ICU Topics > Chart Review
What Should You Look for During a Chart Review?
Before entering an ICU patient's room, a thorough chart review is your most important safety step. Think of it as a sequence: chart → screen → monitor → modify. The decision to treat, defer, or modify your session is rarely made at the bedside — it starts with what you find in the chart.
One structured way to approach a chart review is the VITALS framework. Each letter prompts you to check a category of clinical information that directly affects your therapy decision for the day.
VITALS: A Systematic Approach to ICU Chart Review
| Category | What to Look For | |
|---|---|---|
| V | Ventilation & Oxygen | Current respiratory support: NC → Oxymizer → Face Mask → Venturi → NRB → HFNC → BiPAP → mechanical ventilation → trach. Note FiO2 and PEEP settings. Higher support = more caution with activity. |
| I | Imaging | Recent chest X-ray, CT, or ultrasound results. What is the current clinical picture? New infiltrates, effusions, pneumothorax, or worsening edema may change your approach. |
| T | Tubes, Lines & Drains | Identify all vascular access, monitoring lines, and drains. Trace each line to its insertion site. Note precautions: femoral lines (no hip flexion >90°, no sit/stand/ambulate on affected side), IABP, chest tubes, wound VACs, and epidurals. |
| A | Activity Orders | Review what has been ordered: “Activity as tolerated,” “Up to chair,” “Bedrest,” “Bathroom with assist,” or specific restrictions. No order = consult with the team before proceeding. |
| L | Lab Values & Thresholds |
Key thresholds for activity decisions: • Hgb ≤7 g/dL → defer mobility • Hct <20% → bed-level activity only • K+ <3.0 or >6.0 mEq/L → hold • INR >5 → bed-level activity only • Lactate: trending up = caution; trends matter more than single values |
| S | Sedatives & Vasopressors | Check RASS score and current sedation. Has sedation been lightened for therapy? Vasopressor titration within the past 2 hours = caution/yield. Multiple pressors or an active dose increase = likely defer. |
Oldenburg & Hamby, 2024; Linke et al., 2020; Hodgson et al., 2014
References
Hodgson, C. L., Stiller, K., Needham, D. M., Tipping, C. J., Harrold, M., Baldwin, C. E., ... & Webb, S. A. (2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 18(6), 658. https://doi.org/10.1186/s13054-014-0658-y
Linke, C. A., Chapman, L. B., Berger, L. J., Kelly, T. L., Korpela, C. A., & Petty, M. G. (2020). Early mobilization in the ICU: A collaborative, integrated approach. Critical Care Explorations, 2(4), e0090. https://doi.org/10.1097/CCE.0000000000000090
Oldenburg, H. Y., & Hamby, J. R. (2024). The novice in acute care. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational Therapy in Acute Care (3rd ed., pp. 927–961). AOTA Press.