Patient Name:
|Patient Name: |Agency: |
|Review Date: |Admission Date: |
|Reviewer: |Hospitalization Date: |
|Primary Clinician: |Date last SN visit: |
CHF Hospitalization Audit Tool 2004 (HCANH)
| |Yes |No |N/A |Comments |
|Was the admission weight measured & documented? | | | | |
|Documentation supports evidence of daily weights being done? | | | | |
|Were lung sounds assessed at every SN visit? | | | | |
|Was SOB/ dyspnea assessed at every SN visit? | | | | |
| | | | | |
|Nocturnal | | | | |
| | | | | |
|Cough | | | | |
| | | | | |
|Oxygen compliance | | | | |
|Were B/P, P, R assessed and recorded at every SN visit? | | | | |
|Documentation is present in the record of the patient/ caregiver ‘s response to medication | | | | |
|teaching | | | | |
|Documentation is present in the record of the patient/ caregiver ‘s verbal response to teaching| | | | |
|of ordered diet. | | | | |
|Was the MD notified when: | | | | |
|Weight increased 2 -3 lbs. in 24° or 5 lbs. in 5 days | | | | |
| | | | | |
|Worsening breath sounds from previous SN Visit | | | | |
| | | | | |
|Increased SOB or dyspnea from baseline | | | | |
| | | | | |
|Increased cough | | | | |
| | | | | |
|Non-compliance with Care plan | | | | |
Updated 2/25/04
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