Publication of tool:



Daily Goals ChecklistProblem statement: Clear communication among health care providers is paramount. Communication failures lead to patient harm, increased length of stay, provider dissatisfaction, and staff turnover. Effective communication is particularly important in the unit if complicated care plans are to be effectively managed by the care team.What is a Daily Goals Checklist? A Daily Goals Checklist is a care plan that prompts staff to focus on what needs to be accomplished that day to safely move a patient closer to discharge.Purpose of tool: This tool improves communication among care team and family members regarding the patient’s care plan.Who should use this tool: Health care providers.How to use this tool: During morning and evening rounds, the care team uses the checklist to review the goals for a patient. Once a checklist is completed, the attending signs it and gives it to the patient’s nurse so it can be kept at the bedside.Publication of tool:Pronovost PJ, Berenholtz S, Dorman T, et al. Improving Communication in the ISU Using Daily Goals. J Crit Care 2003; 18(2):71–75.Daily GoalsRoom Number__________Date ___/___/___AM Shift (7 a.m.)PM Shift (7 p.m.)Note Changes From AM in This ColumnSafetyWhat needs to be completed for this patient to be discharged from the unit?Patient’s greatest safety risk?How can we decrease risk?What events or deviations need to be reported?Patient CarePain management/sedation (held to follow commands)?Pain goal______/ 10 w/______CardiacReview EKGsHuman Resources Goal_______ FORMCHECKBOX At goal FORMCHECKBOX Increase FORMCHECKBOX Decrease FORMCHECKBOX Beta Block__________Volume statusNet goal for midnight FORMCHECKBOX Net even FORMCHECKBOX Net positive FORMCHECKBOX Net neg:_____ w/_____ FORMCHECKBOX Patient-determinedPulmonary:Ventilator: (vent bundle; head of bed elevated), (ready to wean) FORMCHECKBOX Out of bed FORMCHECKBOX Pulmonary toilet FORMCHECKBOX Ambulation FORMCHECKBOX Maintain current support FORMCHECKBOX Wean as tolerated FORMCHECKBOX Mechanics every morning FORMCHECKBOX % inspired oxygen FIO2 <_____ FORMCHECKBOX Positive and expiratory pressure_____ FORMCHECKBOX Pressure support/tracheostomy trial____hTo DoTests/procedures today FORMCHECKBOX N/A FORMCHECKBOX Tests completed: _________Scheduled labs FORMCHECKBOX N/AMorning laboratory tests,chest x-ray needed? FORMCHECKBOX Comprehensive metabolic panel FORMCHECKBOX Basic metabolic panel FORMCHECKBOX Coagulant clotting times FORMCHECKBOX Arterial blood gases FORMCHECKBOX Lactate FORMCHECKBOX Core 4 FORMCHECKBOX Chest x-raysWed: FORMCHECKBOX Transferrin FORMCHECKBOX Iron FORMCHECKBOX Pre-albumin FORMCHECKBOX 24-hour urineConsultations FORMCHECKBOX Yes FORMCHECKBOX NoDispositionIs the primary service up to date? FORMCHECKBOX Yes FORMCHECKBOX NoHas the family been updated?Social issues addressed (long-term care; palliative care)? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX N/A FORMCHECKBOX Other—please explain:Systemic Inflammatory Response Syndrome (SIRS)/ infection/sepsis evaluationSIRS criteria FORMCHECKBOX Temp > 38° C FORMCHECKBOX < 36° C FORMCHECKBOX Heart rate > 90 BPM FORMCHECKBOX Respiratory rate > 20 b/min FORMCHECKBOX Amount of carbon dioxide in the arterial blood <32 torr FORMCHECKBOX White blood cells > 12K FORMCHECKBOX < 4K FORMCHECKBOX > 10% bands FORMCHECKBOX No current SIRS/sepsis issues FORMCHECKBOX Known infection: FORMCHECKBOX PAN culture FORMCHECKBOX Blood culture x2 FORMCHECKBOX Urine FORMCHECKBOX Sputum FORMCHECKBOX Other FORMCHECKBOX Antibiotic changes; discontinuation FORMCHECKBOX AG levels: FORMCHECKBOX Sepsis bundleCan catheters or tubes be removed? FORMCHECKBOX Yes FORMCHECKBOX NoGI/nutrition/bowel regimen (Total parenteral nutrition line, NDT, PEG needed?) FORMCHECKBOX Total parenteral nutrition FORMCHECKBOX Total fluids FORMCHECKBOX Nothing by mouthIs this patient receiving deep vein thrombosis/peptic ulcer disease prophylaxis? FORMCHECKBOX Deep vein thrombosis: FORMCHECKBOX Heparin every 8 hours/every 12 hours/continuous drip FORMCHECKBOX Peptic ulcer disease prevention: FORMCHECKBOX Proton pump inhibitor FORMCHECKBOX Thrombo embolic deterrent stockings or sequential compression device FORMCHECKBOX Histamine blocker FORMCHECKBOX Low molecular weight heparinAnticipated LOS > 2 days: TGC3 days: fluconazole by mouth or oral, potassium chloride SS FORMCHECKBOX Fluconazole FORMCHECKBOX Potassium chloride FORMCHECKBOX N/ACan any meds be discontinued, converted to “by mouth” or “oral, adjusted”? FORMCHECKBOX N/A FORMCHECKBOX Discontinued: FORMCHECKBOX By mouth or oral: FORMCHECKBOX Renal metabolized FORMCHECKBOX Liver metabolizedProtocols available if boldedFor WICU only: ICU statusIMC status: vitals q___ Fellow/Attg Initials: ____________ ................
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