VINOD MEMORIAL MULTISPECIALITY

HOSPITAL RECOVERY ROOM TRANSFER SHEET

Patient's Details
Patient's Name :   Age/Sex:
Allergies □ Yes □ No Vulnerable Patient □ Yes □ No
PRN No.:   Ward/Bed No.:
Doctor's Name :   Date of admission:
Diagnosis :  
Post Anesthesia Recovery Score (Aldrete Score)
Scor Admission Order Shifting
Parameter Description of the Patient
e DOCTOR DOCTOR DOCTOR
Moves all extremities voluntarily / on command 2      
Activity Moves 2 extremities voluntarily / on command 1      
Unable to move extremities 0      
Breathes deeply and coughs freely 2      
Respiration Dyspnoea or Limited Breathing 1      
Apnoeic 0      
Within 20% of Preoperative baseline 2      
Vital Sings(BP
20% -40% of Preoperative baseline 1      
& P)
>40% of Preoperative baseline 0      
Full Awake 2      
Consciousnes
Arousable on calling 1      
s
Not responding 0      
SpO2>92% on room air 2      
Oxygenation Needs O2 to maintain SpO2>92% 1      
SpO2>90% even with O2 supplementation 0      
Maximum Total Score is 10 Total Score > 9 is required for
Total Score      
discharge

Recheck before Shifting Patient (by Nurse)

Significant Surgical Bleeding absent □ Yes □ No
Pain relief adequate □ Yes □ No
Nausea / Vomiting absent □ Yes □ No
Eqidural catheter (if present) - site and dressing OK □ Yes □ No
Arterial line (if present)-removed □ Yes □ No
Central Line (if present)-Site and dressing OK □ Yes □ No
Urine Output - Adequate / Inadequate.
Increase abdominal girth Yes / No (In Case of Laparotomy).
If any of the above answer is no an / or Aldrete Score <9 Please inform recovery Room Consultant and await further
instructions for Discharge
Comment / Discharge Order :

Remarks

Name & Signature of anesthetist Date and Time