Dear Nurses: I read a book
called Smart Patients, Safe Patients,
and that is where I got this checklist. I'm using it to help me feel
comfortable and confident during a stressful time, and I hope you will be
understanding and know that I trust and appreciate you and simply want to be an
active, participating member of my health care team. I will keep this checklist
handy throughout my stay and will happily note the safe practices of my
wonderful nurses. Thanks for being understanding.
- I have a list of home medications with me while in the hospital or care facility.
- I have told the doctors and nurses about my allergies.
- A red allergy wristband has been applied if an allergy exists.
- I have asked my nurse to read the History and Physical to me and have found it to be accurate (The History and Physical is written only once upon admission and does not require multiple readings once it is deemed to be accurate.)
- The nurses are telling me names of all medications before I take them.
- The nurses are showing me the medication order for each new medication, and either I have noted the name of the medication, the dose, and how often I need to take it, or I have requested that the nurse give me a printed list of all my medications with that information plus any new medications that are ordered.
- The nurses are bringing me medications in their original package so I can see the name of the medication and the dose. Syringes and bags of medication are likewise labeled by hand if needed.
- I am receiving home medications, and if not, I know the reason why. If I'm not receiving the same dose I take at home, I know why I’m getting a different dose.
- I have been given medication information/education sheets for each of my medications and I have read the information and know of any special instructions.
- Nurses are asking me to state my name and date of birth before they give me any medication or do any treatments. They are comparing the information I give them to the order in my chart.
- Caregivers are washing or sanitizing their hands when entering and exiting my room.
- Caregivers are wearing gloves when starting IVs, doing wound care, or touching any body fluids.
- If I am in isolation due to a contagious illness, my doctors and nurses are wearing PPE; and I know what to tell my visitors what to wear when they arrive.
- If I have multiple lines or tubes, they are labeled with their location and purpose.
- My IV site and IV tubing are dated.
- My IV site dressing and any other dressings are clean, dry, and intact.
- The nurses are using an alcohol pad to clean the port of my IV line before inserting a syringe.
- If I have a urinary catheter, it is secured to my leg so it can't be accidently pulled out.
- If I have a urinary catheter, gentle cleansing is being done daily around the insertion site.
- My caregivers are assisting me with oral hygiene at least twice a day if I need their help.
- If I am unable to turn myself, my caregivers are gently turning me every couple of hours to prevent bed sores.
- The nurse call light is always within reach.
- I know how to call a Code Blue (or Code Arrest) and have taught my frequent visitors how to call one.
- I know how to operate my bed, the television, the phone, and how to order meals.
- My room is free of clutter and all obstacles that might contribute to a fall.
- I am allowing a caregiver to stay within arm's reach when I am in the bathroom or using the bedside commode, if the nurses feel I am at risk for falling.
- If I have several doctors on my case, I am comfortable that they are all on the same page.
- When a sterile procedure is being done, the doctor or nurse is taking care to not contaminate any of the sterile equipment.
- The nurses are giving change-of-shift report, or handoff, at my bedside, and I have an opportunity to correct any inaccurate or incomplete information.
- I am able to understand my caregivers. If I am unable to understand thick accents, provision is being made so that I get all the information I need from my doctor and/or nurse.
- Doctors or surgeons who plan to do surgery or a procedure have informed me of all risks and benefits before I have been asked to sign a consent giving permission for the procedure.
- My nurses have asked me what I need, if anything, to take care of myself at home once I am discharged.
- My nurses are teaching me about any new conditions or diagnoses, such as congestive heart failure, stroke, diabetes, wound care, or anything else I need to know to prevent a readmission after I am discharged to home.
- My nurses have explained what medication I will be going home on, and they have told me when my next dose is due.
- If I am going home on insulin for the first time, I am very clear as to when to take my insulin and how much to take. If I am taking more than one kind of insulin, I know the difference between the two kinds, and I know when and how much to take of each.
- If I will be going home on insulin, I have been taught how to draw it up and inject it and I have practiced injecting myself at least twice in the hospital.
- Valuables have been sent home or locked up with Security.
- I am careful to not set my dentures or eye glasses on a food tray. (Once the tray leaves the room, the dentures or glasses will likely never be seen again.) I was given a denture cup and it is kept in a safe place.
- If I am to have surgery, I am careful to refrain from eating or drinking anything as instructed. My jewelry and valuables have been taken home or locked in a safe place. My underwear has been removed, and I am prepared to go to surgery wearing only my hospital gown. Dentures have been removed and stored in a safe place.
- If I am to have surgery on an arm or leg, I will make sure the surgery staff remembers to mark the correct limb in ink with “YES.”
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