Daily Goals Checklist

CUSP Toolkit

Effective 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):71–75

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?  
  • 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/______ 
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
 
  • 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-rays

Wed:
__   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 evaluation

SIRS 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: 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: ______________
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