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Table 1 Checklist used in the ICU

From: Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study

Analgesia□Good □Bad
Sedation□Good □Bad
Delirium□Yes □No □Cannot evaluate (RASS, − 4 to − 5)
Medical restraint□Applied □Necessary □Not necessary
Mechanical ventilation 
 Spontaneous mode or SBT□Applied □Possible □Impossible
 Airway extubation□Possible □Impossible
Head elevation at least 30°□Yes □No □Impossible □Prohibited
Rehabilitation□Yes □No □Not applicable
Deep vein thrombosis□Yes □Suspicious □No
Anticoagulants□Applied □Necessary □Not necessary
Inotropic agents□Can be reduced □Cannot be reduced □No inotropic agent
Administered caloriesXX kcal/kg/day
Route of nutrition□Enteral □Total parenteral □Parenteral
Stress ulcer prophylaxis□Applied □Necessary □Not necessary
Last defecationXX days ago
Blood glucose level□Good □Bad
Correction of serum electrolyte□Applied □Necessary □Not necessary
Discontinuance of antibiotics□Possible □Impossible □No antibacterial agent
Unnecessary vascular catheter□Yes, now extract □No
Unnecessary urinary catheter□Yes, now extract □No
Today’s goal(ex) SBT and airway extubation
  1. RASS Richmond Agitation Sedation Scale, SBT spontaneous breathing trial