1. No category

Daily Goals Worksheet
Patient Name:
Date:
Effective communication among all members of the interdisciplinary team is necessary to achieve optimal patient
outcomes. Communication failures can lead to increased length of stay, patient harm, and dissatisfaction of the team.
Use this form to ensure that all concerns have been addressed with the entire team during daily rounds.
Note that this worksheet includes the sepsis screening criteria for quick reference.
Safety
Goal:
Shift:
Shift:
What needs to be done to facilitate this patient’s transfer from
the ICU?
What is this patient’s greatest safety risk?
How can this risk be decreased?
Pain management:
Sedation management:
Delirium management: (Use CAM-ICU or ICDSC)
Volume Status:
 Net goal for midnight
Pulmonary:
 Ventilator status
 Ventilator bundle (HOB >30°, sedation vacation, readiness to
Target
Target
Negative
Current
Current
Positive
Target
Target
Negative
Current
Current
Positive
□ Net even
□ Net –
□ Net +
□ Net even
□ Net –
□ Net +
Patient Care
extubate assessment)
Cardiovascular:
 Review ECG
 MAP, HR, hemodynamic parameters
Sepsis Screen:
□ T >38° C or □ <36° C
□ HR >90
□ RR >20 bpm OR □ PaCO2 <32 mm Hg
□ WBC >12 K □ <4 K
Medications:
 Can any drips be discontinued?
 Can any medications be discontinued, converted to PO, or
adjusted?
GI and Nutrition:
 TPN, NDT, or PEG needed?
Invasive Lines and Catheters:
 Can any invasive lines be discontinued?
Mobility:
 Can this patient be mobilized or out of bed?
DVT and PUD Prophylaxis:
□ No SIRS/Sepsis concerns
□ Known/Suspected
infection
□ No SIRS/Sepsis concerns
□ Known/Suspected
infection
□ TPN □ TF
□ TPN □ TF
□ NPO
□ Arterial line □ CVP □ PA
□ PICC □ NG □ Urinary
□ DVT
□ PUD
Tests or Procedures Today:
To Do
Labs Scheduled:
AM Diagnostic:
 Labs
 Chest x-ray
Disposition
Consultations:
Family and Social:
 Any social issues to address?
 Any spiritual issues to address?
 Has the family been updated?
Code Status:
 Code status addressed?
 Advance directives in place?
Copyright © 2013 American Association of Critical-Care Nurses
□ NPO
□ Arterial line □ CVP □ PA
□ PICC □ NG □ Urinary