Date: Team Leaders: Acuity level of Care

Shift:

UNIVERSITY OF SANTO TOMAS COLLEGE OF NURSING RLE TEAM LEADER WORKSHEET RLE Area: Clinical Instructor:

Yr. & Sec., RLE Group:

Student Nurse

Rm No.

Patients Name

CC/ Medical Diagnosis

Diet and Fluid Restriction

Parenteral (IVF, BT, TPN)

Surgeries and Special Procedures

Labs

Medications for the Shift

Contraptions (Dressing, NGT, drainage, O2 Therapy)

Treatments (e.g. CBG, Insulin, Neb)

Special (VS q1, HUM, Precaution Isolation and Safety)

Others (referrals, discharge)

Notes/Reminders: