Appendix H
CARDIOVASCULAR SURGICAL TRANSLATIONAL STUDY (CSTS)
Multi-Disciplinary Inpatient Daily Goals
Room Number
Facilitator (Charge Nurse)__________________
reviewed below**
Specific Timed Goals @ 0700
Rounds
Date:
/
/
**Initial as goals are
Night DR. on Call Review
1700*
Nurse
Review 1900
OR 2300
What needs to be done for patient to be
discharged from the unit?
Anticipated Discharge date: __/____
What is patient’s greatest safety risk and
how can we decrease risk?
Pain Mgt
Cardiac / Volume Status: I/O
Consider Beta blockade?
Rhythm:
Pulmonary
Mobility / Activity
OOB, Turn schedule, up ad lib
ID: Suspected or documented infection
(blood cultures, appropriate and timely
antibiotics)
Duration of Antibiotics:
GI / Nutrition / Bowel regimen
Can any medications be discontinued?
Adjusted for renal function?
Tests / Procedures today
Review scheduled labs / radiology results
and daily orders. Can any be discontinued?
Consultations
Has the family been updated? Have social
issues been addressed?
Can catheters/tubes/Pacing wires be
removed?
Is this patient receiving DVT/PUD
prophylaxis?
Patient Education:
Diet
Diabetic teaching
Anticoagulation
Other:
**Physician Sign out can be acquired by fax, phone or direct observation**
____________________
Initials
______________
Initials
_____________
Initials