Daily Record Form – Aimee W – Night Shift

User's Email
Username:
Client Name*
Name (s) of all Support Workers on shift tonight*
Date of Shift*
Date Format: DD slash MM slash YYYY

If you are undertaking night shifts, please remember to enter the correct date the shift started.
Shift Start Time*

: HH

MM
Shift End Time*

: HH

MM
Is all equipment in good working order?*
- Yes
- No

Night time routine
Please detail what interventions have been required overnight?*
Personal Care
Please detail all personal care provided to Aimee overnight
When brushing Aimee's teeth were there any problems encountered with secretions?
- Yes
- No
If yes, please give details;
Pressure area check
During personal care has Aimee’s skin been thoroughly checked for any signs of redness?
- Yes
- No
Please give details of any changes noted. If all areas are ok, please state this clearly.

Catheter and Bowel Care
Has all catheter care been attended to as per support plan?*
- Yes
- No
If no- please give full details
Are there any signs of urine infection?*
- Yes
- No
If Yes: please give full details of who this has been reported to and any action advised.
What has been the urine output during your shift?*
Has Aimee opened her bowels overnight?*
- Yes
- No
If yes, please give details;
If No when were bowels last open?
Has this been recorded on the bowel chart?
- Yes
- No

Medications
Have all medications been administered as per EMAR and support plan?*
- Yes
- No
IF no- please give more details of why medications have not been administered
Medical wellness
Has Aimee been well in herself overnight?*
- Yes
- No
If No: please describe the symptoms experienced and any advice sought
Has Aimee's temperature been in range overnight?*
- Yes
- No
If No what action has been taken?
Symptoms of seizures
Has Aimee experienced any seizure activity overnight?*
- Yes
- No
If Yes: please give full details and any actions taken and to whom escalated and what advice was given

Nutrition and Fluids
Has Aimee had feed and flushes administered via the PEG as per feeding regimen in the support plan?*
- Yes
- No
If No, please give details;
Has Aimee had all fluid administered via PEG as per regimen in the support plan?*
- Yes
- No
If No, then please provide details

Moving and handling
Have all moving and handling activities been undertaken today as per support plan?*
- Yes
- No

General
Please detail all household chores that have been done overnight? e.g. Ironing, cleaning the bathroom etc.
Please give a detailed overview of all activities and interventions that have required 2 people between the hours of 20:00 - 08:00*
Any moving and handling, bowel management, re positioning, suctioning etc Please state also how long these activities lasted for. Please do not miss anything out.
Are there any issues with missing, broken, or unsuitable equipment or facilities for Aimee or carers that we need to address?*
- Yes
- No
If yes, then please provide details
Any other information to share:
Do you have any safeguarding concerns?*
- Yes
- No
If yes, then please give details
Signature Pad

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