=== data on file === patient: John Mwangi (#1) · ward: General Medicine Ward · bed: GMED-01 === scales: NEWS2 and Braden === scorer sums six parameters to 18 18 scorer calls the emergency team above 6 emergency_team scorer demands continuous monitoring Continuous monitoring; the emergency team is called now. scorer keeps per-parameter work {"respiratory_rate":3,"spo2":3,"temperature":3,"systolic":3,"heart_rate":3,"consciousness":3} Braden 9 bands severe severe Braden 12 stays high high Braden 14 bands moderate moderate Braden 18 dips to low low Braden 19 clears to minimal minimal === admission: the nurse beds the patient === nurse admits the patient onto the ward ok admission opens as admitted admitted bed is held for the stay 1 ward stored on the stay 1 general ward is not critical care 0 bed flips to occupied occupied === kardex: nurse judgement around the physician orders === nurse opens the kardex (firstOrCreate) ok one card per admission 1 card starts active active nurse updates the card ok code status reads DNR DNR fall risk reads High High acuity reads 4 — highly dependent 4 — Highly Dependent card carries who holds it 6 flash confirms the update Kardex updated for ADM-2026-00002. unknown code status refused invalid: code_status === handover: what the next shift must know === nurse records the shift handover ok handover shift reads Night Night outgoing nurse recorded 6 incoming nurse recorded 7 handover flash names the shift Handover recorded for the Night shift. === observations: routine round, the slide, and the middle ground === routine round charts ok collapsed round charts ok borderline round charts ok routine vitals score EWS 0 0 zero score needs no escalation none band reads Low Low routine flash is a status, not a warning Observation charted — EWS 0 (Low). routine score raises no warning banner collapsed vitals score EWS 18 18 score 18 escalates to the emergency team emergency_team band reads High High band colour is red red escalation label reads Emergency Team Now Emergency Team Now high score flashes a warning Observation charted — EWS 18 (High). Escalate to Emergency Team Now. high score writes no status flash borderline vitals score EWS 6 6 score 6 informs the doctor doctor band reads Medium Medium medium score flashes a warning Observation charted — EWS 6 (Medium). Escalate to Inform Doctor. === care plan: the nurse's own clinical reasoning === nurse writes the plan with seeded actions ok plan opens active active three actions parsed from the block 3 plan flash counts its actions Care plan recorded for “Impaired skin integrity” with 3 actions. plan revised ok revision flash Care plan “Impaired skin integrity” updated. extra action added ok four actions now 4 four still open 4 first action ticked off ok action records who completed it 6 action status reads Completed Completed completion stamped 1 complete flash Action marked Completed. second action skipped with a reason ok skip status reads Skipped Skipped two actions still open 2 one action completed 1 evaluating back to active refused HTTP 422 plan evaluated as achieved ok plan now achieved achieved status label reads Goal Achieved Goal Achieved evaluation stamped 1 evaluation flash Care plan “Impaired skin integrity” marked Goal Achieved. === skin: admission survey, interval survey, and the guard rails === admission survey charts ok Braden total 14 14 Braden bands moderate moderate risk label reads Moderate (13–14) Moderate (13–14) stage label reads Stage 2 Stage 2 — Partial Thickness two regions hold findings 2 sacrum note stored 1 flash quotes the Braden Skin assessment recorded — Braden 14/23, moderate risk. interval survey charts ok healed survey Braden 18 18 risk bands low low no injury reads None Present None Present no injury colours green green injury without a stage refused invalid: injury_site,injury_stage === boards: workload arithmetic and the ledger === one card on the board 1 acuity sums to 4 4 one highly dependent patient 1 one high fall risk 1 one admission carrying an EWS alert 1 grouped under its ward General Medicine Ward ledger counts three sets 3 two escalations in the last day 2 alert filter narrows to the two 2 === renders === OK nursing.kardex.index (nurse) 39142 bytes OK nursing.kardex.index q=MRN 39278 bytes OK nursing.kardex.index ward (icu nurse) 37419 bytes OK admissions.kardex.show (nurse) 103067 bytes OK admissions.kardex.show (doctor read) 51740 bytes OK admissions.kardex.print (nurse) 19926 bytes OK nursing.observations.index (nurse) 40330 bytes OK nursing.observations.index alerts (doctor) 41938 bytes OK nursing.care-plans.show (nurse) 52785 bytes OK nursing.care-plans.show (consultant) 49143 bytes OK nursing.skin-assessments.show (nurse) 51974 bytes OK nursing.skin-assessments.show healed 51305 bytes === confidentiality holds at the bedside === confidential patient blocks the kardex HTTP 404 confidential patient blocks charting HTTP 404 confidential patient blocks the handover HTTP 404 clearance holder still opens it ok kardex reopens once cleared ok === role matrix === nurse · kardex.view yes nurse · kardex.manage yes nurse · handovers.record yes nurse · observations.view yes nurse · observations.record yes nurse · care-plans.manage yes nurse · care-actions.record yes nurse · skin-assessments.record yes icu nurse · kardex.manage yes icu nurse · observations.record yes icu nurse · skin-assessments.record yes doctor (read-only) · kardex.view yes doctor (read-only) · observations.view yes doctor (read-only) · care-plans.view yes doctor (read-only) · skin-assessments.view yes doctor (read-only) · kardex.manage no doctor (read-only) · handovers.record no doctor (read-only) · observations.record no doctor (read-only) · care-plans.manage no doctor (read-only) · skin-assessments.record no consultant (read-only) · kardex.view yes consultant (read-only) · kardex.manage no consultant (read-only) · skin-assessments.record no clinical officer (read-only) · kardex.view yes clinical officer (read-only) · care-plans.manage no hospital administrator (read-only) · kardex.view yes hospital administrator (read-only) · kardex.manage no receptionist (no access) · kardex.view no receptionist (no access) · observations.view no receptionist (no access) · care-plans.view no receptionist (no access) · skin-assessments.view no billing (no access) · kardex.view no billing (no access) · observations.record no === audit trail === kardex creation audited under Nursing 1 handover audited 1 care plan audited 1 both skin surveys audited 2 >>> nursing module green — kardex, handover, observations, care plans and skin all verified