Intern Pocket Cards - Pre-Rounding Guide - Daily Checklist

Overnight Events:

 - Night float signout, nursing notes

Interdisciplinary notes:

 - Review original note and any addendum

Vital signs:

 - Trends and ranges (min and max) values

I/O and weights:

 - Input: Oral, IV

 - Output: Urine, stool, drains, ostomy, hemodialysis (include last bowel movement)

 - Weight trends

Labs:

 - Include trends

 - Review pending/send-out labs

 - Consider which ones are truly needed on daily basis

Radiology:

 - Review images yourself

 - Note if interpretation is preliminary or final

Microbiology:

 - Bacterial culture not considered “negative” until at least 48 hours (does not finalize until day 5)

Medication Administration Record (MAR):

 - IV fluids and drips

 - Missed doses of medications

 - Review medications that have expired / “fallen off”

 - Review medications that need to be discontinued

 - Overnight medications that were not written as PRN by primary team

 - Pain medications

 - Insulin requirements (and glucose ranges)

 - Antibiotics received and start/end dates

 - Review if held/modified home meds can be restarted/returned back to home dose

Cardiac monitoring:

 - Review telemetry

 - Consider if it needs to be continued

Tubes, Lines, Drains:

 - Review dates of when these were placed

 - Review indications for removal and/or replacement on daily basis



Dr. Satya Patel @SatyaPatelMD

Full Inpatient Pocket Cards Collection: https://bit.ly/pocketcardset



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