Center for Social Change - Change of Shift Form

 

Original Work Location {loc_name}
Temporary Work Location {ReportLabel2}
Document Date {doc_date}
Coordinator {coordinator}
MEDICATION/CABINET
Medication stored in separate bins for each individual
Medication bins labeled properly
Pills administered initialed on blister pack
Liquids and other bulk medications properly labeled
DCed/Expired medication removed from individual medication bins
New medications and all PRNs accompanied with PMOF
Cabinet neat, organized and devoid of items not belonging to it
Controlled drugs under double lock
Controlled drug count sheet signed and accurate by previous shift staff
All missing pills from controlled drug accounted for
Medication cabinet neat and well organized
First Aid kit with enough supplies and with no item missing
CPR Guard, thermometer/other assigned equipments in cabinet
Blood pressure machine in working condition
Finger-stick machine work; diabetic supply adequate (if applicable)
Medical supply fitting for individual needs adequate
MEDICATION
MARs neat, stapled together with all binder rings intact
All physician orders current, signed and dated
All medications entered on MARs as seen in PMOFs & approved by RN
All medication labels including Rx #s match physician orders and MAR
All documentation in accordance with PMOFs & MTTP policies
Medication errors/omissions explanations, RN notification documented
All pills missing from bubble pack accounted for on MAR
PRN/Stat (one time only) medication recorded correctly
Medication cabinet locked and key handed over
BP, pulse, blood sugar, weight etc documented as indicated (if app.)
OTHER
Seizure Chart updated (if applicable)
Fluid/BM/positioning (if app.)/menstrual (if app.) charts updated
Nurse Contact Logs checked for proper notification of RN as needed
All verbally reported incidents properly documented/signed by staff
Weight recorded for all consumers as indicated
Activity schedule and Emergency Contact List current
All menus updated to reflect current week
Food supply appropriate per menus and adequate for at least 3 days
Medical appointments (brown packet) thoroughly reviewed and instructions passed on
All monies, receipts and other valuables handed over properly (if app.)
All keys, including medication cabinet keys received by incoming staff
INDIVIDUALS
All individuals accounted for, free of injury/complains, well dressed & well groomed
All individual belongings accounted for, have adequate personal need supplies
Individuals have adequate seasonal clothing/footwear/linen/towels/hygiene supplies
Individual rooms/bathrooms/closets/cabinets/dressers clean and orderly
Copy of Current IP/BP (if applicable) with up to date data sheets present
Behavioral incidents (if applicable) verbally reported to authority and written report made  {Image42}
Evidence of implementation of IP goals and BP (if applicable) present
HOME/ENVIRONMENT
All areas of ALU/floor/carpet/appliances/cabinets etc. clean, neat and orderly
Smoke detectors/carbon monoxide detectors/security systems in working order
Fire extinguisher tag current/monthly fire drill done before due date
Water thermometer (notify supervisor if temperature > 110 ?)
ALU free of lice wires/holes in walls/broken furniture and other safety hazards
Water thermometer/vacuum cleaner/kitchen appliances/washer-dryer working
All lights including bedroom lamps working
Any/all existing maintenance need reported
Cleaning/laundry supplies adequate;cooking utensils in good condtion
Over (inside & outside)/stove top clean; kitchen sink free of utensils, dishes
All crockery & cutlery in complete sets and all other small items accounted for
All furniture intact (tables & chairs with no loose legs) & arranged tastefully
Hoyer lift/other common equipments (if applicable) in working condition
Enough walk space between furniture and room free of fall hazard
All household chores completed for the shift
VEHICLES
Vehicle parked in assigned location with/club lock on (unless in authorized use)
Vehicle policy/registration/first aid kit in the glove compartment
Vehicle free of unreported damage including minor scrapes/scratches
Vehicle clean & neat and free of stains/spills etc. seat belts working
Mileage accurately documented and is comparable with approved activities
Vehicle keys/mileage log book taken by incoming staff
No records