P London Health Sciences Centre HALLWAY CRITERIA CHECKLIST ‘The following criteria must have a No response prior to the patient being moved to a Clinical Inpatient Unit Hallway: Does the patient require isolation? Does the patient require suction? “Does the patient have a need for frequent toleting or perineal care? Does the patient require special devices or equipment (ie. CPAP, dialysis, patient lift anticipated prior to room placement}? Does the patient require invasive procedures ordered to be completed on Ward rior 1 ticipated room placement (excluding ambulatory hemodiah isthe patient's Expected Date of Discharge within the next 48 hours (for within ward _haliway placement)? “Is the patient a wanderer? OYes [No By signing below you verify that the above criteria have been met and that the Clinical Inpatient Unit Algorithm has been applied in the selection of this patient. Primary Care Nurse Name isisea Date owrvaioos Coordinator / After Hours Coordinator Name joe Date prvvraaio0)