This page outlines the writing, documentation, charting and assessements you will be doing. Although its a long list to remember and you will be introduced to every single one of them, some are used a lot more frequently than others, so don’t worry about trying to memorise them all off by heart.
This page is a Work in Progress…
- eMR
- Terms on a Medical Chart
- Clinical Handover Sheets
- Writing Progress Notes
- Making patient care plan
- SAGO Chart
- Wound Chart
- Fluid Balance Chart
- Mini Nutritional Assessment (MNA)
- Accident Incident Form
- Waterlowpressure Injury Risk Screen Assessment and Pressure Injury Care Plan
- Ontario Falls Risk Screen
- Falls Risk Assessment and Management Plan (FRAMP)
- Wound Assessment and Management Form
- Patient Risk Assessment Form
- Neurovascular Assessment Chart
- Neurological Observation Chart
- Glasgow Coma Scale
- Stool Chart
- Adult Inpatient Assessment Form
- Urinalysis
- Katz-ADL
- Standardised Mini Mental State Examination (SMMSE)
- Clinical Institute Withdrawal Assessment of Alcohol Scale
- BMI
- A-G Assessment
- Head to Toe Assessment
- PQRST Assessment
- DRSABCD- Action Plan
- Work in Progress…
Nursing Study Companion 