美國重症醫學會建議的ICU 每天查房時使用的查檢表

在加護病房的每日巡房時，光是見招拆招，把不穩定/不正常的狀況弄到穩定/正常還不夠，還需要完整的檢視病人目前的狀況，調整目前的處置，擬定處置的計畫，才能讓病人早日轉出。我們部落格之前介紹過FAST HUGS BID以及達叔的八炫法則(VPN IS RCC)，都是很好用的工具。 

這裡再介紹另一個，這是在2022年，美國重症醫學會提出的，在每日巡房(daily care rounding)時可以使用之查檢表，列出了12個項目，並且簡要說明其原由。(見下圖)

這12個項目是:

- Spontaneous awakening trial (SAT) has been performed.

- Spontaneous breathing trial (SBT) has been performed.

- Sedation goals have been set.

- Patient has been mobilized.

- Assessment has been completed for central line needs.

- Assessment has been completed for bladder catheter needs. 

- Nutrition needs have been discussed. 

- Diagnostic tests have been reviewed. 

- Assessment has been completed for transfusion needs. 

- Assessment has been completed for antibiotic needs.

- Patient goals of care have been reviewed with patient and/or family or surrogate decision-maker. 

- Code status has been documented. 

翻成中文的話是:

- Spontaneous awakening trial (SAT) has been performed. 是否有進行中斷鎮靜藥物的使用的測試

- Spontaneous breathing trial (SBT) has been performed. 是否有進行呼吸器脫離的評估

- Sedation goals have been set. 訂定鎮靜藥物使用之目標

- Patient has been mobilized. 儘早讓病人活動

- Assessment has been completed for central line needs. 評估病人是否仍需中心靜脈導管

- Assessment has been completed for bladder catheter needs. 評估病人是否仍需導尿管

- Nutrition needs have been discussed. 是否已評估病人之營養需求

- Diagnostic tests have been reviewed. 檢驗/檢查結果是否已檢視過

- Assessment has been completed for transfusion needs. 評估病人是否需要輸血

- Assessment has been completed for antibiotic needs. 評估病人是否需要抗生素

- Patient goals of care have been reviewed with patient and/or family or surrogate decision-maker. 是否跟病人或者家屬檢視過目前治療的目標 

- Code status has been documented. 要不要急救的決定是否有清楚記載在病歷中 

美國重症醫學會在說明中提到，這12項都是有實證醫學的佐證，可以提供安全、高品質之重症醫療，並減少浪費。不過執行時也要把病人的臨床狀況、緊急程度一起考慮進去。我覺得，這個查檢表確實非常完整，比較困難的是沒有一個口訣來讓人背誦這12個項目。