Staff
Must initial below every shift …..If no BM on your shift leave area blank …But you still must sign your initials below
Days
Eves
Nights
Do Not Count Smalls when counting for PRN NEED
Notify ___________ in AM of ___ day if no BM and document in notification in daily notes
Notify ___________ for loose stools or if having small hard Bowel Movements
OR-FM-HS-CN-10(11-6-09)
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