Templates
SPEC-01
SPEC-01High Risk

IV Therapy & Infusion Record

Specialty & Advanced ជំនាញពិសេស និង កម្រិតខ្ពស់

BS DERMA
Clinic Management System
💉 IV INFUSION RECORD — Verify patient identity and allergies before every administration / ផ្ទៀងផ្ទាត់អត្តសញ្ញាណ និង អាល់លែកហ្សីមុនពេលឲ្យឱសថ
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IV Solution / សារធាតុ IV

Infusion Parameters / ប៉ារ៉ាម៉ែត្រ

💧
RATE
mL/hr
⏱️
DURATION
hours
💉
DROP FACTOR
gtt/mL
🔢
DRIP RATE
42
gtt/min
▶
START TIME
⏹
END TIME
⚠️DOUBLE CHECK: Verify pump settings against physician order before starting infusion.

Pump Verification Checklist

TimeBPHRRRSpO₂TempPainSite CheckInitials
⚠️STOP INFUSION IMMEDIATELY if any adverse reaction occurs. Notify physician and document.
Nurse Initiated
ព្យាបាលចាប់ផ្តើម
Signature
Nurse Verified
ព្យាបាលផ្ទៀងផ្ទាត់
Signature
Physician Reviewed
វេជ្ជបណ្ឌិតពិនិត្យ
Signature
BS Derma Clinic | IV Infusion Record | Template: SPEC-01 v2.0