Daily Goals Checklist CUSP ToolkitEffective communication is particularly important in the unit if complicated care plans are to be effectively managed by the care team 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):71–75Daily GoalsRoom 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? Patient's greatest safety risk?How can we decrease risk? What events or deviations need to be reported? Patient Care Pain management/sedation (held to follow commands)?Pain goal______/ 10 w/______ CardiacReview EKGsHuman Resources Goal_________ At goal__ Increase__ Decrease__ Beta Block__________ Volume statusNet goal for midnight__ Net even__ Net positive__ Net neg:_____ w/_______ Patient-determined Pulmonary:Ventilator: (vent bundle; head of bed elevated), (ready to wean)__ 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__ Basic metabolic panel__ Coagulant clotting times__ Arterial blood gases__ Lactate__ Core 4__ Chest x-raysWed:__ Transferrin__ Iron__ Pre-albumin__ 24-hour urine Consultations__ Yes__ No Disposition Is the primary service up to date?__ Yes__ No Has the family been updated?Social issues addressed (long-term care; palliative care)?__ Yes__ No__ Yes__ No__ N/A__ Other—please explain: Systemic Inflammatory Response Syndrome (SIRS)/ infection/sepsis evaluationSIRS criteria__ Temp > 38° C__ < 36° C__ Heart rate > 90 BPM__ Respiratory rate > 20 b/min__ Amount of carbon dioxide in the arterial blood <32 torr__ White blood cells > 12K__ < 4K__ > 10% bands__ No current SIRS/sepsis issues__ Known infection:__ PAN culture__ Blood culture x2__ Urine__ Sputum__ Other__ Antibiotic changes; discontinuation__ AG levels:__ Sepsis bundle 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: TGC3 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 boldedFor WICU only: ICU status IMC status: vitals q___ Fellow/Attg Initials: ______________ Current as of December 2012 Internet Citation: Daily Goals Checklist: CUSP Toolkit. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/toolkit/dailygoals.html
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