When writing a shift report for surgical patients, you should not write: the name of the surgeon.

The handwriting must be clear and must not be altered or pasted at will. Use a blue (black) pen to fill in all the items in the eyebrow column, such as ward, date, time, total number of patients, admission, discharge, transfer out, transfer in, and surgery. , childbirth, number of patients at risk of death, etc. Write down the patients who left the ward first (discharged, transferred out, died). Then write the patients who enter the ward (admission, transfer).

Finally, write about the key patients in this class (surgery, delivery, critically ill and abnormal patients). Contents in the same column are written in order of bed number. In the content column, fill in the name, bed number, hospitalization record number, and diagnosis order. Fill in the day shift with black pen, and the diagnosis and night shift with red pen.

When the content needs to be transferred to the second page, the name of the ward, date and page number should be filled in the column, and other items do not need to be filled in. For newly admitted, transferred, surgery, and delivery patients, use a red pen to mark "new", "transfer", "operation" and "delivery" in the lower right corner of the diagnosis. For critically ill patients, use a red pen to mark "critical" or make a red mark. .

The page number must be indicated on each page and signed in full. The head nurse should check the ward handover report for each shift and sign it in full if it meets the quality requirements. Surgery patients on the same day: report the name of the operation, anesthesia method, whether the operation went smoothly, the time to return to the ward, and the time the patient woke up under general anesthesia.

Whether the drainage tube is unobstructed, the nature and amount of the drainage material, whether you can relieve yourself to urinate, the condition of the wound, the use and effect of analgesics, the function of the organs at the surgical site, etc. Prepare the patient for surgery the next day: report on preoperative preparation, night sleep conditions, patient psychology, etc.