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 Transfer to intermediate care unit, Up and Pharmacist on rounds? walking, taking out chest tubes, taking feeds Y N without using feeding tube 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? Y N 3 Reason: ___________________ Sedation/paralytic holiday? Y N n/a Can anything be removed? 4 Y N PT/OT/Speech/Rehab consulted? Y N DNR 5 Y N 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 Transfer to intermediate care unit, Up and walking, taking out chest tubes, taking feeds without using feeding tube 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
VSD-POD2.docx