Daily Goals Checklist
CUSP Toolkit
Problem 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 Goals
Room Number____________ Date ___/___/___
| AM Shift (7 a.m.) | PM Shift (7 p.m.) Note Changes From AM in This Column |
|
|---|---|---|
| Safety | ||
| What needs to be completed for this patient to be discharged from the unit? | ||
|
||
| What events or deviations need to be reported? | ||
| Patient Care | ||
| Pain management/sedation (held to follow commands)? | Pain goal______/ 10 w/______ | |
| Cardiac Review EKGs |
Human Resources Goal_______ __ At goal __ Increase __ Decrease __ Beta Block__________ |
|
| Volume status Net goal for midnight |
__ Net even __ Net positive __ Net neg:_____ w/_____ __ Patient-determined |
|
|
__ Out of bed __ Pulmonary toilet __ Ambulation __ Maintain current support __ Wean as tolerated __ Mechanics every morning __ % inspired oxygen FIO2 <_____ __ Positive and expiratory pressure_____ __ Pressure support/tracheostomy trial ____ h |
|
| To Do | ||
| Tests/procedures today | __ N/A __ Tests completed: _________ |
|
| Scheduled labs | __ N/A | |
| Morning laboratory tests, chest x-ray needed? |
__ Comprehensive metabolic panel Wed: |
|
| Consultations | __ Yes __ No |
|
| Disposition | ||
| Is the primary service up to date? | __ Yes __ No |
|
|
__ Yes __ Yes |
|
|
Systemic Inflammatory Response Syndrome (SIRS)/ infection/sepsis evaluation SIRS criteria |
__ No current SIRS/sepsis issues
|
|
| Can catheters or ubes be removed? | __ Yes __ No |
|
| GI/nutrition/bowel regimen (Total parenteral nutrition line, NDT, PEG needed?) | __ Total parenteral nutrition __ Total fluids __ Nothing by mouth |
|
| Is this patient receiving deep vein thrombosis/peptic ulcer disease prophylaxis? | __ Deep vein thrombosis: __ Heparin every 8 hours/every 12 hours/continuous drip __ Peptic ulcer disease prevention: __ Proton pump inhibitor __ Thrombo embolic deterrent stockings or sequential compression device __ Histamine blocker __ Low molecular weight heparin |
|
| Anticipated LOS > 2 days: TGC 3 days: fluconazole by mouth or oral, potassium chloride SS |
__ Fluconazole __ Potassium chloride __ N/A |
|
| Can any meds be discontinued, converted to “by mouth” or “oral, adjusted”? | __ N/A __ Discontinued: __ By mouth or oral: __ Renal metabolized __ Liver metabolized |
Protocols available if bolded
For WICU only: ICU status IMC status: vitals q___ Fellow/Attg Initials: ______________
