Objective To develop a rapid screening and graded early warning tool for the risk of postoperative pulmonary complications in ICU patients and to conduct a preliminary evaluation of its feasibility. Methods An initial pool of assessment indicators was generated through a systematic literature review and group discussions from June to August 2025. The Delphi expert consultation method was then used to construct the ICU postoperative pulmonary complication risk screening and graded early warning tool from September to November 2025，which consists of 2 modules, namely an assessment and screening indicators module and a risk grading module. From December 1 to 20，2025， adult patients transferred to the ICU following surgery and ICU nurses from a tertiary general hospital in Beijing were selected as study subjects. A descriptive study design was adopted to analyze the feasibility of this tool in terms of its implementation in the ICU and nurses’acceptability. Results A total of 2 rounds of expert consultation were completed，with a 100% valid questionnaire recovery rate in both rounds. The expert authority coefficients were 0.925 and 0.900， respectively. After the 2 rounds of consultation， the Kendall’s coefficient of concordance for the indicators was 0.124（P=0.040）. The final tool consisted of Module 1，a screening and assessment form, which included 3 first-level domains（individual factors，treatment factors，and physiological function），9 second-level indicators， and 33 graded scoring items； Module 2， the risk level classification, in which the risk level was determined using a dual-criterion method combining total score and the number of high-score items. For the feasibility analysis, 30 postoperative patients transferred to the ICU and 8 nurses were included. A total of 753 assessments were planned， of which 738 were actually completed， yielding a completion rate of 98.01%. The mean time required for the first assessment was（4.80±0.52） minutes. Among all assessments， 6 patients were identified as being at persistently high risk，and 5 of them subsequently developed postoperative pulmonary complications，accounting for 83.33% of the persistently high-risk patients. The results of the nurse acceptability evaluation showed that the tool received high scores in terms of ease of use， clarity of scoring criteria, reasonableness of time burden, clinical relevance， and willingness for continued use， all>4.75 points. Conclusion The ICU postoperative pulmonary complication risk screening and graded early warning tool developed in this study has a clear structure and well defined procedures. Preliminary application suggests that it has good operability and high acceptability among nurses.
