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Manager Rounding
Manager Rounding
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Created by Qualaris Staff
Inpatient Nursing
Table of Contents
Audit Form
Audit Form
Manager Rounding
Description
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Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Shift
AM
PM
Night
Manager Rounding Checklist
Mark all as...
Respect: Have staff introduced themselves to you?
Yes
No
N/A
Respect: Are staff treating you respectfully and courteously?
Yes
No
N/A
Listening: Do you feel staff are listening to your concerns?
Yes
No
N/A
Listening: Do you feel that your questions are answered?
Yes
No
N/A
Explaining: If yes, do you understand the explanations that were given to you?
Yes
No
N/A
Explaining: Has the staff included you and your family in the shift report?
Yes
No
N/A
Responsiveness: When you needed anything, were you able to get help quickly?
Yes
No
N/A
Medications: When receiving medications is staff explaining what it is for?
Yes
No
N/A
Medications: Are staff describing medication side effects in a way you can understand?
Yes
No
N/A
Inclusion: Have staff reviewed your plan of care for today?
Yes
No
N/A
Inclusion: Are staff involving you in decision making about your care?
Yes
No
N/A
Pain: Is your pain being controlled?
Yes
No
N/A
Comfort: Has staff visited hourly, when awake, to check on your needs?
Yes
No
N/A
Comfort: Have we addressed your personal needs?
Yes
No
N/A
Comfort: Are you satisfied with room temperature?
Yes
No
N/A
Comfort: Are you able to rest without noise disturbances?
Yes
No
N/A
Comfort: Are we keeping your room clean?
Yes
No
N/A
Comfort: Are you receiving assistance with bathing?
Yes
No
N/A
Comfort: Has your bed been changed every day?
Yes
No
N/A
Discharge: Did any staff discuss your length of stay and possible discharge date?
Yes
No
N/A
Discharge: Did any staff ask whether you will need help at home?
Yes
No
N/A
Discharge: Do you know your follow-up plan of care and medication needs?
Yes
No
N/A
