ICU Daily Patient Acuity Scoring Worksheet

Per-shift acuity scoring worksheet for ICU patients to support balanced assignments and staffing decisions.

Shift Details

• Unit Name
• Shift Date
• Shift
• Charge Nurse / Reviewer
  Optional. Collect only if needed for audit trail or handoff documentation.

Patient List

• Patient Acuity Entries

Acuity Scoring Factors

• Monitoring Intensity
• Respiratory Support Level
• Vasoactive / Hemodynamic Support
• Isolation Precautions
• High-Workload Procedures Needed This Shift

Staffing Impact and Escalation

• Current Assignment Balance
• Additional Staffing Needed?
• Staffing Request Details
  Describe the staffing gap, patient factors driving the request, and any immediate mitigation steps.
• Handoff Notes
  Optional. Include only information needed for the next shift’s assignment planning and audit trail.