Table 1: ICU Daily Goals Worksheet ICU Patient-Centered Rounds27, 29 Neuro Y Sedation Holiday? Y Analgesia-Sedation adequate? Y Reduce Sedation?

Y Moves All Extremities? Y Follows Commands? Y Able to Communicate Effectively? Preferred Method? Y Speech/Interpreter Referral Y Cardiac Y Vitals/Hemodynamics Stable? Y ECG Changed? Y Pacer Check? Y Can Chest Tubes Be Removed? Y Change in Parameters? Y Can Drips Be Titrated? Y Respiratory/Ventilator Y Ventilator/Arterial Blood Gas Goals Met? Y Weaning Trial? Y Change In Parameters? Y Head of Bed > 30 Degrees? Y Oral Care? Y Vascular Y Pulses present? Y Warm and Well-Perfused? Y Sequential Compression Devices? Thromboembolic Disease Anti-Embolism Stockings? Y Deep Vein Thrombosis Prophylaxis? Y GI Y Diet ordered? Advance Diet? Y Dobhoff/OG/NG Tube in Place? Y OG/NG Tube Functioning? Comments/Plan/Rounding Updates N N N N N N N N N N N N N N N N N N N N N N N N NA NA NA NA NA NA NA NA Comments/Plan/Rounding Updates NA NA NA NA NA NA NA Comments/Plan/Rounding Updates NA NA NA NA NA NA Comments/Plan/Rounding Updates NA NA NA

N N N N N

NA NA Comments/Plan/Rounding Updates NA NA NA

Y Y Y Y Y

Tube Feeding at Goal? GI Prophylaxis? Abdominal Drains Intact? Can Any Tubes Be Discontinued?

N N N N

NA NA NA NA

N NA ICU Patient Centered Rounds (cont) Comments/Plan/Rounding Updates N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N NA NA NA NA NA NA Comments/Plan/Rounding Updates NA NA NA NA Comments/Plan/Rounding Updates NA NA NA NA NA Comments/Plan/Rounding Updates NA NA NA NA NA NA Comments/Plan/Rounding Updates NA NA NA NA NA Comments/Plan/Rounding Updates NA NA NA NA NA

GU Y Urine Output Adequate? Y Fluid Balance Goals Met? Y Foley DC? Y Dialysis Goals Met? Y Appropriate IV Fluids? Y ID Y Dressing Changes Per Policy? Y All Lines Necessary? Y Any Lines Need Changed? Y Heme/Endo Y Need Blood Products? Y Platelet Count? Aspirin? Y PT/PTT/INR Goal Met? Y Blood Glucose at Goal? Y Skin/Wounds Y Incision Wound Appropriate? Y Dressing/Treatment? Y Pressure Ulcers? Y Wound Healing Appropriate? Y Referral? Y Mobility/Safety Y Chair? Out of Bed? Ambulating? Y PT Initiated? Goals Met? Y Fall Risk? Y Restraints? Current Order? Y Social/Disposition Y Code Status Addressed? Y Transfer to Floor? Y Discharge Teaching Provided? Y Patient/Family Updated? Y

Medications/Miscellaneous Y All Medications Necessary? Y Antibiotics Dates Correct? Y MAR Reconciled? Y Current Type and Screen? Y Are Labs Appropriate?

Comments/Plan/Rounding Updates N N N N N NA NA NA NA NA