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Safety Thermometer Form 2026

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The document outlines a protocol for assessing and documenting various patient conditions related to Venous Thromboembolism (VTE), urinary tract infections (UTI), patient falls, and pressure ulcers. It specifies criteria for categorizing VTE prophylaxis and treatment based on the timing of admission, as well as guidelines for recording the severity of falls and the status of pressure ulcers. The document serves as a framework for healthcare providers to ensure accurate reporting and management of these conditions.

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Click ‘Get Form’ to open the Safety Thermometer Form in our editor.
Begin by assessing the patient's VTE risk. Indicate if the patient is at risk, has VTE, and select the appropriate treatment category based on whether it started before or after admission.
Next, document if a VTE Risk assessment has been conducted. Choose 'Yes' or 'No' accordingly.
For catheter usage, specify the number of days a urinary catheter was in place during the last 72 hours.
Record any UTI treatments based on clinical notes. Select 'Old UTI' for treatments that began before admission and 'New UTI' for those that started afterward.
Document any patient falls within the last 72 hours, noting their severity as per your observations.
Finally, fill in details regarding pressure ulcers by categorizing them as Old or New based on their development timeline relative to admission.

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Versions	Form popularity	Fillable & printable
2015	4.3 Satisfied (41 Votes)

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