What is FAST HUGS BIDS
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FAST HUGS BIDS mnemonic ICU critical care checklist
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Here is a complete breakdown of FAST HUGS BIDS (also written as FAST HUGS BID), the evidence-based ICU daily care mnemonic:
Origin
The original FASTHUG mnemonic was published by Jean-Louis Vincent in 2005 as a self-directed daily mental checklist for critically ill patients. In 2009, Vincent and Hatton updated it to FAST HUGS BID, adding four more items. It has since been further extended (see below).
The Mnemonic - Letter by Letter
| Letter | Element | Key Questions to Ask |
|---|---|---|
| F | Feeding | Is the patient receiving nutrition? Can the route be optimized (enteral preferred over parenteral)? Is nil-by-mouth still necessary? Should TPN be considered? |
| A | Analgesia | Is pain adequately controlled? Are non-opioid adjuncts being used? Can IV infusions be converted to oral analgesics? |
| S | Sedation | Is sedation being minimized? Is a non-benzodiazepine strategy being used (favor propofol or dexmedetomidine)? Is a daily sedation interruption (wake-up trial) being done? |
| T | Thromboprophylaxis | Is VTE prophylaxis in place (LMWH/UFH)? Does it need renal dose adjustment? For high bleeding-risk patients, are compression stockings or sequential compression devices being used? |
| H | Head of bed elevation | Is the head of the bed elevated to at least 30 degrees (ideally 30-45°) to prevent ventilator-associated pneumonia (VAP)? |
| U | Ulcer prophylaxis | Does the patient need stress ulcer prophylaxis (e.g., PPI or H2 blocker)? Is it still indicated, or can it be stopped? |
| G | Glycemic control | Is blood glucose being monitored? Is it within target range (typically 140-180 mg/dL in ICU patients)? |
| S | Spontaneous breathing trial (SBT) | Is the patient ready for an SBT? Has the underlying cause for intubation been controlled? Can the patient protect their airway? |
| B | Bowel care | Is the patient having bowel movements? Is constipation or diarrhea being managed? Is the oral/enteral medication route being used where possible? |
| I | Indwelling catheter review | Are all indwelling lines/catheters (central venous, arterial, urinary) still necessary? Remove anything no longer needed to reduce infection risk. |
| D | De-escalation of antibiotics | Are antibiotics still indicated? Can broad-spectrum agents be narrowed based on culture results? Do all antibiotic orders have stop dates? |
| S | Skin care | Are pressure areas being assessed and managed? Is positioning being changed regularly? Is there any evidence of pressure injuries? |
Why It Matters
FAST HUGS BID(S) is a structured daily rounding tool that helps ICU teams avoid omissions of well-evidenced interventions. Key benefits:
- Reduces VAP (head of bed elevation, SBT)
- Reduces VTE (thromboprophylaxis)
- Reduces catheter-related infections (indwelling catheter removal)
- Reduces antibiotic resistance (de-escalation)
- Reduces harm from over-sedation and prolonged mechanical ventilation
- Implementation of the original FASTHUG concept has been shown to decrease VAP incidence in surgical ICUs
Expanded Variants
The mnemonic has been further expanded by others:
- FAST HUGS IN BED Please (Chris Nickson, LITFL) - adds Immunization, Nurse concerns, Environment (delirium prevention), De-escalate therapies, Psychosocial support, Lab/test review, End-of-life planning
- DANISH BUG FEST - another ICU rounding variant that also incorporates skin care and other domains
- FASTHUG-MAIDENS - a pharmacy-focused adaptation for identifying drug-related problems in the ICU
The core principle across all versions is the same: use a systematic daily checklist to ensure no evidence-based intervention is missed for every critically ill patient.
Point 1 and 2 from suggestions
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