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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

Contents

Assessment

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 calories

XX kcal/kg/day

Route of nutrition

□Enteral □Total parenteral □Parenteral

Stress ulcer prophylaxis

□Applied □Necessary □Not necessary

Last defecation

XX 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