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Home
About Us
Our Official Charity Partner
Meet the Team
Clients
Testimonials
Acquired or Traumatic Brain Injury
Spinal Injury
Other Medical Conditions
Live Vacancies
Register CV
Candidates
Apply online
Supporting Our Official Charity Partner
Subject Access Requests
Refer a Friend Scheme
Care Packages for Brain and Spinal injury
Contact Us
Submit a Daily Record
Daily Record Form - Piotr A - Night Shift
Step 1 of 3
33%
Client Name
*
First
Name of Support Worker(s) on Shift
*
Date of the shift
*
Date Format: DD slash MM slash YYYY
Please remember to enter the correct date the shift started.
Shift Start Time
*
:
HH
MM
Shift End Time
*
:
HH
MM
Night Time Routine
Can you confirm that you have received detailed handover?
*
I can confirm
I cannot confirm
What time did Piotr retire to his bedroom at this evening?
*
:
HH
MM
What time did Piotr go to sleep?
*
:
HH
MM
Have all Piotr's night-time medications been administered as prescribed?
Yes
No
Detail any issues preventing this below.
*
Were there any issues with bedtime routine?
please record what the issues were, and how issues were resolved?
Was Piotr assisted with his evening hygiene routine?
If yes -please, describe how and when Piotr was assisted. How long it took? How many members of staff assisted Piotr ?
State the times that Piotr woke during the night? What did he need support with? For how long Piotr was up?
e.g. toileting, needed reassurance etc.
Did Piotr attempt to climb out of bed tonight?
*
Yes
No
Personal Care
Did Piotr require any assistance with hygiene during the night, for instance as a result of incontinence?
*
Yes
No
If so, please detail below
• If Piotr bowels opened, please confirm Bristol Stool type, and time this happened. • If Piotr passed urine, please confirm times and whether bottle used, or otherwise
How would you rate Piotr's overall quality of sleep during the shift from 1-5?
*
1
2
3
4
5
1 being poor & 5 would be excellent.
Was Piotr assisted to change his position every 4 hours as directed overnight?
Please document times, and confirm LHG Position Change chart updated
Record any other issues or concerns you may have encountered?
*
Please record a brief summary of the shift.
*
Is there anything you would like to raise to Piotr's Case Manager or Libertatem Healthcare?
*
Yes
No
Please give further details
*
Do you have any safeguarding concerns?
*
Yes
No
Please give further details
*
Signature
*
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