Dd Form 2551 - Workload Management System For Nursing - General Worksheet Page 2
Download a blank fillable Dd Form 2551 - Workload Management System For Nursing - General Worksheet in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Dd Form 2551 - Workload Management System For Nursing - General Worksheet with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2WORKLOAD MANAGEMENT SYSTEM FOR
NURSING - GENERAL WORKSHEET
ENTER DATE, RN INITIALS,
ENTER DATE, RN INITIALS,
AND LAST FOUR SSN
AND LAST FOUR SSN
ACUITY
POINT
ACUITY
POINT
SECTION I - CRITICAL INDICATORS (Continued)
SECTION I - CRITICAL INDICATORS (Continued)
CODE
VALUES
CODE
VALUES
7. RESPIRATORY THERAPY (Continued)
6. TREATMENTS/PROCEDURES/MEDICATIONS
(Continued)
85
Chest pulmonary therapy bid or x 2
2
55
Dressing - complex 30 mins x 1
4
86
Chest pulmonary therapy q6h or x 4
4
56
Lab tests performed/collected on the unit x 3
2
87
Chest pulmonary therapy q4h or x 6
6
57
Do EKG
2
88
Suctioning q4h or x 6
2
58
Venipuncture, arterial puncture x 2
2
89
Suctioning q2h or x 12
4
59
Medications - exclude IV - 3-11 trips or q3h - q8h
2
90
Ventilator
10
60
Medications - exclude IV - 12 trips or more or q2h
4
91
Tracheostomy care x 3
4
61
Irrigations or instillations x 4 or less
2
8. TEACHING
62
Restraints, 2 point, 4 point, Posey
2
92
Teaching - group - per hour
2
63
Assist OOB chair/gurney and return, x 3
2
93
Teaching - individual - per 30 minutes
4
64
Assist to ambulate and return, x 1
2
9. EMOTIONAL SUPPORT
65
Infant circumcision or phototherapy
2
94
Patient/family support (per 30 minutes)
4
66
Isolation mask, gown and gloves x 8
2
95
Lifestyle modification (per 30 minutes)
4
67
Chest tube insertion or lumbar puncture (assist)
4
96
Sensory deprivation - blind, deaf, retarded, etc.
6
68
Thoracentesis or paracentesis (assist)
4
97
Maximum points for emotional support
10
69
Range of motion exercises x 3
4
10. CONTINUOUS
70
New admission - assessment and orientation
12
98
Patient requiring 1:1 coverage all shifts
96
71
Transfer - in-house (receiving unit only)
4
99
Patient requiring greater than 1:1 coverage
all shifts
72
Accompany patient off unit 15 minutes
2
146
0
0
0
0
0
73
Accompany patient off unit 30 minutes
4
SUBTOTAL D POINT VALUE
0
0
0
0
0
74
Accompany patient off unit 45 minutes
6
SUBTOTAL A POINT VALUE
0
0
0
0
0
75
Other activities requiring 15 minutes
2
SUBTOTAL B POINT VALUE
0
0
0
0
0
76
Other activities requiring 30 minutes
4
SUBTOTAL C POINT VALUE
0
0
0
0
0
77
Other activities requiring 45 minutes
6
TOTAL POINT VALUE
78
PATIENT ACUITY CATEGORY
Each hour requiring continuous staff
attendance
8
SECTION II - ADDITIONAL DATA
7. RESPIRATORY THERAPY
1. ACUITY TABLE
2. TYPE OF PATIENT (X as applicable)
79
Oxygen therapy or oxyhood
2
e. ANTEPARTUM/
CATEGORY
POINTS
a. MED/SURG
80
Incentive spirometer or C&DB q4h or x 6
2
POSTPARTUM
0
O
81
IPPB or Maximist bid or x 2
2
I
1 - 12
b. ICU
f. PEDIATRIC
II
13 - 31
82
IPPB or Maximist q6h or x 4
4
III
32 - 63
83
IPPB or Maximist q4h or x 6
6
c. NURSERY
g. PSYCHIATRIC
IV
64 - 95
84
Croup tent or mist tent
8
V
96 - 145
d. NEONATAL ICU
0
0
0
0
0
VI
146 - 262
SUBTOTAL C POINT VALUE
DD FORM 2551, FEB 92
Page 2 of 2 Pages
Reset
ADVERTISEMENT
0 votes
Related Articles
Related forms
Dd Form 2962 - Personnel Security System Access Request (pssar) Defense Manpower Data Center (dmdc)
Business
Dd Form 2648 - Preseparation Counseling Checklist For Active Component (ac), Active Guard Reserve (agr), Active Reserve (ar), Full Time Support (fts), And Reserve Program Administrator (rpa) Service Members
Business
Related Categories
Parent category: Business