What is the  Plan?

One of the major weaknesses exhibited by residents is their unwillingness to lay out a plan of care for ICU patients. This is a far easier undertaking than most realize. Again the methodology is to follow the systems approach. Here is an example of a plan of care for a patient:

“Neuro – the plan is to discontinue all sedation, and wake the patient up and assess him neurologically. We will address agitation at that stage if necessary.

Respiratory – the plan is to switch him over from pressure control ventilation to pressure support and wean the peak pressure level.

Cardiovascular – the plan is to increase beta blockade to 10mg metoprolol q6hourly. Consult cardiology for possible PCI

GIT/nutrition – the plan to advance feeds to goal and to administer a phosphate enema to treat fecal impaction.

Renal/fluids – the plan is to reduce maintenance fluids to KVO (keep the vein open) once enteral feeds have reached goal.

Endocrine – the plan is to switch the patient over from i.v. insulin to subcutaneous – 10units of NPH q12 with a 4 hourly sliding scale of regular insulin.

Extremities / Skin – no change in treatment is planned.

Heme and labs – the plan is no transfusion unless the hemoglobin falls below 7.0g/l or platelets fall below 50,000.

Analgesia – the plan is to convert the morphine infusion to PCA as the patient wakes up.

ID – the plan is to discontinue all antibiotics today, and re-culture if he spikes a new temperature.

Devices – the plan is to remove the subclavian line, which is no longer needed.”

Copyright Patrick Neligan 2001-2002

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