M-FAST HUG2S: Mouthcare, Feeding, Analgesia, Sedation, Thromboprophylaxis, Head Up, Ulcer prophylaxis, Glucose, Gut (bowels) & Skin
THE
T E A M WARD ROUND: CHEAT SHEET – ENSURE ALL ASPECTS OF MNEMONIC ARE DOCUMENTED
Check these:
M
F
A
Use this guide:
Mouthcare?
•
•
Attended every 6 hours, or
If unable – document why not
•
•
Flowchart, or
Specify: notes
Feeding?
•
•
Commence by day 1 in ICU, follow guide, or
If unable – document why not
•
•
Flowchart, or
Specify: notes
•
Review medication chart and flowchart (remember: IV
analgesia can be changed to oral or NG liquid paracetamol etc.)
To assess level of pain, use the attached:
 Visual pain scale (awake patients) or,
 Behavioural Scale (ventilated & sedated/ coma)
•
•
•
Medication chart or,
Flowchart or,
Comments section
of flowchart
Record pain scale
on flowchart
Review ventilation, level of consciousness, lung function
and disease process/reason for tube.
Specify weaning goals eg: keep MAP > 70mmHg, RR < 40
bpm.
Specify
what
sedation
score
should
be
attained/maintained.
A 'sedation vacation' must be prescribed when sedation
score is > 2; and this is NOT the goal of therapy - see
sedation score guide attached.
•
•
•
•
Prescribe heparin or alternative
C/Is? Specify these.
Review legs, any C/Is for TEDs?
•
•
Medication chart
C/Is: in Notes
•
Flowchart: under
"special Instructions"
Analgesia?
•
Pain assessed?
S
•
Sedation?
Sedation prescribed?
Document desired
sedation score and
weaning goals.
T
Write this:
s.c. heparin?
prescribed?
•
•
•
•
•
•
•
Specify: notes
Medication chart or,
Flowchart
Sedation score and
parameter
goals
recorded on chart:
"special instructions"
TEDs insitu
H
Head up 
30O?
•
•
•
•
U
G
Ulcer
prophylaxis?
•
•
Review drug therapy, any C/Is?
If feeding goal rate attained, state why ulcer prophylaxis is
being ceased.
•
•
Medication chart
C/Is-specify in notes
•
Maintain tight glucose control as per flow diagram
(attached)
•
BSL: on flowchart
•
•
Date for bowels last opened is specified
When Bowels opened - charted, type
movement…diarrhoea +++, etc.
•
On flowchart
•
•
On flowchart
On flowchart
•
On bed
Glucose?
GUT: Bowels
last opened?
Specify desired patient position
Document the position attained on flowchart
Measure from the angle of the patient's hip up to tip of
shoulder
Wipe over laminated protractor after use
of
bowel
•
S
•
Skin care?
•
Assess pressure ulcer risk using Waterlow Scale:
document (attached) and then document how often PAC is
required
If scale > 20 – mattress needs to be ordered
V A P diagnosed? Is there a new and persistent infiltrate on CXR? Plus 2 of the following:
 Febrile  38.5ºC, Total WCC outside normal range, Purulent sputum ….
 If Y E S : Document on flowchart or in the health care record.
See: attached laminated 'cheat sheets' based on formal guidelines to help you assess your patient and provide care.
Liverpool ICU: Ward Round: Ventilator Acquired Complications - Prevention Bundle Checklist
M. Edgtton-Winn - D:\533565431.doc