Comprehensive SICU Plan - New Jersey Medical School

University of Medicine & Dentistry of New Jersey: Comprehensive SICU Plan

A single page form, to be completed by a member of the palliative care/family support team, documenting the areas covered at the time of the family meeting to discuss a comprehensive palliative care plan for an Intensive Care Unit patient.

Clinical Care Tools - Case Management & Coordination

University of Medicine and Dentistry of New Jersey
150 Bergen Street
Newark, New Jersey 07103-4300

Anne Mosenthal, M.D.
Director, SICU

How the grantee used this instrument:
The form is to be filled out by a member of the palliative care/family support team at the family meeting within 72 hours of admission. The topics include: Goals of care, communication, psychosocial issues, pain and symptom management, religious/cultural considerations, and other observations.

care plan, pain assessment, symptom management, health status, protocols, continuity of care, advance directives, communication, family education, care coordination

To use this tool:
You may print and copy for your own use from this site. Please credit the source.

Developed specifically for this project by the project team.

To view this tool:

Comprehensive SICU Plan 5 page PDF
(Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted: July 2006

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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.

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