Table 1:

Comprehensive multicomponent checklist for routine ICU care^*

Principle	Routine practice suggestion
Prevention of delirium	Provide patients with hearing aids and glasses Implement ABCDEF bundle^† Minimize use of restraints and tethers
Sleep	Earplugs, minimization of noise Conversion to daytime bolus feeds to decrease night-time interruptions^†
Cognition	Cognitive-stimulation activities such as music, family-voice reorientation and family involvement
Mood	Screening for depressive symptoms in patients with prolonged ICU admissions, with referral to psychiatry as needed Not suggested to screen acutely unwell, newly admitted patients^†
Mobility and early rehabilitation	Early physiotherapy or occupational therapy assessment for advancing mobility and function toward maintenance of activities of daily living
Nutrition	Dietitian consult Prompt correction of dehydration
Continence	Removal of indwelling catheters to avoid catheter-associated bladder infections and promote mobility Maintenance of regular bowel movements
Skin integrity	Frequent turning to avoid pressure injuries
Minimization of polypharmacy	Daily medication review by pharmacist using STOPP/START criteria17 or American Geriatrics Society Beers criteria18 of potentially inappropriate medications Monitor new high-risk medications (antipsychotics, sedative-hypnotics, opioids) with a plan to taper or discontinue while in ICU^†
Environmental modifications to facilitate physical and cognitive function	Large clocks and calendars Handrails, uncluttered hallways to allow mobilization Elevated toilet seats and door levers (not knobs) Paint colours that emphasize earth tones with contrast between floor, wall and ceiling, to aid patients with impaired depth perception
Early discharge planning	Early involvement of social worker and family Multidisciplinary team rounding with early ongoing emphasis on the goal of returning home (or to pre-hospital living environment)

Note: ACE = acute care of the elderly, ICU = intensive care unit, START = Screening Tool to Alert to Right Treatment, STOPP = Screening Tool of Older Persons’ Prescriptions.
↵* Based on evidence-based principles of ACE unit care.19^–23
↵† Not included in traditional ACE unit protocols. ABCDEF bundle is a multicomponent strategy for delirium prevention and treatment, and includes pain management, trials of spontaneous awakening, choice of analgesia and sedation, monitoring and management of delirium, early mobilization, and family engagement.24