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Critical illness rehabilitation checklist for healthcare professional(s)* coordinating the patient’s
rehabilitation care pathway
Patient’s name: ID number:
Healthcare professional(s): Date of admission to critical care unit:
Patient pathway Measure (Circle or highlight) Date and Comments
signature
During the Short clinical assessment completed (see table 1 below) Yes No
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critical care Patient given information Yes No
stay Information given more than once during the patient’s critical Yes No
care stay
Patient at risk Yes Low risk
If patient at risk
Comprehensive clinical assessment completed Yes No
Short-term and medium-term rehabilitation goals agreed Yes No
Rehabilitation started as early as clinically possible Yes No
Rehabilitation included:
1. measures to prevent avoidable physical and non-physical Yes No
morbidity (including review of previous and current medication)
2. nutrition support Yes No
3. an individualised, structured rehabilitation programme with
frequent follow-up reviews. Yes No
Review 1 completed Yes No
Review 2 completed Yes No
Review 3 completed (as required). Yes No
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Information about: the patient’s critical illness, interventions and treatments; the equipment used during the patient’s critical care stay; and if applicable, any possible short-term and/or long-term
physical and non-physical problems which may require rehabilitation. All the above should be given to the patient more than once during their critical care stay and should also be given to their
family and/or carer, unless the patient disagrees.
Rehabilitation after critical illness checklist 1
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Patient pathway Measure (Circle or highlight) Date and Comments
signature
Before Short clinical assessment completed if patient previously Yes No
discharge from identified as low risk
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critical care Patient given information Yes No
Patient given the contact details of the healthcare Yes No
professional(s)
Patient at risk Yes Low risk
If patient at risk, or if started individualised rehabilitation programme in critical care
Comprehensive clinical reassessment completed Yes No
Rehabilitation goals agreed, reviewed and updated Yes No
Particular attention paid to:
1. physical, sensory and communication problems Yes No
2. underlying factors such as psychological or psychiatric distress Yes No
3. symptoms that developed during critical care stay such as Yes No
delusions, anxiety or nightmares
During ward- Short clinical assessment completed if patient previously Yes No
based care identified as low risk
Patient at risk Yes Low risk
If patient at risk
Comprehensive clinical reassessment completed Yes No
An individualised, structured rehabilitation programme offered Yes No
The individualised, structured rehabilitation programme Yes No
developed and delivered by members of a multidisciplinary
team
A structured and supported self-directed rehabilitation manual Yes No
offered, based on clinical judgement and the individual
patient's rehabilitation needs, if applicable
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Information about: the rehabilitation care pathway; differences between critical care and ward-based care including the differences in the environment, and staffing and monitoring levels; and the
transfer of clinical responsibility to a different medical team (this includes the formal structured handover of care recommended in ‘Acutely ill patients in hospital’ (NICE clinical guideline 50). If
applicable: emphasise possible short-term and/or long-term physical and non-physical problems that may require rehabilitation; and give information about sleeping problems, nightmares and
hallucinations and the readjustment to ward-based care. The information should also be given to their family and/or carer, unless the patient disagrees.
Rehabilitation after critical illness checklist 2
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Patient pathway Measure (Circle or highlight) Date and Comments
signature
Before Functional assessment completed if the patient was receiving Yes No
discharge to an individualised rehabilitation programme. This includes
home or physical and non-physical dimensions (see table 2 below)
community Rehabilitation goals reviewed, updated and agreed with the Yes No
patient
Patient given the contact details of the healthcare Yes No
professional(s)
Information, including documentation such as this checklist, Yes No
communicated as appropriate to any other healthcare settings
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and the patient or their carer
At 2–3 months The patient reviewed and a face-to-face functional assessment Yes No
after critical completed, based on the first functional assessment
care discharge Patient referred to appropriate rehabilitation or specialist Yes No
services if recovering at a slower rate than anticipated or if the
patient has developed unanticipated physical and/or non-
physical morbidity that was not previously identified
Information, including documentation such as this checklist, Yes No
communicated as appropriate to any other healthcare settings
and the patient or their carer
* The healthcare professional(s) may be intensive care professional(s) or, depending on local arrangements, any appropriately trained
healthcare professional(s) from a service (including specialist rehabilitation medicine services) with access to referral pathways and medical
support (if not medically qualified).
This checklist can be used as part of a trust’s clinical audit process – see NICE audit support tool.
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Information about: their physical recovery, based on the goals set during ward-based care if applicable; diet and any other continuing treatments; how to manage activities of daily living including
self-care and re-engaging with everyday life; driving, returning to work, housing and benefits; local statutory and non-statutory support services, such as support groups. General guidance,
especially for the family and/or carer, on what to expect and how to support the patient at home. This should take into account both the patient’s needs and the family’s/carer’s needs. Give the
patient their own copy of the critical care discharge summary. The information should also be given to their family and/or carer, unless the patient disagrees.
Rehabilitation after critical illness checklist 3
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Table 1: Examples from the short clinical assessment that may indicate the patient is at risk of developing physical and
non-physical morbidity
Physical Unable to get out of bed independently.
Anticipated long duration of critical care stay.
Obvious significant physical or neurological injury.
Lack of cognitive functioning to continue exercise independently.
Unable to self ventilate on 35% of oxygen or less.
Presence of premorbid respiratory or mobility problems.
Unable to mobilise independently over short distances.
Non-physical Recurrent nightmares, particularly where patients report trying to stay awake to avoid nightmares.
Intrusive memories of traumatic events which have occurred prior to admission (for example, road traffic accidents) or during
their critical care stay (for example, delusion experiences or flashbacks).
New and recurrent anxiety or panic attacks.
Expressing the wish not to talk about their illness or changing the subject quickly off the topic.
Note: This list is not exhaustive and healthcare professionals should use their clinical judgement.
Rehabilitation after critical illness checklist 4
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Table 2: Symptoms from the functional assessment that may indicate the presence of physical and non-physical
morbidity
Physical dimensions
Physical problems Weakness, inability/partial ability to sit, rise to standing, or to walk, fatigue, pain, breathlessness, swallowing difficulties,
incontinence, inability/partial ability to self-care.
Sensory problems Changes in vision or hearing, pain, altered sensation.
Communication Difficulties in speaking or using language to communicate, difficulties in writing.
problems
Social care or Mobility aids, transport, housing, benefits, employment and leisure needs.
equipment needs
Non-physical dimensions
Anxiety, depression and New or recurrent somatic symptoms including palpitations, irritability and sweating; symptoms of derealisation and
PTS-related symptoms depersonalisation; avoidance behaviour; depressive symptoms including tearfulness and withdrawal; nightmares, delusions,
hallucinations and flashbacks.
Behavioural and Loss of memory, attention deficits, sequencing problems, deficits in organisational skills, confusion, apathy, disinhibition,
cognitive problems compromised insight.
Other psychological or Low self-esteem, poor or low self-image and/or body image issues, relationship difficulties, including those with the family
psychosocial problems and/or carer.
Note: This list is not exhaustive and healthcare professionals should use their clinical judgement.
This checklist should be used in conjunction with the clinical guideline on rehabilitation after critical illness and the results of the assessments
should be recorded in the patient’s clinical records. For further information about the guideline please visit: http://www.nice.org.uk/CG83
Rehabilitation after critical illness checklist 5
