Transcription of Research College of Nursing Mother-Baby Care Report …
1 Research College of Nursing Mother-Baby care Report (Hand-off) Form S MOM Patient _____ Room _____ HC Provider _____ Staff RN _____ Date of care _____ Student _____. Age _____ Del. Date/Time _____ SVD or C/S ____(C/S indication) _____ Gravida ____ Para ____ AB ____ LC ____. B Bld Type/Rh _____ Rubella (imm/nonimm) Hep Screen(+/-) Group B Strep(+/-) treated? (antibiotics/#doses) _____/_____. Allergies _____ History/Complications _____ Lab ordered (postpartum Hgb & Hct) _____/_____. A Fundus _____ Lochia _____ Perineum/Incision _____ (REEDA, tears/lacerations/epis) Breasts/Nipples _____. Dressing _____ Voiding/Foley _____ IV/Lock/Site _____ I&O _____/_____ Activity _____ Diet _____ tDap/Rhogam VS: B/P_____T_____P_____R_____ Breath sounds _____ Bowel/flatus/ BM Last Pain Meds (time)/Score _____/_____ Discharge Date _____.
2 R VS/Assessments (times?) _____/_____ Scheduled Meds (times?) _____/_____ Reassess Pain? _____/_____. Bath/Bed Change? _____ Fresh Water/Linen? _____ Hourly Rounding? _____ Teaching? _____Procedures? _____. S baby Female/Male _____ HC Provider _____Gestational Age_____ Breast/Bottle (formula type) _____. B Birth wt _____ Today's wt _____ %Loss _____ Blood type/Rh _____ Coombs _____ Apgars _____/_____. A VS: T_____P_____R_____ Voids _____ Stools _____ Last feeding _____ Blood glucose (heal sticks) _____ Bili level_____ Jaundice_____. R VS/Assessments (times?) _____/_____ Circ/Consent signed/time? _____ PKU? _____ Hearing Screen (pass/fail)? ____ Birth Cert? _____. Student Schedule Break _____ Lunch _____ Clinical Conference _____ Report off to staff nurse _____ Report off to Instructor/Charting checked _____.
3 Include the following (in SBAR format) in your hand-off to Staff RN: MOM Last VS/Assessments & time_____ Last Pain Meds/Score _____/_____ Diet/Activity Change _____/_____. IV/saline lock/foley/Dc'ed? _____ Teaching sheet/BC completed: _____ Daily care completed (Linen change/Bath) _____ New Orders? _____. baby Last VS/Assessments & time_____ Voids/Stools/Charted? _____ No. of feedings _____ Last feeding _____. Amount formula/time @ breast _____ New orders? _____. Notes/Plan for the Day/Hourly Rounding Schedule: Research College of Nursing Maternal History/Assessments Newborn History/Assessments Psychosocial: Significant other/family _____ Labor History: ROM (date/time) _____ Fluid Appearance _____. Family type _____Family Developmental Stage _____ EBL _____ Analgesia/anesthesia _____.
4 Returning to work _____Childcare _____ Length of Stage I _____ Stage II _____ Stage III _____. Culture/Ethnicity _____Childbearing Customs _____ Complications: Fetal decels _____ variability _____. Bradycardia/Tachycardia _____Maternal fever _____. Previous pregnancy history: Date _____ (Vag or C/S) _____ Sex _____ Wt. ____ Neonatal resuscitation: Blow-by O2 _____ PPV _____. _____ Additional Assessment Data: Heart sounds _____ Breath sounds_____. Apnea ____Color _____ Acrocyanosis ____Capillary refill _____ Molding ___. Prenatal care : Trimester started _____ Total wt. gain _____ Caput _____ Cephalohematoma _____ Sutures _____ Fontanelles _____. Meds/Herbs taken _____ Tobacco/alcohol/drugs _____ Bruises ___ Lacerations __ Mongolian spots ___ Milia ___ Erythema toxicum __.
5 Illnesses/complications during pregnancy _____ Telangiectatic nevi ___ Umb cord ____ Bowels sounds _____ABD ____. Prenatal Labs: First Hgb & Hct ____/____ Glucose screen _____ Clavicles (crepitus) ___ Activity _____ Posture _____ Reflexes (Moro- suck- HIV _____ RPR/VDRL _____ babinski-grasp) Cry ___ Consolability ___ _Anomalies _____. Past health history (chronic diseases, depression, abuse, surgeries):_____ Gestational age: SGA-AGA-LGA sole creases/ testes/labia/breasts _____. _____ Nutrition/ I & O: (Breast/Formula) Freq _____ Duration/Amt _____. Voidings/24 hours _____Stools/24 hours _____. Labor and Delivery admission labs: Hgb & Hct ____/____ Platelets _____ Circumcision: Type (Gomco/Plastibell) _____Circ care _____.
6 Compare L & D Hgb & Hct to Postpartum values: % change _____/_____ Site assessment _____ Instructions to parents _____. Prioritized Problems/Diagnoses for Mom Prioritized Problems/Diagnoses for Newborn 1. _____ 2. _____ 3. _____ Prioritized Strategies/Interventions for Mom Prioritized Strategies/Interventions for Newborn 1. _____ 2. _____ 3. _____ Outcomes of care : _____ Outcomes of care : _____. _____ _____. _____ _____. Evaluation/Patient Responses: _____ Evaluation/Patient Responses: _____. _____ _____. _____ _____.
