MICU Pre-rounding Technique

  1. The evening before starting in the ICU, take notes during sign out (typically a phone call from intern currently on that service) and ask lots of questions. Then, sit down and complete a chart review for yourself. Just because something is documented in a note, doesn’t mean you can accept it as truth.
  1. In the morning:Print the team list in descending order by location/or pick up copy printed by Night Call Intern (it is their job to print copies for everyone)
  1. In the morning, BEFORE 6:30 AM, go to each of your patient’s rooms, introduce yourself and ask the nurse for a brief synopsis, changes/eventsovernight, specific concerns and if there are questions from family members.
  1. For each patient assigned to you, open the chart and complete the following:
  1. Click on “Results Review” in the left hand tab
  • Click on the following tabs and note any abnormalities
  • Vitals
  • Laboratory
  • Microbiology (even if not RED)
  • Radiology
  • I’s and O’s
  • Click on the following tabs if applicable
  • AP
  • Other Diagnostics
  • Click on Multi-D Summary to check the nursing note for overnight events (or talk to the nurse directly if feasible) and to briefly check for updated recs from PT/OT, nutrition, etc.
  1. Click on “MAR Summary” to review missed medications and pertinent PRN medications
  • Pain medication, correctional insulin, benzos for EtOH w/d, etc.
  1. Click on “Clinical Notes” in the left hand column
  • Review any pertinent consult notes for updated recommendations
  • Consider rearranging notes “by date” to check for any new notes in the last 24 hours
  1. Start your daily notes
  • Fill out 24-hour events and import medication list, vitals and labs
  1. See the patients
  • Perform focused interview and exam
  • Don’t forget a thorough skin exam
  • Take note of the following:
  • What drips are running and rate at which they are running?
  • What lines are in place? Does the skin look infected?
  • What are their vent settings including plateau pressure/oxygen requirement?
  1. Return to the computer/WOW and complete the daily note
  • Fill in subjective, physical exam and plan (by organ system)
  • Click “Save & Close”. Don’t “Sign” until after rounds.
  1. Place any pertinent orders
  • Many orders, particularly electrolyte replacement and insulin adjustments, can’t be made prior rounds
  • Any more complex orders should be placed after rounds to achieve a team consensus, but this SHOULD NOT preclude you from committing to a very specific plan to present on rounds, nor should it be used as a crutch to prevent you from having a specific plan on the majority of your patients prior to rounds.
  1. Whenever there is something you do not understand, ASK!!!