What is FAST HUGS BIDS
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FAST HUGS BIDS ICU mnemonic critical care daily checklist
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Here is a full breakdown of FAST HUGS BIDS - an ICU daily care mnemonic:
FAST HUGS BIDS - ICU Daily Care Mnemonic
Origins
The mnemonic evolved over time:
- FAST HUG (2005) - Originally introduced by Prof. Jean-Louis Vincent in Critical Care Medicine as a 7-point mental checklist for ICU rounds.
- FAST HUGS BID (2009) - Expanded by Vincent WR & Hatton KW to include surgical ICU patients, adding 3 more elements.
- FAST HUGS IN BED Please - Further extended by Chris Nickson (LITFL) to cover emergency/ICU holistic care.
Letter-by-Letter Breakdown
| Letter | Component | What to Check |
|---|---|---|
| F | Feeding / Fluids / Fever | Is enteral nutrition started? Is fluid balance appropriate? Is there fever to address? |
| A | Analgesia | Is pain being adequately assessed and managed? |
| S | Sedation | Is the sedation level appropriate? Is a daily sedation hold being done? |
| T | Thromboembolic prophylaxis | Is DVT/PE prophylaxis in place (heparin, compression stockings)? |
| H | Head of bed elevation | Is the head of bed elevated 30-45° to prevent VAP and aspiration? |
| U | Ulcer prophylaxis | Is stress ulcer prophylaxis prescribed (PPI or H2 blocker)? |
| G | Glucose control | Is blood glucose being monitored and kept within target range? |
| S | Spontaneous breathing trial | Is the patient ready to be weaned from ventilation? Has a SBT been performed? |
| B | Bowel care | Is bowel function being monitored? Is ileus or constipation being addressed? |
| I | Indwelling catheter review | Can any lines, catheters, or tubes be removed to reduce infection risk? |
| D | De-escalation of antibiotics | Can antibiotics be narrowed, stepped down, or discontinued? |
| S | Skin care | Are there pressure sores? Is turning/positioning being done? |
Why It Matters
FAST HUGS BIDS is a structured daily checklist designed to:
- Reduce preventable ICU complications (VAP, DVT, pressure ulcers, line infections)
- Promote antibiotic stewardship through daily de-escalation review
- Encourage early liberation from mechanical ventilation via spontaneous breathing trials
- Ensure holistic, patient-centred care rather than disease-focused management
Key Points
- It is meant to be used during ICU ward rounds as a systematic prompt, not a rigid protocol.
- The original FAST HUG had 7 elements; FAST HUGS BID added 3 more (Spontaneous breathing trial, Bowel care, Indwelling catheter review, De-escalation) - making it 10-11 items depending on the version.
- The "S" at the end (Skin/Skin care) was added in later iterations to round out the mnemonic to FAST HUGS BIDS.
- Some versions expand it further (e.g., FAST HUGS IN BED Please from LITFL) to include delirium prevention, psychosocial support, and environmental modifications.
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