Guideline 1-450-66 - Rounding Form

CMH EMS & MIH Protocols

Scope:

LicenseVolunteerCareerCMH
EMDNANoNA
EMRNoNoNA
EMTNoNoYes
AEMTNoNoYes
RNNoNoYes
MedicNoNoYes
CPNoNoYes

Guideline:

Purpose:

Procedure:

This form is to be used by Crew Leaders rounding on staff members. Once complete, forward the form to the appropriate manager for entry into MyRounding software.

Demographic info:

Staff member's name being rounded on:

Crew Leader's name:

Date rounding completed:

Is there someone we can recognize for doing good?

Name of person to be recognized:

Description of why they should be recognized:

Do you have any questions or concerns we can address?

Description of conversation:

Follow-up (answered by Crew Leader):

Description of what follow-ups need to happen (i.e. what needs to be passed up the chain or issues to add to the stoplight report):

Citations:

Change Log:

DateLink to
previous
version		Description of change
08/13/20Developed this section as a tool for Crew Leaders.
10/07/20Renamed all policies to guidelines.
06/05/21pdfMoved to emsprotocols.online

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CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff." CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."
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