Table 6.

The Brain Roadmap

Where is the patient going?

Report the target level of consciousness (RASS or SAS).

Where is the patient now?

Report current level of consciousness (RASS or SAS) and delirium status (CAM-ICU or ICDSC). Consider also reporting a pain score (CPOT or BPS).

How did the patient get there?

Report sedatives, analgesics and antipsychotics the patient is receiving or has received over the last 24 hours.

Conversation Points

Should sedation targets be adjusted?

Does this information represent a change in the patient’s clinical status?

If newly delirious or a new altered level of consciousness, why?

Can any medications be stopped?

Should any medications be started or adjusted?

Can the patient be mobilized?

The Brain Roadmap serves as a communication framework for interdisciplinary team members to rapidly (less than 10 seconds) communicate about a patient’s level of consciousness and delirium status during bedside rounds. This framework allows clinicians to address the status of the patient’s brain (e.g., Is the patient over-sedated and sedatives should be held? If delirious, what is the likely cause? Can we modify that cause?). RASS, Richmond Agitation-Sedation Scale. SAS, Riker Sedation-Agitation Scale. CAM-ICU, Confusion Assessment Method for the ICU. ICDSC, Intensive Care Delirium Screening Checklist. CPOT, Critical-Care Pain Observation Tool. BPS, Behavioral Pain Scale. Adapted from Balas, et al., Crit Care Nurse 2012; 32:35.