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Nurses have the knowledge and skills to recognize and intervene when the condition of patients on medical or surgical units deteriorates. Despite this, deterioration is sometimes missed resulting in unexpected ICU admissions. This study explored the nursing process factors associated with unexpected ICU admissions. A chart audit was undertaken in a large urban hospital and data were collected measuring nursing assessment (vital signs), communication and documentation. Results showed that the most common reason for an unexpected ICU admission was respiratory distress. At the same time, respiratory rate was the least documented vital sign. Communication, documentation and recognition of patient deterioration play a key role in intervening and preventing unexpected ICU admissions. Attention to adequate staffing levels as well as implementation of clinical tools may assist nurses to more readily address patient deterioration and prevent unexpected ICU admissions.