TREATMENT NURSE CHECKLIST

CONFORMANCE GENERAL EVALUATION

Response Interpretation
Category
Always Performed 4 3.26 - 4.00 82% - 100% Very Good
Often Performed 3 2.51 3.25 62% - 81% Good
Rarely Performed 2 1.76 - 2.50 44% - 61% Fair
Never Performed 1 1.00 1.75 43% below Poor

DESCRIPTION AND TASKS CONFORMANCE REMARKS

1. Do bedside round together with the Charge Nurse. 4
2. Request IV fluids per Physicians order. 4
3. Prepare IV Fluids Complete name of Patients. 3
with IV tags Room and Bed number. 3
complete labels: Date Started. 3
Time started. 3
Time ended. 3
IV fluid no. 3
Type of IV fluid. 4
Signature of NOD. 3
NOTE: GRAY IV TAG- Plain IV
Fluid.
PINK IV TAG- Fluid
with Infusion.
4. Do follow IV (if Midwife/Attendant is not around). 4
5. Responsible for initiating Nursing Procedures (e.g IV 3 Patients for IV reinsertion is
reinsertion, IV trouble shooting, NGT insertion, usually referred to the ER
Urinary Catheterization.) Nurse
6. IV Reinsertion IV carriage 4
Prepare all Dry and wet cotton 4
necessary Alcohol 4
materials. Sharp container 4
Tourniquet 4
Plaster 4
splints 4
IV catheter (gauge may vary 4
on patients status)
Cellophane ( trash container) 3
7. IV trouble Shooting Dry or wet cotton. 4
prepare Plaster 4
necessary Syringe 4
materials such Splint 4
as: Dry or wet cotton. 3

12. NGT Inform the Resident on Duty for NGT Not There was no NGT
insertion insertion. assessed insertion during evaluation
Asepto syringe
Prepare all NGT (depends on patients
necessary size)
Sterile Gloves ( depends
 materials on RODs size)
such as: Plaster (leucoplast)
KY jelly
Asepto syringe
13. Urinary Urinary catheter (depends Not There was no urinary
catheterization on patients size) Assessed catheter insertion during
Prepare the evaluation
necessary materials Urine bag
such as: Plaster
10cc syringe with sterile
water for injection.
Sterile gloves
14. Do fast drip of IVF for Verify physicians order. 4
stat orders. Mark a line corresponding 4
to the level of the residual
fluid volume after infusion.
Write the date and time the 4
infusion (fast drip) is
started in the parenteral
sheet.
Regulate back the IV fluid 4
according to its prescribed
rate.
May also act as Charge Nurse 2 (who will carry out the 4
STAT and MGH orders, receive new admissions).
May also act as Medication Preparation Nurse (who will do 4
Skin Test).
Will administer PRN medications ( e.g paracetamol, pain 3 *Treatment Nurses give
relievers) PRN medications in station
II and in cases where there
is no treatment nurse in
station I
Help the Charge Nurse in documenting Nurses Notes 3
(starting from Lobby, ward, semi-private to private rooms
and suite rooms)
Make discharge Instruction and health teachings for 3 *incomplete discharge
discharge patients. instructions and health
teachings
Answer Ward Calls and inquiries of patients and 4
significant others.
3.64 = 91% Very Good Conformance

Note: The senior nurses and Trainee Preceptors act as treatment nurses during evaluation since there
was no Treatment Nurse trainee and Treatment Nurse on duty

GENERAL RECOMMENDATIONS:
1. There should always be a treatment nurse in both stations. In cases of surge in the number of
patients, the treatment nurse should act as Medication Nurse 2. However, if there are more than
the usual number of orders to be carried out the Charge Nurse could no longer handle, the
Treatment Nurse should assist the Charge Nurse.
PREPARED BY:

May Princes T. Abucejo, RN RM MAN

Assistant Chief Nurse

NOTED BY:

Robert John Tupas, RN RM MAN

Chief Nurse
APPROVED BY:

Annabelle D. Murillo, MD, FPOGS, FPSOUG

Medical Director