A reproducible, systems-based ICU round with a FAST HUG-style checklist, daily goals, and line/catheter/antibiotic reviews — so that nothing preventable is missed and the whole team (and family) knows the plan.
At the bedside
Timed steps- 1
Collect data
Pre-roundOvernight events, vital-sign trends, fluid balance, ventilator settings and ABGs, drug chart and infusions, lab/microbiology/imaging results, nursing concerns. Calculate SOFA or the unit's severity score if used.
- 2
Examine and present by systems
At bedsideNeuro (sedation/RASS, delirium/CAM-ICU, pain), respiratory (mode, settings, P/F, SBT readiness), cardiovascular (MAP, vasoactives, perfusion, lactate), renal/fluids (urine, balance, creatinine, RRT), GI/nutrition, haematology/VTE, infection (cultures, antibiotics day number), lines/tubes, skin, mobilisation, family/goals.
- 3
FAST HUG every day
ChecklistFeeding, Analgesia, Sedation, Thromboprophylaxis, Head of bed elevation (30–45° if ventilated), stress Ulcer prophylaxis (if indicated), Glucose control. Many units add: spontaneous breathing trial, bowel care, indwelling catheter/line removal, de-escalation of antibiotics.
- 4
Write explicit goals
Daily goalsWrite today's goals on a daily goals sheet/whiteboard: targets (MAP, SpO₂, RASS, fluid balance), tests, procedures, consults, what must happen before discharge, and who updates the family. Ask: 'What is needed for this patient to leave ICU?'
- 5
Line and catheter review
DevicesIs every central line, arterial line and urinary catheter still needed? Insertion date, site condition; remove what is not needed. Use insertion and maintenance bundles for CLABSI prevention.
- 6
Stewardship time-out
AntibioticsIndication, culture results, day number, planned stop date; de-escalate or stop where possible.
- 7
Summarise and communicate
CloseRead back the plan for each patient; assign tasks with names and times; family update; document. Revisit at an afternoon/evening 'board round'.
FAST HUG — what to ask
| Item | Question on the round |
|---|---|
| Feeding | Can we feed enterally today? Target calories/protein met? |
| Analgesia | Pain score? Analgesia first before sedation? |
| Sedation | RASS target (usually −2 to 0)? Daily sedation hold? |
| Thromboprophylaxis | LMWH/UFH or mechanical? Contraindications? |
| Head-of-bed | Elevated 30–45° if ventilated? |
| Ulcer prophylaxis | Still indicated (ventilated >48 h, coagulopathy)? Stop when risk resolves |
| Glucose | Within target (e.g. 140–180 mg/dL)? Hypoglycaemia? |
| (+) SBT / Bowels / Indwelling devices / De-escalation | Ready for spontaneous breathing trial? Bowels open? Lines/catheters needed? Antibiotics narrowed/stopped? |
Daily goals sheet — minimum content
| Domain | Example goal |
|---|---|
| What needs to happen to leave ICU? | 'Off noradrenaline, extubated, tolerating feeds' |
| Patient's greatest safety risk | 'Self-extubation; bleeding from line site' |
| Targets | MAP ≥65, SpO₂ 92–96%, RASS −1, balance −500 mL |
| Tests/procedures | CT abdomen, change CVC (day 7) |
| Consults | Surgery, nephrology |
| Communication | Family meeting 5 pm — consultant |
Calculators for this topic
Daily round per patient
Step 1 of ~8
A repeatable sequence for each bed.
Overnight events, trends, results, nursing concerns
Based on Vincent JL; Pronovost P, Berenholtz S, Dorman T, et al. Educational use; follow local protocol.
Pathophysiology
Complex ICU care involves hundreds of daily actions; errors of omission (forgetting thromboprophylaxis, leaving unnecessary lines) are more common than errors of commission. Checklists compensate for cognitive load and variable experience.
Evidence
- FAST HUG (Vincent 2005): a mnemonic for key preventive aspects of ICU care; extensions (FAST HUGS BID) add spontaneous breathing trial, bowel care, indwelling catheters and de-escalation.
- Daily goals (Pronovost 2003): before/after study in a surgical ICU; understanding of daily goals by residents and nurses increased from <10% to >95%; ICU length of stay decreased (from 2.2 to 1.1 days).
- Keystone ICU (Pronovost 2006): in 103 Michigan ICUs, an evidence-based checklist intervention (hand hygiene, full barrier precautions, chlorhexidine, avoid femoral site, remove unnecessary catheters) reduced median CRBSI rates from 2.7 to 0 per 1,000 catheter-days, sustained at 18 months.
Controversies
- Checklist fatigue and 'tick-box' behaviour — effectiveness depends on culture and leadership.
- Family presence on rounds — improves communication and satisfaction but needs time and privacy.
🇮🇳 India notes
- In many Indian ICUs, rounds are consultant-led with large teams; assign one person to read the checklist aloud for each patient.
- Antibiotic stewardship is critical given high carbapenem resistance (ICMR AMR surveillance) — include a daily antibiotic time-out.
- Bilingual family updates at a fixed time reduce repeated queries and conflict.
References
Test yourself
Module quiz · score 70% to complete the module
Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.