Daily Record Form – Piotr A – Day Shift

Client Name*
Name of Support Worker(s) on shift today*
Date of Shift*
Date Format: DD slash MM slash YYYY
Shift Start Time*

: HH

MM
Shift End Time*

: HH

MM

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Handover and checks
Did you receive a handover before starting work?
- Yes
- No
Was all equipment, including slings and hoists, checked before use to ensure it is safe to use?
- Yes
- No
Any issues of concern reported via handover?
Record below-and include actions taken to resolve any issues
Confirm staff have followed Covid 19 requirements, including testing prior to attending, mask wearing and PPE/hand washing expectations. Record any problems below.
Morning Routine
What time did Piotr wake up and start his day routine?*
Confirm 2 staff assisting with manual handling requirements at all times, and record any issues (if any) encountered below
Confirm Piotr’s skin was fully checked for non blanching and broken areas.
Please describe any issues with skin integrity (such as wounds, eczema, pressure area care-please confirm that this has been recorded on a body map, and an incident form been completed
Provide information below if this is the case.
Was errorless programme followed when dressing Piotr? Provide details of what Piotr was able to do with guidance
Were all medicines administered as prescribed?
- Yes
- No
Have you completed a medication stock check on the team drive?*
- Yes
- No
If stock check completed, Have you notified Clinical Lead?
If any problems or issues were encountered, please detail below.
This could be information about PRN medicines requirements, or even stock issues.
Confirm Piotr was observed at all times during the day shift? If not, please explain why this did not happen

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Fluids & Nutrition
Was Piotr's overall dietary intake sufficient today? If not-please provide brief summary explaining why this is the case.
What time did Piotr have meals at?
Provide further details below, such as food choice, any problems noted, amount taken, and confirm he was observed at all times in case of choking.
Was Piotr's overall fluid intake sufficient today?*
- Yes
- No
Please estimate amount taken, and describe any issues that have stopped Piotr drinking enough during the shift

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Behaviours,Sleep, Mood and Insight
Were any issues with motivation and engagement noted today?
- Yes
- No
If so-please provide further details
Please rate Piotr's overall mood today from 1-5
- 1
- 2
- 3
- 4
- 5
(1 is low, and 5 is high/good).
Were any episodes of challenging behaviour noted
- Yes
- No
Please describe
If yes - please record all the details If not, detail issues encountered.
Please record a summary of Piotr's sleep during the day
How long Piotr slept for? What times?
How would you rate Piotr's overall quality of sleep during the day shift from 1-5?

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Pain / Spasticity
Did Piotr experience any difficulties with pain / spasticity during your shift?
- Yes
- No
Please detail when Piotr had pain, and where this pain was.
Consider also how long the pain lasted, and what strategies were used to minimise discomfort. Rate pain from 1-5-with 1 being low.
Did any of these difficulties cause Piotr to have to reschedule plans or activities?
- Yes
- No

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Skin Integrity
Was Piotr assisted to have his position changed at least 4 hourly?
Has positional chart been updated to confirm specific details of pressure area care given, and of positional changes? If not, please explain why not?
Meds Administration
Have Piotr's medications been administered as prescribed and recorded on the eMAR chart?*
- Yes
- No
Did Piotr take all her medications as prescribed?
- Yes
- No
If not-please detail issues below, and consider whether incident form is required.*
Has Piotr had any changes to her medications?
- Yes
- No
Were any PRN medications administered today?
Please state which medication, the time administered and why. E.g. in response to pain. If so-has this been recorded on eMAR, and has detailed carer’s note been entered describing why, where and when this medication was administered-and whether it was effective.
Did any medical appointments took place today, time and duration. Please provide feedback from the appointment.
Has a daily medication audit been done ?
- Yes
- No
Has any required meds been ordered from GP ?

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Have you given a detailed handover to staff taking over from you in the evening?*
Please detail any major issues you are handing over.

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Safeguarding & Additional Feedback
Were any monthly regular tasks, such as ordering of PPE/repeat medicines or pad stocks completed today?
- Yes
- No
If yes , provide further information and confirm any outstanding tasks still needing to be done?
Is there anything that either Libertatem Healthcare or Piotr's Case Manager need to be aware of ?
- Yes
- No
Please provide further details*
Do you have any safeguarding concerns?*
- Yes
- No
Please provide further details*
Signature*
Untitled
- First Choice
- Second Choice
- Third Choice

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Submit a Daily Record

Daily Record Form - Piotr A - Day Shift

Step 1 of 10

Handover and checks

Morning Routine

Fluids & Nutrition

Toileting

Therapies

Community

Behaviours,Sleep, Mood and Insight

Pain / Spasticity

Skin Integrity

Meds Administration

Covid

Domestic

Safeguarding & Additional Feedback