Vap Worksheet Wpb Va
2
Ventilator Associated Pneumonia Worksheet – VAMC West Palm Beach Cindy Lang, BSN, RN, CIC – Senior Infection Control Specialist Name________________________________Last 4 SSN_________________________ Diagnosis___________________________________________________ ____________________________________________________________ ________________________ Date of Admission___________________________________________________ _____ Precautions/ Reason______________________________________________________ ____________________________________________________________ _____________ Code Status______________________________________________________ _______ Respiratory Status______________________________________________________ _ Ventilator – Intubation/Trach Date_________________________________________ ____________________________________________________________ ___________ Days on ventilator__________________________________________________ ______ HOB_________________________________________________________ ____________________________________________________________ ____________________________________________________________ __________________________________ Stress Ulcer Prophylaxis_________________________________________________ __
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Transcript of Vap Worksheet Wpb Va
Ventilator Associated Pneumonia Worksheet – VAMC West Palm BeachCindy Lang, BSN, RN, CIC – Senior Infection Control Specialist
Name________________________________Last 4 SSN_________________________Diagnosis_______________________________________________________________________________________________________________________________________Date of Admission________________________________________________________
Precautions/Reason_______________________________________________________________________________________________________________________________Code Status_____________________________________________________________Respiratory Status_______________________________________________________Ventilator – Intubation/Trach Date________________________________________________________________________________________________________________Days on ventilator________________________________________________________HOB___________________________________________________________________________________________________________________________________________________________________________________________________________________Stress Ulcer Prophylaxis___________________________________________________
DVT Prophylaxis
Daily Sedation Vacation/Assessment Readiness to Wean/Daily Spont BreathingTrial
Antibiotics______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Micro Data______________________________________________________________
Imaging/CXR/Bronch_____________________________________________________
Temp/WBC_____________________________________________________________Ventilator Associated Pneumonia – YES / Date NO (Circle) -______
C. Lang, BSN, RN, CIC 1/07 VAMC WPB
