A Community of Exceptional Nurses
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.
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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