Quality Control Measures (mandatory) ICU MD please complete for family – At the end of rounds include the main goals – Events or deviations? Incident Report? Yes No to be communicated with the family for the □ □ Y N n/a (Ex.unplanned extubation; medication error; near miss) day even if they are already on rounds. – HOB elevated 30 deg, OOB, inc spirom? Examples: Y N Up and walking, turning down the ventilator, Pharmacist on rounds? Y N taking out chest tubes, tolerate feeds. Over 30kg requiring adult doses? RN PLEASE TRANSCRIBE TO WHITE BOARD Y N Antibiotic levels due? Y N Respiratory weaning goals? 1 Y N n/a Ulcer prophylaxis? Y N n/a Glucose control? 2 Y N n/a DVT prophylaxis? Y N n/a Isolation? 3 Y N Reason: ___________________ Sedation/paralytic holiday? Y N n/a Can anything be removed? 4 Y N PT/OT/Speech/Rehab consulted? Y N DNR Y N 5 Staff concerns addressed? Y N Nursing, Respiratory Therapy Pressure ulcers? Y N Medication reconciliation? Y N CPOE vs. MAR Time: _____
Quality Control Measures (mandatory) ICU MD – please complete for family Events or deviations? Incident Report? □ Yes □ No (Ex.unplanned extubation; medication error; near miss) Y N n/a At the end of rounds – include the main goals to be communicated with the family for the day – even if they are already on rounds. HOB elevated 30 deg, OOB, inc spirom? Y N Examples: Pharmacist on rounds? Y N Up and walking, turning down the ventilator, taking out chest tubes, tolerate feeds. Over 30kg requiring adult doses? Y N RN PLEASE TRANSCRIBE TO WHITE BOARD Antibiotic levels due? Y N Respiratory weaning goals? Y N n/a 1 Ulcer prophylaxis? Y N n/a Glucose control? Y N n/a 2 DVT prophylaxis? Y N n/a Isolation? Reason: ___________________ Y N 3 Sedation/paralytic holiday? Y N n/a Can anything be removed? Y N 4 PT/OT/Speech/Rehab consulted? Y N DNR Y N 5 Staff concerns addressed? Nursing, Respiratory Therapy Y N Pressure ulcers? Y N Medication reconciliation? CPOE vs. MAR Time: _____ Y N
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