High Risk Checklist ​

In-hospital cardiac arrest is frequently preceded by early warning signs of clinical deterioration that can be recognized and treated by trained in-hospital staff. The improvement in recognition, situational awareness, and training amongst healthcare providers in the complex, high-stress setting of a pediatric critical care setting may have an important impact on patient outcomes.

Utilizing a "High Risk Checklist" of clinical indicators and provider intuition variables at each team huddle: 

  • Can facilitate early identification to capture those patients at the highest risk for cardiac arrest.

  • Allows the multidisciplinary clinical team additional time and resources to prepare hospital staff, equipment, and the patient in the event of a cardiac arrest.

How to implement High Risk Checklist in the ICU:

  1. Screen with high risk checklist during morning & evening pre-rounding/huddles

  2. Assign a charge nurse or a respiratory therapist to do the daily screening -- it is important to have "Checklist Champions" for each shift!

DISCLAIMER: Please be respectful of intellectual property; these are the proprietary documents of their respective institutions.

The following high risk screening forms have been made voluntarily available for reference and use thanks to the efforts of the collaborative.

Check out Instituto Roosevelt's for a Spanish translation!

High Risk Screening Forms

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2020