Essential Components of a Daily ICU Checklist for Pre-Rounding and Rounding
A comprehensive daily ICU checklist should include systematic assessment of ventilation, hemodynamics, infection control, sedation, nutrition, prophylaxis measures, and daily goals to reduce mortality and improve patient outcomes. 1
Pre-Rounding Components
Patient Identification and Vital Signs
- Demographics and admission diagnosis
- Current vital signs and trends (temperature, heart rate, blood pressure, respiratory rate, oxygen saturation)
- Neurological status (GCS, sedation score, delirium assessment using ICDSC) 1
Ventilation and Respiratory
- Ventilator settings (mode, FiO2, PEEP, pressure support)
- Ventilator parameters (tidal volume, minute ventilation, peak/plateau pressures)
- ABG results and trends
- Readiness to wean assessment 1
- Ventilator bundle compliance (HOB elevation, oral care, SBT) 1
Hemodynamics and Fluid Status
- Hemodynamic parameters (BP, MAP, CVP if available)
- Vasopressor/inotrope requirements and trends
- Fluid balance (24-hour and cumulative)
- Weight trends
- Cardiac rhythm and recent ECG findings
Laboratory and Diagnostic Data
- Recent lab values (CBC, electrolytes, renal/liver function, coagulation)
- Microbiology results (cultures, sensitivities)
- Recent imaging findings
- Pending tests and procedures
Medications
- Current medication list with doses
- Antimicrobial therapy (indication, day of therapy, planned duration)
- Sedation/analgesia regimen
- DVT and stress ulcer prophylaxis 1
- Glucose management protocol adherence
Rounding Components
Systems-Based Assessment
- Neurological: Mental status, sedation goals, delirium assessment
- Cardiovascular: Hemodynamic goals, perfusion status, rhythm management
- Respiratory: Ventilation strategy, weaning plan, oxygenation goals
- Gastrointestinal: Nutrition status, bowel function, feeding tolerance
- Renal: Fluid balance goals, renal replacement therapy needs
- Infectious: Source control, antimicrobial stewardship, isolation needs
- Endocrine: Glucose control, hormonal issues
- Hematologic: Transfusion needs, anticoagulation status
- Skin/Wounds: Pressure injury prevention, wound care
Daily Goals and Care Planning
- Primary problems list with daily goals for each
- Ventilator liberation strategy
- Mobility/physical therapy plan
- Nutrition plan (route, rate, goals)
- Invasive device necessity assessment (central lines, urinary catheters)
- Family communication plan
- Code status/goals of care 1
Quality and Safety Measures
- Central line necessity and bundle compliance
- Urinary catheter necessity
- DVT prophylaxis
- Stress ulcer prophylaxis
- Early mobility progress
- Medication reconciliation
- Pain management adequacy 1
Implementation Tips
- Format: Keep the checklist concise (6-20 items per section) to ensure compliance 1
- Medium: Physical checklists remain most common, but electronic checklists are increasingly used 1
- Timing: Complete pre-rounding checklist before team rounds, review during rounds
- Accountability: Assign specific team members to different components
- Integration: Incorporate into daily workflow rather than adding as separate task
Evidence-Based Benefits
The use of ICU rounding checklists has been associated with:
- Reduced in-hospital mortality (RR 0.80; 95% CI, 0.70-0.92) 2
- Reduced ICU mortality and 30-day mortality 2
- Decreased hospital length of stay 2
- Reduced catheter-associated infections (CAUTI and CLABSI) 2
- Improved compliance with evidence-based practices 3
Common Pitfalls and Solutions
- Checklist fatigue: Prioritize most critical elements, avoid redundancy
- Incomplete adoption: Ensure buy-in from all team members through education about mortality benefits
- Lack of customization: Adapt the checklist to your specific ICU population and resources
- Poor integration: Incorporate into existing workflow rather than adding as separate task
- Missing elements: In one study, 64% of patients had at least one forgotten element of care that was caught by checklist use 3
By systematically implementing this ICU checklist during pre-rounding and rounding, you can ensure comprehensive patient assessment, reduce missed care elements, and improve patient outcomes through standardized, evidence-based care.