Paediatric Care Plan - MR88i(T)
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Paediatric C
are Plan
MR 88i(T)
v7
01
0
2
20
10
DARLING DOWNS –
WEST MORETON
HEALTH SERVICE DISTRICT
Paediatric Care Plan
DOCTOR ADM DATE
TRANSFER DATE DISCHARGE DATE
LOS ALLERGIES
WARD ADM WEIGHT
ADM HC
ADM HEIGHT
DAY ………….. DAY ………….. DAY …………..
PLAN OF CARE PLAN OF CARE PLAN OF CARE
BY BY BY
TIME TIME TIME
PDS INDICATOR
DATE DATE DATE
Plan discussed with
patient/carer Yes No Yes No Yes No
GOAL
OBSERVATIONS
HYGIENE / ORAL HEALTH
MOBILISATION
PAC
PATIENT ROUNDING Hourly Hourly Hourly
NUTRITION
TECHNICAL ACTIVITIES
FLUID BALANCE
INCONTINENCE
URINARY DRAINAGE
SPECIMENS
Facility: ..........................................................
URN ...................................................................................
Family name ......................................................................
Given names .....................................................................
Address .............................................................................
Date of birth ................... XXXXXXXXXXSex M F
(Affix patient identification label here)
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Page 1 of 2
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Name: DOB: UR:
DAY ………….. DAY ………….. DAY …………..
P N OF CARE PLAN OF CARE PLAN OF CARE
BY BY BY
TIME TIME TIME
PDS INDICATOR
DATE DATE DATE
IVT IV Checked:
AM ….../……/…...
PM ….../……/…...
N/D ….../……/…...
IV Checked:
AM ….../……/…...
PM ….../……/…...
N/D ….../……/…...
IV Checked:
AM ….../……/…...
PM ….../……/…...
N/D ….../……/…...
ACCT DRUGS
MEDICATIONS
ESCORT
ISOLATION
SENSORY DEFICIT
MENTAL HEALTH
PATIENT EDUCATION
WOUND CARE
IMMEDIATE OUTCOMES
DISCHARGE OUTCOMES
TO BE SIGNED BY ALL CARING FOR PATIENT EACH SHIFT
DATE DATE DATE
AM AM AM
PM PM PM
ND ND ND
Page 2 of 2
Paediatric Interview & Assessment Guide - MR88f(T)
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Paediatric Interview
&
A
ssessm
ent G
uide
MR 88f(T)Page 1 of 2
v6
01
0
1
20
10
Admitting Consultant
Admitting Nurse Signature Date
Date of admission Expected date of discharge
Local doctor
Address
Parents’ names - Mother Father
Temporary address (if necessary)
Contact phone number
Previous hospital admissions
Age Hospital Reason Response to hospital
How much do you and your child understand about this admission:
Has your child had Anaesthetic before ? Yes No
Response to Anaesthetic
Is your child on medications at home? Yes No Bring In: Yes No
Allergies: (record in red) Drugs / Foods / Other
Immunisations – up to date: Yes No Due:
Skin integrity: Complete on admission (black biro)/Discharge (red biro) (4 & under)
Rashes Red area skin intact
Contusions Blisters
Lumps Broken superficial
Skin tear Urticaria
Swelling Lacerations
Wound Mouth – teeth/pathology
Refe
als required:
Aboriginal Liaison
Allied Health (specify) ..................................................................................................................................................................................
Child Health
Oral Health
Other (specify) ................................................................................................................................................................................................
Follow up management:
Medical: GP Outpatient Department Oral Health
Allied health: Physiotherapist Occupational Therapist Social Worker
Dietitian Speech Therapist
Nurse: Child Health Community Liaison Aboriginal Liaison
Appointment details: ................................................................................................................................................
DARLING DOWNS –
WEST MORETON
HEALTH SERvIcE DISTRIcT
Paediatric Interview &
Assessment Guide
URN ...................................................................................
Family name ......................................................................
Given names .....................................................................
Address ......................