An Acronym To Care for ICU Patients

How Should Nurses Deal With Difficult Physicians

Am I Too Old to Pursue Nursing??

Deepak Dero's Recommendations

FAST HUGS BID

 I remember being so overwhelmed when I was a new ICU nurse. Much of this anxiety was due to my inability to organize my thoughts and assess my patients' needs. Everything seemed important, so I was confused about how to make sure I was addressing the right stuff

 One day my preceptor shared an acronym with me that changed the game and left me much more confident when getting reports on my patients and having meaningful conversations with the physicians and care team. 

 Ok Let's break it down

FAST HUGS BID

Feeding

Analgesia

Sedation

Thrombophylaxis

HOB elevated

Ulver prevention

Glycemic Control

SAT/SBT

Bowel Regimine 

Indwelling Catheter

Discontinue Abx

Feeding

Is the patient eating or being fed? This is an element that can easily be overlooked but is crucially important. Nutrition supports the healing, rebuilding of tissue and enhances wound healing. Find out when was the last time your patient ate, how much, and work to implement proper strategies for promoting nutrition. TPN, tube feeding, antiemetics, etc. 

Analgesia

How is the patient's pain? This is a broad but meaningful question. Our ICU patients are often experiencing pain due to their underlying conditions, invasive procedures, surgical interventions, etc. #1 pet peeve is seeing patients receiving mechanical ventilation without any analgesia onboard. Imagine having a tube down your throat and a machine forcing you to breathe. If they're on invasive mechanical ventilation, they need some pain meds.

Addressing pain also promotes rest and sleep, which is fundamental to healing. We can write an entire paper about the benefits of pain management. But understanding analgesia does not automatically equate to opioids. Try to suggest a multimodal approach to pain management to the care team.

Sedation

How sedated is your patient? Do they need more sedation? Less sedation? Assess and advocate. 

Thromboprophylaxis

Well, that's a word. Remember, many ICU patients are experiencing prolonged immobilization, which increases their risk for thromboembolism (VTE) and deep vein thrombosis (DVT). Be sure your order set includes prevention strategies such as sequential compression devices (SCDs)  and/or pharmacological interventions.

HOB Elevation

There are a few reasons for the patient's HOB to be less than 30 degrees. This is a simple fix and takes less than 10 seconds. As patients lay flat, we do them a disservice as we increase their risk of GI reflux, pneumonia, impaired ventilation, and gas exchange.  

Ulcer prophylaxis 

ICU patients are at an increased risk for developing stress ulcers which can lead to gastrointestinal bleeding. Remember, our job is to have the patient leave the ICU in a better condition, not make them worse.

Glycemic Control

We should continuously check labs on our patients; one of the labs we assess is serum glucose. As blood glucose levels elevate, so does the patient's risk for nosocomial infections. Hyperglycemia also impairs wound healing and affects neurological function. Many ICU patients receive exogenous insulin, so don't hesitate to ask your intensivist how you plan to tackle hyperglycemia. Keep in mind that some of the steroids we administer to patients also play a role in increasing blood glucose. Also, ensure patients aren't hypoglycemic, as low blood glucose has many negative consequences.

Sedation awakening Trial/ (SAT) Spontaneous Breathing Trial (SBT)

This assessment is specific to our mechanically ventilated patients. SAT, also known as sedation vacation, is titrating the patient's sedation to assess their baseline neurologic and hemodynamic status. It's common practice for an SAT to be performed once daily. Be sure to ask about this when receiving a report from a nurse. 

If a patient can tolerate SAT and the overall assessment is showing improvement, I may be able to advocate for an SBT. A spontaneous breathing trial is when the mechanical ventilation setting is adjusted to allow the patient to do the majority of breathing on their own, so they must be stable before SBT.

Bowel regimen 

Pretty straight forwards. Is the patient pooping? Do we have interventions lined up to prevent constipation? This can especially be problematic with patients receiving opioids.

Indwelling Catheter

Assess the need for all invasive lines the patient has. Central lines, arterial lines, urinary catheters, ect. The longer these lines are in the patient the increased risk for infection. Get 'em out if appropriate ! 

De-escalation of antibiotics

This is not something you will directly be manipulating, but mentioning it to the physicians can be helpful if you see the patient has been receiving abx for an abnormally long time.

Assessing ICU patients is an art. You get better with time, and many of the components of FAST HUGS BID become second nature at some point. I hope this acronym was as helpful to you as it was for me early in my career.