🔘Typical ICU CHART🔘
🔺SAMPLE ICU ROUNDING SCRIPT🔺
In general, when you are in ICU approaching each patient presentation with a snapshot in your mind. Before starting the presentation, ask yourself:
👉Is this patient getting worse, getting better, or staying the same?
👉What are the patient’s top 1,2,3,4 issues? (As indicated.)
👉Thinking about this global assessment will focus your presentation.
🔸 An example would be, “Mr. P is now ICU day #7, and he is not really getting better.
🔸His major issues are the COVID-related ARDS, now with a superimposed pneumonia, as well as acute kidney injury.” – then you know what issues below you really need to focus on.
✔️Different ICUs will organize these data differently, but these are the key concepts to focus on, using a data/assessment/plan structure in an organ system-based approach.
☑️Neuro:
▪️(Data) Neuro exam, delirium – CAM; Current RASS and RASS goals, sedative requirements, pain medication, results of any recent neuro imaging
▪️(Assessment) Is pain well controlled? The sedation plan appropriate? Mental status improving/declining?
▪️(Plan) Do we need to lighten or deepen sedation? Do we need to change pain/sedation medications? Do we need imaging? Do we need EEG? Neuro consult?
☑️Cardiovascular:
▪️(Data) HR, BP, - and trends for both over last 24 hours, cardiac rhythm, the type of shock – distributive, cardiogenic, hypovolemic, obstructive; current volume status, current pressor or inotrope requirements – include medication, current dose, and any trends or changes, EKG, troponin, BNP, use of any antihypertensives or anti-arrhythmics
▪️(Assessment) Is the hemodynamic status improving/worsening? Is the patient hypo/eu/hypervolemic? Is the rate/rhythm controlled?
▪️(Plan) What are our hemodynamic goals (HR, MAP)? Will we give fluid/diurese? Will we change our pressors/inotropes? Do we need an echo? Should we consult Cardiology?
☑️Pulmonary:
▪️(Data) Type of respiratory failure – hypoxemic, hypercarbic; h/o underlying lung disease, current ventilator settings – the mode, the TV, RR, PEEP, FiO2, the PIP, Plat, the minute ventilation; PaO2/FiO2 ratio, recent proning, use of inhaled pulmonary vasodilators, most recent ABG, use of bronchodilators, any home medications for pulmonary conditions, incentive spirometry, results of any recent SBT, results of any recent chest imaging
▪️(Assessment) Is the respiratory failure improving/worsening? List barriers to extubation – recent SBT results, mental status, airway patency, unresolved shock, deconditioning;
▪️(Plan) Can we change the ventilator? Can the patient be put on pressure support? SHould we perform an SBT, if not already done? Can we extubate? Does the patient continue to require proning or pulmonary vasodilators? Do we need to add medications?
☑️Renal:
▪️ (Data) BUN, Cr, UOP, total body balance for last 24 hrs, Na, K, other lytes, AKI - causes of AKI
▪️(Assessment) Improving/worsening AKI, Volume status – can include here or CV, or can repeat as appropriate,
▪️(Plan) Volume goals for the day. Do we plan to diurese/give fluids? Does the patient meet any criteria for dialysis?
☑️GI/Nutrition:
▪️(Data) underlying liver condition, acute liver injury, abdominal exam, LFTs, INR as indicated, nutrition plan and tolerance
▪️(Assessment) Is the liver function improving/worsening? Are the bowels working?
▪️(Plan) Nutrition plan for the day. Bowel regimen? Do we need to check imaging?
☑️Heme:
▪️(Data) Underlying condition, Hgb, Plts, coags, Ddimer, fibrinogen
▪️(Assessment) Are counts improving? Any evidence of bleeding or clotting?
▪️(Plan) Anticoagulation plan, transfusion goals
☑️ID:
▪️(Data) WBC, Tmax, Tcurrent, culture data, current abx with day, procalcitonin
▪️(Assessment) Is the infection improving/worsening? Any concern for new infections?
▪️(Plan) Planned course, any other evaluations for sources (like CT or US)
☑️Endo:
▪️(Data) Glucose, steroids, thyroid issues
▪️(Assessment) Adequate glucose control?
▪️(Plan) Changes to regimen?
☑️Ppx:
▪️ GI prophylaxis, DVT prophylaxis, PT.
🔺SAMPLE ICU ROUNDING SCRIPT🔺
In general, when you are in ICU approaching each patient presentation with a snapshot in your mind. Before starting the presentation, ask yourself:
👉Is this patient getting worse, getting better, or staying the same?
👉What are the patient’s top 1,2,3,4 issues? (As indicated.)
👉Thinking about this global assessment will focus your presentation.
🔸 An example would be, “Mr. P is now ICU day #7, and he is not really getting better.
🔸His major issues are the COVID-related ARDS, now with a superimposed pneumonia, as well as acute kidney injury.” – then you know what issues below you really need to focus on.
✔️Different ICUs will organize these data differently, but these are the key concepts to focus on, using a data/assessment/plan structure in an organ system-based approach.
☑️Neuro:
▪️(Data) Neuro exam, delirium – CAM; Current RASS and RASS goals, sedative requirements, pain medication, results of any recent neuro imaging
▪️(Assessment) Is pain well controlled? The sedation plan appropriate? Mental status improving/declining?
▪️(Plan) Do we need to lighten or deepen sedation? Do we need to change pain/sedation medications? Do we need imaging? Do we need EEG? Neuro consult?
☑️Cardiovascular:
▪️(Data) HR, BP, - and trends for both over last 24 hours, cardiac rhythm, the type of shock – distributive, cardiogenic, hypovolemic, obstructive; current volume status, current pressor or inotrope requirements – include medication, current dose, and any trends or changes, EKG, troponin, BNP, use of any antihypertensives or anti-arrhythmics
▪️(Assessment) Is the hemodynamic status improving/worsening? Is the patient hypo/eu/hypervolemic? Is the rate/rhythm controlled?
▪️(Plan) What are our hemodynamic goals (HR, MAP)? Will we give fluid/diurese? Will we change our pressors/inotropes? Do we need an echo? Should we consult Cardiology?
☑️Pulmonary:
▪️(Data) Type of respiratory failure – hypoxemic, hypercarbic; h/o underlying lung disease, current ventilator settings – the mode, the TV, RR, PEEP, FiO2, the PIP, Plat, the minute ventilation; PaO2/FiO2 ratio, recent proning, use of inhaled pulmonary vasodilators, most recent ABG, use of bronchodilators, any home medications for pulmonary conditions, incentive spirometry, results of any recent SBT, results of any recent chest imaging
▪️(Assessment) Is the respiratory failure improving/worsening? List barriers to extubation – recent SBT results, mental status, airway patency, unresolved shock, deconditioning;
▪️(Plan) Can we change the ventilator? Can the patient be put on pressure support? SHould we perform an SBT, if not already done? Can we extubate? Does the patient continue to require proning or pulmonary vasodilators? Do we need to add medications?
☑️Renal:
▪️ (Data) BUN, Cr, UOP, total body balance for last 24 hrs, Na, K, other lytes, AKI - causes of AKI
▪️(Assessment) Improving/worsening AKI, Volume status – can include here or CV, or can repeat as appropriate,
▪️(Plan) Volume goals for the day. Do we plan to diurese/give fluids? Does the patient meet any criteria for dialysis?
☑️GI/Nutrition:
▪️(Data) underlying liver condition, acute liver injury, abdominal exam, LFTs, INR as indicated, nutrition plan and tolerance
▪️(Assessment) Is the liver function improving/worsening? Are the bowels working?
▪️(Plan) Nutrition plan for the day. Bowel regimen? Do we need to check imaging?
☑️Heme:
▪️(Data) Underlying condition, Hgb, Plts, coags, Ddimer, fibrinogen
▪️(Assessment) Are counts improving? Any evidence of bleeding or clotting?
▪️(Plan) Anticoagulation plan, transfusion goals
☑️ID:
▪️(Data) WBC, Tmax, Tcurrent, culture data, current abx with day, procalcitonin
▪️(Assessment) Is the infection improving/worsening? Any concern for new infections?
▪️(Plan) Planned course, any other evaluations for sources (like CT or US)
☑️Endo:
▪️(Data) Glucose, steroids, thyroid issues
▪️(Assessment) Adequate glucose control?
▪️(Plan) Changes to regimen?
☑️Ppx:
▪️ GI prophylaxis, DVT prophylaxis, PT.
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