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Run: ICU Daily Patient Acuity Scoring Worksheet

ICU Daily Patient Acuity Scoring Worksheet for per-shift patient scoring, balanced assignments, and staffing escalation. Use it to compare workload across pa...

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Shift Details

Unit Name (required)

Shift Date (required)

Shift (required)

Charge Nurse / Reviewer

Optional. Collect only if needed for audit trail or handoff documentation.

Patient List

Patient Acuity Entries (required)

Acuity Scoring Factors

Monitoring Intensity (required)

Respiratory Support Level (required)

Vasoactive / Hemodynamic Support

Yes No N/A

Isolation Precautions

High-Workload Procedures Needed This Shift

Staffing Impact and Escalation

Current Assignment Balance (required)

Additional Staffing Needed? (required)

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.

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Email (required)

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