Hospital Care Checklists
Simple “to-do’s” for safe care and peace of mind
Until the Nurse-Patient Ratio is 1:1, Prepare to Pitch In
Nurses typically care for up to 8 patients in their units – sometimes even more. Most patientsare very sick and their care demands a high level of detail, focus and energy. As you sit bedside, you can pitch in to support care for your loved one! Help make sure they don’t suffer any of the common complications in hospital care that often add extra days to hospital stays.
These complications can be prevented with attention to details outlined in the checklists below. Not rocket science — but labor-intensive. And totally worth it!
You’ll understand why nurses are hard pressed to find time to “cover all the bases.” Please offer your thanks for what they do whenever you can!
How to Help Prevent Superbug Infections (MRSA/VRE)
One out of every 25 patients[2] will pick up an infection in the hospital. These can be fatal and cause about 100,000 needless deaths every year.
The most common infections are MRSA (pronounced “mur-SAH”), VRE and CRKP, also known as “superbugs.” Superbug germs thrive on any surface:
- Skin: Hands, especially
- Fabric: Uniforms, drapes, purses
- Hard surfaces: Hospital furniture, medical instruments, doorknobs, elevator buttons, TV remotes, call buttons, tray tables
WHO’S AT RISK:
All patients are at risk for getting a Superbug infection during a hospital stay! The bugs are EVERYWHERE! Even carried around on clothing.
There are a few kinds of Superbugs: MRSA, VRE, and CRKP are the most common. And what they have in common is they are hard to cure and can be deadly.
HOW to Help Wipe Out Superbugs:
- Make sure you and everyone else who comes close to your loved one washes their hands first with warm, soapy water or antimicrobial hand gel
- In a rush, nurses and doctors may forget to wash up – a reminder from you could be a life-saver. (Yes, it can be hard to speak up, but it’s your job.)
- Help make sure your loved one washes their hands, especially under nails, after using the bathroom and before eating.
Use alcohol wipes to clean away germs from any surfaces your loved one and others touch:
- Cell phone
- Doorknobs
- Call buttons
- Tray table, including the drawer and underside
- Bedside tables and chairs
- Wheelchair arms/backs
- Telephone
- Faucets
- Bed rails
- Inhalers
- Grab rails
- IV pole
- TV remote
- Toilet handle
- Spirometer
Get a nurse if you see or your loved one tells you about:
- Oozing, pus, increasing redness, tenderness around surgery stitches
- Bumps or spots that look like boils, pimples or bug bites
- Breaks in the skin or a rash
- Chills
- Shivering
- Confusion
- Extreme pain
- Headache
- Diarrhea
- Nausea
- Fast heartbeat
- Fast breathing
PREVENTION is literally in your hands!
The #1 way to help prevent an infection is thorough hand washing! No one should ever touch a patient without washing their hands first. That includes doctors and nurses—don’t be afraid to speak up if they forget!
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How to Help Prevent C. Diff Infections
C. diff is another type of dangerous bacterial infection found in hospitals and long-term care facilities. It causes diarrhea and dehydration that can lead to heart failure. Unlike Superbugs, C. diff can only be eradicated with the use of bleach wipes, not alcohol wipes.
Like Superbug germs, C. diff bacteria can thrive on any surface:
- Skin: hands, especially
- Fabric: uniforms, drapes, purses
- Hard surfaces: hospital furniture, medical instruments, doorknobs, elevator buttons, TV remotes, call buttons, tray tables, and especially toilet levers and sink faucets
WHO’S AT RISK:
All patients are at risk of C. diff, especially those age 65 and older. Other risk factors include:
- Use of antibiotics,
- Prior history of C. diff
- Prolonged diarrhea
- Weak immune system
- Living in a nursing home or other long-term care facility
HOW to Help Prevent C. Diff Infection:
If your loved one has been on antibiotics in the past year, or lives in a nursing home or long-term care facility, make sure these facts are part of the medical record. To be on the safe side, tell your loved one’s nurses yourself.
Follow the checklist for preventing Superbug infections.
Alcohol wipes won’t kill C. diff germs. In addition to alcohol wipes, help keep your loved one’s surroundings extremely clean with bleach wipes.
It’s OK to ask for bleach wipes. If the hospital doesn’t have a supply, buy them yourself. Be sure to choose a trusted brand of bleach wipes from a well-known store.
Make sure you and your loved one wash hands with warm soap and water before eating and after using the bathroom. A soft soapy nail brush helps clean under nails where C. diff spores can hide.
Bring clean clothes to the hospital for your loved one to wear home. Store until needed in a suitcase or plastic bag to keep germ-free.
As soon as you get home, wash all clothing you and your loved one wore in the hospital with warm soapy detergent and bleach. Use a clothes dryer, which helps kill germs.
Share this tip with visitors, too!
Get a nurse if you see or your loved one tells you about:
- Diarrhea (may be bloody)
- Stomach pains, cramps
- Loss of appetite
- Nausea
- Chills
- Fast heartbeat
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How to Help Prevent Sepsis, a Deadly Blood Infection
The key to preventing blood stream infections — which can lead to deadly sepsis — is a 100% germ-free central line (also called an IV) installation and 100% germ-free maintenance.
The central line is a good “tool of the trade” to use when patients need several liquid medications and/or fluid.
A hub, placed under the patient’s skin near a large vein, allows fluids to get into the patient’s blood stream for fast, efficient delivery. Unfortunately, this super-highway for good meds can also be used by very bad germs.
Help make sure that tools of the trade include super attention to super clean practices.
WHO’S AT RISK:
All patients who receive liquid medications or other fluids through a tube and needle that goes into a vein. The fluid, itself, comes from a plastic bag attached to a bedside pole. Terms your nurse or doctor use to describe this set-up are “IV” line or “central” line.
HOW to Help Prevent Sepsis:
Watch to make sure nurses and doctors follow these safety steps:
- Wash their hands thoroughly before touching your loved one and wear a mask
- Choose the safest spot – if groin is chosen, ask, “Why?”
- Use a clean sheet to drape your loved one’s body
- Clean the skin with an alcohol wipe
- Cover the area with a sterile pad
- Use sterile instruments and supplies
- Make sure any openings in the skin are kept covered at all times.
When a tech or nurse is inserting an IV or central line, ask: “Are you using a central line bundle and checklist?”
Get a nurse if you see or your loved one tells you about:
- Oozing, pus, increasing redness, tenderness around surgery stitches
- Bumps or spots that look like boils, pimples or bug bites
- Breaks in the skin or a skin rash
- Chills
- Shivering
- Confusion
- Extreme pain
- Headache
- Diarrhea
- Nausea
- Fast Heartbeat
- Fast Breathing
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How to Help Prevent Falls and Fractures
(Way More Common Than You Think!)
NOBODY WANTS TO BE THIS GUY!
“Guy” went into the hospital for a simple torn rotator cuff repair — too much tennis! Being such an active person, he decided to ignore the nurses’ instructions to ask for help when he needed to get out of bed. Woozy from the anesthesia, and unfamiliar with the room, Guy tripped on his IV pole trying to get to the bathroom on his own.
Falls are a risk for all patients, from the young and athletic to the older and infirm.
As your loved one’s Care Partner, don’t fall down on the job! Use our quick checklist to help your loved one go home fracture-free.
WHO’S AT RISK:
ALL patients — regardless of age or fitness level — are at risk for falling!
HOW to Help Prevent Falls:
- Tell the nurses if you are concerned about your loved one taking a fall, or falling out of bed.
- Ask for a bed alarm and a room close to the nurses’ station.
- Look for things in your loved one’s room that might cause a trip and fall.
- Point out all furniture and equipment on wheels. Discuss ways to move around the room without leaning on wheeled items for support.
- Ask the nurses for non-skid socks for your loved one to wear when out of bed.
- Ask about getting a cane or walker, and using bed rails.
- Ask about fall protection equipment, such as low beds and floor padding.
- Watch to make sure the hospital gown and IV tubes won’t trip your loved one.
- Make sure someone helps your loved one go back and forth to the bathroom or commode, and someone is on standby in your loved one’s room for every trip.
- If you’re able, lend your arm for support when your loved one walks.
- Please don’t take a risk. You might injure yourself—it’s okay to ask for help.
Get a nurse if you see or your loved one tells you about:
- Don’t try to move them or pick them up by yourself.
- Put a blanket over your loved one.
- Go in the hall and call for help. Repeat as necessary to get immediate help.
Afterward, ask to be part of the hospital’s post-fall huddle to find out:
- How the fall happened
- What will be done to help make sure your loved one doesn’t fall again.
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How to Help Prevent a Blood Clot
(Pulmonary Embolism/PE)
Dangerous and deadly blood clots claim upwards of 100,000 lives every year. Hospitalized patients are especially at risk because of long bed rest and little activity.
They are also more likely to have had a recent heart attack, or given birth, or had some sort of injury to the lower body, which increase the risk of blood clotting.
If a blood clot travels to the lungs, it can cause a blockage — known as a pulmonary embolism (PE) or lung clot — 30% of all lung clots cause death.
The good news is that blood clots are usually preventable: special elastic stockings, “pulsing boots,” and medications to thin the blood are effective.
Use this Care Partner Project checklist with simple to-dos so you will know how to work with the nurses and doctors to help make sure your loved one doesn’t suffer a deadly clot.
WHO’S AT RISK:
- Anyone with surgery – stomach, hip, and knee
- Family history of clotting, often from genetic Factor V Leiden Malformation
- Diabetes
- Smoking
- Birth Control and other hormone pills
- Obesity
- Spinal Cord injury
- Multiple Injuries
- Lack of exercise
HOW to Help Prevent a Blood Clot/PE
- Tell doctors and nurses you’re concerned about blood clots.
- Ask for special stockings, boots or arm bands that pulse
- Encourage regular and frequent walks while in the hospital – if allowed by your loved one’s doctor
- Ask about a prescription for a blood thinner*
- Watch for signs of blood clots for at least one month after your loved one leaves the hospital. (See list under “Get a Nurse if”.)
- Remember that blood clots can form even if your loved one feels 100% “back-to-normal” in other ways.
- Encourage walks and exercise after your loved one leaves the hospital (if okayed by doctor).
- A review of your loved one’s diet is a good idea, too.
*To be on the safe side, be sure the doctor is aware of other medications, vitamins, or herbs your loved one is taking, plus any prior bad reactions to medications. If you are not sure, it’s okay to ask “Before you give the blood thinner, can we make sure nothing else will interfere with it?”
Get a nurse if you see or your loved one tells you about:
- Swelling in a leg or arm
- Pain or a burning feeling in a leg or arm
- A cramp or “charlie-horse” type of pain in the leg calf that lasts for hours, or longer
- Shortness of breath, difficulty breathing
SPECIAL NOTE: If your loved one is on pain medication or on a breathing machine, you need to be especially watchful because their senses are dulled.
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How to Help Prevent Medication Mistakes
Medication mix-ups are more common than you might think — despite all the checks and balances in hospital systems.
The Institute of Medicine estimates preventable medication errors cause upwards of 9,000[4] deaths every year in hospitals. Not all medication mix-ups are fatal, but they can cause harm.
How do they happen?
- Sound alike names (e.g. Celebrex and Cerebyx)
- Unknown patient allergies
- Taking medications at the wrong time
- Taking medications (or eating foods) that “don’t get along”
Imagine you are supposed to receive 1.0 milligrams of a drug and a clerical or math error causes the pharmacist to deliver 10 milligrams instead. Details matter — but they are easy to check. It just takes a bit of extra time and focus.
Follow this simple checklist to prevent medication mix-ups from harming your loved one in the hospital and at home.
WHO’S AT RISK:
Patients tend to get several medications in the hospital. Many look alike and their names sound alike. Nurses can be distracted, especially when others talk or interrupt them while giving a medication.
HOW to Help Prevent Medication Mistakes
- Make sure your loved one’s allergies and any bad experiences with medicines in the past are included on the medical record—and highlighted in a bold way.
- Before a nurse ever gives a medicine, ask:
- What is the medicine you’re planning to give? (If an IV bag is used, read the label to double-check it’s the right medicine.)
- What is it for?
- What is the dose?
- Who prescribed it?
- Say: “Let’s confirm that it’s for (your loved one’s name).”
- Don’t talk to nurses when they give medicines—or distract them.
- However, speak up immediately if you sense a mistake is being made. (For example, wrong patient, wrong medicine, wrong time, wrong dose, wrong way.)
- If you have any concerns, bring them up immediately with the attending doctor.
- Record every time your loved one gets a medicine.
- For medicines in an IV bag, ask: “What time do you think this bag will run out?” If the bag empties completely, get a nurse, especially if you see blood creeping up the IV tube.
Research the pros and cons of every drug prescribed, and make notes about potential side effects and interactions. Buy a drug guide or look on the Internet. If your loved one is 65 or older, check the Beers List, too, for info about medications considered unsafe or “iffy” for seniors.
Get a nurse if you see or your loved one tells you about:
- Diarrhea
- Stomach cramps
- Coughing
- Wheezing
- Difficulty breathing
- Difficulty swallowing
- Swelling face
- Swelling/itchy eyes
- Rash or hives
- Confusion, anxiety, restlessness
- Light-headedness, dizziness
- Fainting
- Swelling in neck
- Bluish lips
- Cool, clammy skin
- Chest pain
- Unusual sweating
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How to Help Prevent UTIs
Urinary Tract Infections (UTIs) are the most common hospital-acquired bacterial infection among patients.
According to the latest research, many hospitals still do not monitor catheter duration despite the fact that every day a patient is fitted with a urinary catheter, the likelihood of acquiring an infection significantly increases.
Studies also reveal that 25% of patients receive a urinary catheter at some point during their hospital stay and up to 50% of these are placed unnecessarily.[5]
Help make sure your loved one doesn’t suffer a urinary tract infection in the hospital — share and follow this simple checklist!
WHO’S AT RISK:
Anyone using a plastic tube and bag system for urine collection — called a “Foley” catheter
Get a nurse if you see or your loved one tells you about:
- Chills, shivering
- Confusion
- Pain or a burning feeling in the lower stomach area
- Headache
- Lower back pain
- Body aches
- Blood in urine bag
HOW to Help Prevent a Urinary Tract Infection (CAUTI/UTI):
- Every day, ask if the Foley catheter can be removed.
- When no longer needed, ask the doctor for a written order to take it out.
- If not taken out as ordered, politely remind at every shift change until the tube and bag are removed from your loved one’s body.
- Ask about the cleaning plan (daily is ideal).
- To prevent urine from going back into your loved one’s body, keep an eye on the tube for kinks and tangles, and straighten them.
- Make sure the bag hangs below your loved one’s stomach area so urine can’t back up the tube.
- Make sure the bag is replaced when full.
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How to Help Prevent Ventilator Pneumonia
Most cases of pneumonia developed in the hospital are among patients who need a breathing tube (ventilator) which becomes contaminated with bacteria — it’s known as “ventilator-associated pneumonia,” or VAP.
One little thing you can do will help in a big way! Make sure your loved one’s mattress is angled at 30-45 degrees so fluids won’t pool in the lungs. Small discomfort for big rewards — pneumonia is life-threatening.
WHO’S AT RISK:
- Use of ventilator for breathing
- Lung disease
- Age 65 and older
HOW to Help Prevent Ventilator Pneumonia:
- Ask about the sterile steps used to put the breathing tube into your loved one.
- Ask for a daily check of your loved one’s ability to breathe without machine help.
- Use our angle guide to help make sure your loved one’s back and head are always at least at a 30-degree angle by raising the mattress.
- If your loved one slumps, tell a nurse right away.
- If you are able-bodied, ask if you can help position your loved one to sit up straighter.
- Be on the lookout for bed sores on your loved one’s tailbone and “sit bones.” Follow the checklist to prevent bed sores.
- Ask about medicines to help prevent your loved one from getting stomach ulcers (sometimes caused from the breathing tube).
- Ask about care for your loved one’s teeth, gums and tongue every four hours to kill germs that could go from mouth to lungs. Make sure these are used every time:
- A toothbrush with soft bristles and 1.5% peroxide toothpaste
- A vacuum tool to pull germs and waste from the mouth
- A chlorhexidine rinse (It tastes bad—but it works!)
Get a nurse if you see or your loved one tells you about:
- White patches or sores in your loved one’s mouth or on the lips
- Cough with phlegm (can be yellow or green)
- Increasing need for suctioning
- Need for higher settings on the breathing machine
- The tube comes loose
- A pool of water inside the tube
- Chills, shivering
- Confusion
- Headache
- Body aches
NOTE: Sometimes patients on ventilators have their hands bound to keep them from pulling out the tubes by accident. This may be scary for your loved one, and may even cause a panic attack. If this happens, get a nurse to help ease your loved one’s fears.
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How to Help Prevent Bed Sores
(also known as Pressure Ulcers/Pressure Wounds)
A staggering 60,000[6] patients die from complications from bed sores each and every year — yet 95% of them are preventable.
These are caused by constant pressure or friction on skin, especially in bony areas that normally have limited circulation — or in folds of fat where moisture can accumulate. The open wounds can erupt from bed rest or sitting in one place and can be a “highway” for bacteria and infection. Actor Christopher Reeves, who was wheelchair-bound after a riding accident, was an unfortate victim who died from an infected pressure wound.
You can make a difference! Thousands of lives could be saved every year just by following these simple prevention steps.
Bed sores are much easier to prevent than to heal.
WHO’S AT RISK:
- Thin skin
- Stroke
- Lung conditions
- Cancer treatment
- Diabetes
- Spinal cord injury
- Bed/chair-bound
- Poor circulation
- Very thin/overweight
- Age 65 and older
HOW to Help Prevent Painful Bed Sores/Wounds:
- Help make sure your loved one changes positions every two hours—even more often if your loved one can manage it. (It helps to set a timer.)
- Ask for an alternating air pressure mattress and some type of pad to absorb moisture.
- Make sure your loved one has foam cushions between ankles and knees, for elbows, and back of head.
- If the hospital gown or sheets become wet, get help to change them as soon as possible. If you are able-bodied, help change the sheets.
- Help make sure that nothing rubs or scratches your loved one’s skin—ask nurses about barrier cream for fragile skin areas.
- When your loved one gets out of bed, either alone or with help, make sure it’s done very gently to avoid scraping any skin.
- Ask the attending doctor about “upping” the protein in your loved one’s diet. Ask if it’s OK for you to bring high-protein snacks, drinks or food.
- It’s OK to ask for the hospital wound care specialist if you have any concerns.
WHERE TO LOOK:
Bony Areas
Back of head
Elbows Behind Ears
“Sit” Bones
Hipbones
Knees
Tailbone
Heels
Where Sweat Collects
Between buttocks
Between folds of fat
Under breasts
WHAT TO LOOK FOR:
- Any skin breaks or scrapes
- Abnormally white patches of skin (especially on bony areas)
- Pinkness, redness, or swelling of the skin that doesn’t go away in minutes
- Areas of skin that are extra-warm
HELP MAKE SURE:
- Nurses check your loved one’s skin every day
- If okay with your loved one, check his/her skin daily—or even more often.
- Make sure no pressure is put on the abnormal areas of the skin for the next 24-48 hours, or until the skin is back to normal.
Get a nurse if you see or your loved one tells you about:
- Chills, shivering
- Confusion
- Extreme pain
- Fast heartbeat
- Headache
- Diarrhea
- Nausea
- Fast breathing
- Body aches
- Cramps
- No appetite
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