ICU Admission Note Generator

RESPONSIBILITY

Referring team

Referring consultant

Referring consultant aware?

Yes No Unknown

ICM consultant

ICM consultant aware?

Yes No Unknown

Admitting practitioner

Role

GMC/NMC number

ICNARC / AUDIT

This information is collected nationally. It is imperative that this data is recorded on the admission document.

Decision to admit time

Actual ICU admission time

Source of admission

CPR in last 24 hours

PRE ADMISSION OBSERVATIONS

Please document the last recorded observations prior to the delivery of any critical care expertise. If intubated in ED, document the observations prior to intubation. If intubated in theatre, document last observations prior to going to theatre.

Respiratory support on admission

O2 Scoring scale

GCS: E V M

CHECKS

Meds reconciliation Yes No VTE form Yes No

CLINICAL

EXAMINATION

Airway:

Breathing: Respiratory exam Mode of ventilation and settings FiO2 / SpO2 ABG

CVS: CVS exam HR / BP / ECG Rhythm etc. Cardiovascular support

Infection, Micro & Antimicrobials: Micro / Antimicrobials Temp Fever in last 24 hours

GIT

Renal

Neuro

Any other findings

PLAN

Plan

The above plan has been discussed with an ICM consultant Yes No