FOCUS:
Transfer In
DATA, ACTION, RESPONSE
A: Reviewed and verified the preoperative checklist.
Brought to _________ per stretcher.
(PROCEDURE) done by (SURGEON) assisted by
(ASST. SURGEON)
Closely monitored all throughout procedure.
Surgical Safety Checklist accomplished.
General Surgical Assessment captured by flow sheet.
Brought to recovery Room, monitored and assessed.
Aldrete Scoring done.
FOCUS:
Transfer Out.
DATA, ACTION, RESPONSE
Brought back to ward.
BABY (without complications)
F: Delivery
D: Delivered an alive baby ___ in ___ presentation via ___.
Assessed by Dr. ___, APGAR score ___.
A: Routine Essential Newborn care done.
Feeding cues noted.
Assisted on breastfeeding.
___ sucking and attachment noted.
F: Transfer out
A: Roomed-in with mother at room ___
Endorsed to MBF Staff for further care and management.
BABY (with complications)
F: Delivery
D: Delivered an alive baby____ in ____ presentation via ____.
Assessed by Dr. ___, APGAR score ____
PROM for ____ hours; Thickly meconium stained;
Premature. 36 weeks AOG
Cyanosis and sternal retraction noted.
A: Dried thoroughly and placed under droplight.
Oronosal suctioning done Obtained ____ amount
Of ____ secretions
O2 started at ___ LPM via ___ as ordered.
Transferred to NICU armborne and placed under
Radiant warmer / incubator.
Initial temperature of ____ C taken per rectum.
Endorsed to NICU staff for further care and management.
MOTHER (CS)
F: Transfer In
D: For ____ CS; G2P1 381/7 weeks AOG; CPD
A: Reviewed and verified the preoperative checklist.
Brought to CS room per stretcher.
____ CS done by Dr. ____ assisted by Dr.____.
Delivered an alive baby ___ in ____ presentation with
APGAR score_/__.
Closely monitored for all throughout th procedure by Dr._______.
Surgical Safety Checklist accomplished.
Obstretrical/ Gynecological assessment checklist captured by flowsheet.
F: Transfer out
A Brought back to ward with baby on her chest.
Endorsed to NOD.
BABY (NSVD)
F: Delivery
D: Delivered an alive baby ___ in ___ presentation via ___.
Assessed by Dr. ___.
Pinkish, good cry and active movements noted.
A: Immediate drying done.
Cord clamped and cut aseptically after pulsation stopped.
Uninterrupted skin to skin contact observed.
Latched on to mother’s chest.
Feeding cues noted. Assisted on breastfeeding.
___ sucking and attachment noted.
A: Routine Newborn care done.
Uninterrupted skin to skin contact observed.
Latched on to mother’s chest.
Feeding cues noted. Assisted on breastfeeding
____ sucking and attachment noted.
F: Transfer out.
A: Roomed-in with mother at room ____
Endorsed to MBF staff for further care and management.
MOTHER (NSVD2)
EINC checklist accomplished.
Transferred to stretcher safely. Latest BP___
F: Transfer out
A: Brought back to ___ per stretcher with baby on her chest.
Endorsed to NOD.
MOTHER (NSVD)
F: Transfer in
*If for Labor Room:
A: Brought to LR safely per stretcher.
Progress of labor captured in the monitoring sheet.
A: Brought to DR table safely per stretcher.
General Obstetrical and Gynecological
Assessment reflected in the flowsheet.
Delivery Record and EINC checklist accomplished
F: Transfer out
A: Brought back to ___ per stretcher with baby on her chest.
Endorsed to NOD.
BABY (CS)
Delivered an alive baby ___ in ___ presentation via CS.
Assessed for breathing.
Cried loud.
Turned pink.
Active movements noted.
Attended by Dr. ___.
Umbilical cord clamped and cut after pulsation
stopped.
Kept dry & warm with blanket and bonnet.
Placed in uninterrupted skin to skin contact in
prone position
Breastfeeding initiated.
Roomed-in with mother at room ___.
For further care.
