ICU Pre-Rounding Bundle Checklist VITALS: trends! • Important to know if the pt is getting better or worse 9 don't forget context! • Write down your vitals all together, but know they are in the context of drips (BP/HR) and the vent (RR/SpO2) • If your VS changes, it's important to know if the drips or vent have changed. VENT: mode + settings + what the patient is doing (breathing over? dyssynchronous? how?) • AC/VC (VTE/RR/PEEP/FiO2; know actual RR, and P plateau) • AC/PC (PC/PEEP/RR/FiO2; know actual RR, exhaled volumes: VTE) • On SBT? If so, know PS, PEEP, Pt's own RR, FiO2, VTE and RSBI, and if they failed, know why! DRIPS: trends! (how long on/off, increased/decreased, response) • Sedation: know RASS + goal (+/- CAM-ICU) • Pressor: know BPs, HR, UOP (see below) I+Os: trends! 24hr total + NET + for hospitalization • INS: what's their main source of ins? (drips, abx, transfusions, feeds - PO or parenteral - ie PPN/TPN?) • OUTS: UOP (total and hourly, note if it is rapidly dropping off), CRRT (total and hourly net negative), • iHD (how much out in a session?), BMs (know last BM/how many per 24 hrs. and bowel regimen) ABX: day #? total course length? new/updated culture data? STEROIDS: day #? total course length? taper? PPX: GI, DVT, ABX (ppx for chronically immunosuppressed - transplant, HIV, etc.)? EXAM / LABS / IMAGING: trends! + changes/new findings LINES / TUBES: know gauges, types, and locations Dr. Meredith Greer @EmmGeezee #ICU #PreRounding #Bundle #Checklist #CriticalCare #Management
