What should be included in daily ICU (Intensive Care Unit) progress notes in the Frichman style?

Daily ICU Progress Notes in the Frichman Style

Daily ICU progress notes should follow a structured format that includes patient demographics, vital signs, neurological status, ventilator settings, hemodynamic parameters, infection control, prophylaxis measures, and daily goals to reduce mortality and improve patient outcomes. 1

Essential Components of ICU Progress Notes

Patient Identification and Demographics

• Patient name, medical record number, date of admission
• Primary diagnosis and reason for ICU admission
• Current ICU day number

Vital Signs and Physiological Parameters

• Temperature, heart rate, respiratory rate, blood pressure (systolic and diastolic)
• Oxygen hemoglobin saturation (SpO2)
• First documented cardiac rhythm after hospital arrival 2
• Pupillary light reaction 2

Neurological Assessment

• Glasgow Coma Scale (GCS) score or other age-appropriate system (ABC, AVPU)
• Sedation score
• Delirium assessment using validated tools
• Best neurological function during hospitalization 2

Respiratory Status

• Ventilator settings and parameters (if applicable)
• FiO2, PEEP, mode, tidal volume, respiratory rate
• Arterial blood gas results (pH, PaO2, PaCO2) 2
• Presence of pulmonary edema or ARDS 2
• Readiness to wean assessment
• Airway and ventilation requirements 2

Hemodynamic Status

• Vasopressor/inotrope requirements (type and dose)
• Fluid balance (input/output) in last 24 hours
• Weight trends
• Documentation of hypotension episodes 2
• Circulatory support requirements 2

Infection Control

• Current antibiotics (name, dose, duration, indication)
• Culture results and sensitivities
• Temperature trends
• White blood cell count
• Presence of any healthcare-associated infections

Medication and Sedation

• Current sedatives and analgesics
• Neuromuscular blockers (if used) 2
• Thromboprophylaxis status 2
• Stress ulcer prophylaxis 2

Nutrition and Gastrointestinal Status

• Current nutrition plan (enteral vs. parenteral)
• Feeding rate and tolerance
• Bowel movement status
• Gastric residual volumes (if applicable)
• Swallowing assessment (especially for patients with tracheostomy) 2

Prevention Measures

• DVT prophylaxis status
• Central line necessity and bundle compliance
• Urinary catheter necessity
• Early mobility progress and plan 2
• Pressure ulcer prevention measures

Laboratory Data

• Relevant laboratory values (electrolytes, renal function, liver function)
• Serum glucose levels (initial, highest, lowest) 2
• Serum lactate levels 2

Daily Goals and Care Planning

• Primary problems list with daily goals for each
• Ventilator liberation strategy (if applicable)
• Mobility/physical therapy plan
• Code status/goals of care
• Family communication plan 1

Systems-Based Review

• Brief review of each organ system with pertinent findings
• Any complications or new issues in the past 24 hours
• In-hospital resuscitation events (if applicable) 2

Implementation Tips

1. Complete the checklist before team rounds and review during rounds
2. Assign team members responsibility for different components
3. Incorporate the checklist into daily workflow rather than as a separate task 1
4. Use the note as a communication tool between different care teams 3

Common Pitfalls to Avoid

1. Discrepancy between ICU and ward documentation: Ensure continuity in documentation of patient issues when transferring between units. Research shows only 42% agreement between ICU and ward notes 3

2. Excessive length: ICU notes tend to be longer than ward notes (mean 21 vs. 15 lines of text) 3. Focus on relevant information to improve readability

3. Inconsistent structure: Maintain a consistent format to improve communication between healthcare providers

4. Inadequate documentation of interventions: Document all therapeutic interventions, even when patients are admitted for monitoring purposes only 4

5. Missing prophylaxis documentation: Always document DVT and stress ulcer prophylaxis status 1

By following this structured approach to daily ICU progress notes, clinicians can ensure comprehensive documentation that facilitates effective communication, improves patient care, and reduces mortality in the intensive care setting.