Figure 4. Daily Goals Checklist

Room Number _____ MD/NP COVERING Pt today: Date ____/____/____ (Protocols available if bolded) PM shift (7pm) AM shift (7am) **Note Changes from AM** y t What needs to be done for patient to be e f discharged from the ICU? a

S . Patient’s greatest safety risk? . How can we decrease risk? What events or deviations need to be PSN reported? PSN’S?  Better  Unchanged  IMPRESSION/PLAN Worse e r NEURO Pain Mgt / Sedation Pain goal ____/10 w/  Wean sedation for a

C  Daily lightening of sedation extubation in AM t

n  OOB/ pulm toilet/ambulation  wean vent e i

t RESP  Maintain current support  mechanics by __am a . Pulmonary: P  FIO2 <_____ PEEP < ____  plan to extubate . Ventilator: (vent bundle: HOB  Wean as tol elevated), RTW/Weaning)  Swallow Eval  PS/Trach trial ___h x ____  Mechs before/after CARD Cardiac HR Goal______ at goal Review EKGs    ß Block______GI  NPO TF Type______goal GI / Nutrition / Bowel regimen _____ (TPN line, NDT, PEG needed?)  TPN INSULIN REQ_____Adj needed y/n GU  Net even  Net positive Volume status  Net neg:____ w/______Net goal for midnight  Pt determined ID SIRS/Infection/Sepsis  no current SIRS/Sepsis issues Evaluation  Known/suspected infection: SIRS Criteria  PAN Cx  Bld x2  Urine  Temp > 38° C or < 36 ° C  Sputum  Other  HR > 90 BPM  RR > 20 b/min or PaCO2 <  ABx changes: Initiate / D/C 32 torr  AG Levels:  WBC > 12K < 4K or > 10%  Sepsis Bundle bands  Y  N Can catheters/tubes/lines be removed/rewired? DVT:  Hep q8 / q12 / gtt (protocol?) Is this patient receiving DVT/PUD PUD: PPI prophylaxis?  TEDS/SCDs Is the patient receiving PT/OT/ROM H2B  LMWH PT/OT [] ROM [] Contraindication if any [] Anticipated LOS > 2 days: TGC  TGC  Fluc  KCl  Transition from 3 days: fluconazole PO, KCl SS  N/A TGC SSI by AM Can any meds be discontinued, converted  N/A to PO, adjusted?  D/C:  PO:

 Renal:  Liver: : o Tests / Procedures/ OR today  N/A  line change D  Consents needed/obtained o

T Scheduled labs  N/A (Reassess need q12h) AM lab needed  CMP  BMP  H8 Coags CXR? ABG  Lactate  Core 4 CXR Wed: Transferrin  Iron Prealb 24h urine Consultations  Y  N n Is the primary service up-to-date? o i t i s o

p Y  N s i D

ICU status IMC status: vitals q______Fellow/Attg Initials: ______Nursing Initials: ______