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VTE Checklist
VTE Checklist
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Created by Qualaris Staff
Inpatient Nursing
Learn more about managing Nursing data with Qualaris
Table of Contents
Audit Form
Audit Form
VTE Checklist
Description
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Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Pt Risk for VTE
Low
Moderate
High
Very High
Not Assessed
VTE Checklist
Mark all as...
Pt assessed for VTE upon admission?
Yes
No
If indicated, VTE prophylaxis ordered?
Yes
No
N/A
Pt educated on VTE?
Yes
No
N/A
Pt mobility plan in place?
Yes
No
N/A
Pt following mobility plan daily?
Yes
No
N/A
If indicated, compression stockings in use?
Yes
No
N/A
If ordered, SCDs in use?
Yes
No
N/A
January
February
March
Sun
Mon
Tue
Wed
Thu
Fri
Sat
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26
27
28
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31
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