Patient Name: Date:

Time:

Neurosurgery Ward Round Proforma

SpR(s).....................................................................
...

Cons: DP ST JT GT SR GS KD RC JG NP AT PC

Neurosurgical Diagnosis:

Surgery:

Neuro GCS: Limb powers: Normal [ ] Abnormal:

Observations NEWS = O [ ] NEWS Unchanged [ ] Deterioration [ ]

Bloods Hb: WCC: Na: CRP: Other:

CQUIN VTE form [ ] Tinzaparin treatment [ ] MRSA sticker [ ]

Dementia CQUIN: N/A [ ] Yes [ ] No [ ]

Antibiotics N/A [ ] Yes [ ] Indication & review date:

PICC line: N/A [ ] Yes [ ] Referred [ ]

Lines Catheter [ ] Wound drain [ ] EVD [ ] LD [ ]

Lines to remove:

Steroids N/A [ ] Reducing to stop [ ] Reducing to 2mg [ ] PPI [ ]

SALT Oral [ ] NG [ ] PEG [ ] Date referred for PEG:

Discharge Ongoing treatment [ ] Medically fit [ ] For repatriation [ ]

Repatriation hospital: Repatriation consultant:

Other:
Patient Name: Date:
Time:
Plan:

Name: Signature: Contact

number: