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Run: ICU Daily Patient Acuity Scoring Worksheet

Use this ICU Daily Patient Acuity Scoring Worksheet to score each patient’s care needs, compare the unit’s workload, and document staffing actions for the sh...

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Shift Details

Shift Date (required)

Shift (required)

Unit / Pod (required)

Completed By (required)

Does this shift require staffing review or escalation? (required)

Patient Census

Patient Acuity Entries (required)

Use a local patient identifier, room number, or other minimum-necessary identifier instead of full name whenever possible.

Acuity Drivers

Respiratory Support Level (required)

Hemodynamic Monitoring (required)

Vasoactive or High-Risk Drips (required)

Number of Active Drips (required)

Frequent Interventions Needed This Shift

Procedure or Transport Planned (required)

Procedure / Transport Type (required)

Safety, Isolation, and Mobility

Isolation Precautions

Mobility / Turning Assistance Needed (required)

Restraints or Sitter Required (required)

Special Safety Needs

Assignment Summary

Overall Unit Acuity (required)

Are assignments balanced for this shift? (required)

Staffing Action Needed

Summary Notes

Document the rationale for acuity scoring, any unusual workload drivers, and what happens after submission.

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