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Abstract

Introduction: For the last 14 years, the daily goal sheet (DGS) has been used in our surgical ICU's to improve communication and ensure best practices for patient care. Patient care goals (PCG) are determined on rounds and executed and communicated through orders and protocols. This study examines whether PCG are achieved after rounds. Methods: Over 3 months, random DGS were collected and medical records were reviewed to categorize goals and verify the implementation of corresponding orders and interventions to meet patient care goals. Descriptive statistics were utilized to describe the effectiveness of care. Results: 81 DGS were collected on 41 patients on ICU day 11 (range 1-75 days). The primary reason for continued ICU stay was hemodynamic instability. The average pain goal was set at 3/10 for the majority of patients and this goal was achieved 79% via the use of PCA and PO medications. Established hemodynamic goals (HR <110, MAP >65) were met 81% of the time through the use of vasopressors (56%) and beta blockers (28%). Fluid status goals were met for 94% of the patients through CVVHD (61%) and diuretics (26%). 98% of the patients had pulmonary and activity goals identified (weaning mechanical ventilation and oxygen as tolerated, "pulmonary toilet", ambulation and OOB), which were met 94% of the time. Goals for the use of PPI's, DVT prophylaxis and nutrition were all achieved > 74% of the time. Communication with the primary service and family was achieved at 91%. Conclusions: In real life practice, now 14 years after the institution of the daily goal sheet in our surgical ICU's, this tool continues to serve as a guide to meet the patient plan of care for the day. The majority of goals determined on rounds were completed. In immediate post-operative patients, a pain goal of 3/10 is achievable as well as communication with the primary service and the family. The DGS encompasses total patient care needs and is a useful tool to remind staff of patient care needs.