eICU - page 3

Does anyone work in one of these new parts of the ICU care? Was wondering...looking for opinions of this. Thanks... Read More

  1. by   Dinith88
    Quote from CVRNof4
    First off it was not my pt.-I was in charge of the unit and had other nurses to help out...Believe it or not the pt. was not symptomatic (bilateral amps to the groin, ESRD, spends most of the time in the hospital...). As RNs I do not remember learning or being licensed to hang pressors without an order. The eICU MDs can only give orders on certain pt.s in our CVICU-they are catergorized. This was not a category III pt. where they could freely give orders. They went above and beyond when I called them-not the RN at the bedside. The so called intensivist who did not answer his pages was fine with the orders. Later that night he did not return a call on a pt. that was admitted for over three hours. You can have your opinion, but obviously the Magnet hospital I work at finds a need for it...and yes we are one of the number one heart centers in the Midwest, unfortunately some of the overflow pt's we receive have to have incompetent intensivist (and not the eICU MDs-they are only allowed to do so much in the unit I work in). Best of luck to you in your nursing career.
    So...this frequent-flying asymptomatic patient...required pressors and volume to correct his hypotension when the doc finally called???

    Regardless.... The eICU's purpose is to 'monitor' these people..and if the eICU
    failed to notice or failed to 'phone in' for an entire HOUR while the patient layed there for 60minutes (because your nurses are unable to correct this without a doctor telling you to) then in my estimation the eICU failed.

    Luckily @ most places (including my non-magnet hospital), the ICU nurses have more freedom and are expected to know how to handle things and are covered/protected by standing protocols and orders (for pt's admitted to icu).
    Last edit by Nurse Ratched on Sep 27, '05 : Reason: TOS
  2. by   bellehill
    Quote from CVRNof4
    Here is another example of how the eICU has worked. Last night while I was in charge a pt. was admitted-SBP 55. The Intensivist that was consulted did not call back after one hour of numerous pages and calls to his home. Called the eICU and received orders for volume and pressors as needed. As RNs we cannot just start a drip...and I really am offended by Diniths post-definately not one open for change. What if you go to computerized charting like we did a few years ago...what negative things will he/she have to say about that, or getting rid of NAs, or pt. to RN ratio changes for productivity? Come on-until you have used it you cannot have anything to say
    That is one of the reasons we are looking forward to the eICU. We had that same situation the other night, SBP in the 50's, boluses started, no MD call back for 30 minutes. Unfortunately in this state as, well as yours, RNs are not allowed to write med orders or initiate medications without a doctors order. Were we geting ready to hang Dopamine without an order? Yes. Did we already send an order to pharmacy for Levo? Yes. The nurse put her head on the block hoping that the meds she "ordered" would be okay with the MD when they called back. This is not effective nursing, we are not doctors nor do I want to be. I'm glad to hear the eICU worked so well for your unit, now I am even more excited.
  3. by   bellehill
    Here is an eICU update for those of you who were interested. We have been "live" for one week, of course the acuity on the unit dropped as soon as we went live. The main problem is our attendings not allowing eICU to write orders on non-emergent issues (K+ replacement, temps, low hgb...) but they also don't want to be called in the middle of the night. We are working on that issue. I have not been bothered by the eICU at all. I was floated to ICU the other night and saw eICU in action in a code, it was awesome. The resident needed a cool, level-headed person backing him up and that is what he got. I'm still waiting for the shift it helps me, but like I said, our acuity is very low right now.
  4. by   Dinith88
    Quote from bellehill
    Here is an eICU update for those of you who were interested. We have been "live" for one week, of course the acuity on the unit dropped as soon as we went live. The main problem is our attendings not allowing eICU to write orders on non-emergent issues (K+ replacement, temps, low hgb...) but they also don't want to be called in the middle of the night. We are working on that issue. I have not been bothered by the eICU at all. I was floated to ICU the other night and saw eICU in action in a code, it was awesome. The resident needed a cool, level-headed person backing him up and that is what he got. I'm still waiting for the shift it helps me, but like I said, our acuity is very low right now.
    I still think eICU's are stupid
  5. by   Teachchildren123
    No, eICU is not stupid at all.
    We are getting soooo much better nouw that we have night coverage on most of the nights.
    You have to make pressure so you docs can order electrolytes replacement, give you orders for cultures and Tylenol, Haldol...
    Keep on calling them, have your manager work with you to have eICU work with you, this is what's it's all about.
    Last night, for ex. the nurse at eICU called to ask if we noticed that bed #3 K was 2.4. I told the nurse in ICU the message and asked her if she wanted an order for K runs. She, herself said:"Do you think they'll give me one?"
    Sure, they did. We have to get used to have them to support us.
    It is so great not to have to awaked the "Grumpy ones"!:hatparty:
  6. by   Dinith88
    Quote from connyrn
    No, eICU is not stupid at all.
    We are getting soooo much better nouw that we have night coverage on most of the nights.
    You have to make pressure so you docs can order electrolytes replacement, give you orders for cultures and Tylenol, Haldol...
    Keep on calling them, have your manager work with you to have eICU work with you, this is what's it's all about.
    Last night, for ex. the nurse at eICU called to ask if we noticed that bed #3 K was 2.4. I told the nurse in ICU the message and asked her if she wanted an order for K runs. She, herself said:"Do you think they'll give me one?"
    Sure, they did. We have to get used to have them to support us.
    It is so great not to have to awaked the "Grumpy ones"!:hatparty:
    So umm.. the eicu nurse knew about the hypokalemia before the floor nurse??? scarey.

    And i'll never be convinced...eicu's are a misuse of resources. Maybe (in best case scenario) it makes your night nurses more comfortable because they're scared to call the doc regarding a dangerous k level when it's late.

    Spend bazillions of dollars...so skittish nurses wont get their feelings hurt when a jerk doc. gets grumpy when you wake him up for a potentially lethal lab result. Hmmm. MOney well spent.

    I'm well aware of my inability to convince 'eicu advocates' of it not being all it's cracked-up to be (and not worth the bazillions$$$). HOwever...the truth remains that the eicu is little more than a prying monitor tech that lets doctors sleep in the middle of the night...sure it can give an occaisional order (if intensivist is at the eicu desk) but it can never replace bedside care-givers.

    Sure it can 'supplement' things...but at a ridiculous cost...with very little REAL ability that the bedside care-givers need (tell the eicu nurses to come over and clean blood, puke, or wipe a butt...then it may be a little more worth the money)

    And how about during the day...do you call the patients doc re: your pt's labs...what if they're napping? or eating? or on a strole??
    You know, those guys are on call for a reason...if your scared of 'grumpy one'...you need more confidence...or something...

    and please explain why getting an order from an eicu doc is better than obtaining it from on-call doc???

    something is wrong here....
  7. by   Nurse Ratched
    Thanks to Bellehill for keeping us up to date on the progress of her adventure . Health care quality and associated expenditures are the #1 business issue currently affecting the American economy (and possibly worldwide.) It's interesting to read what efforts are being made to try and increase efficiency without sacrificing patient outcomes. It may or may not be successful long term, but we sure need to do something before the system completely tanks.
  8. by   sirI
    Thank you for that comment, Nurse Ratched. Yes, the eICU has been proven to be most beneficial especially in our rural areas. I know there are some issues surrounding its presence for some, but, for the most part, we are very fortunate to have this. I know many are reaping the benefits of this elsewhere as well.
  9. by   Auri
    [FONT="Comic Sans MS"]We have used EICU for over a year where I am currently working. I must say there are certainly times when I could do without them, i.e. one time I got an admission, had the pt. fully admitted to both their system and ours. pt brady'd down to like 25, sustained, although asymptomatic. I happened to be in the room w/ the pt. the entire time and I guarentee the camera never initiated and I NEVER got any calls saying " umm did you know so-n-so's HR is in the 20's". It was onlt after I called the attending, Medical CCS, HO, Critical care admitting resident ad never got call backs from anyone that they intervened. Pt was a Lvl IV. Which means that EICU could write for ANYTHING from tylenol to levphed for the pt. They could have interveined at any point, yet they werewaiting to see if this pt's MD's called back, which they clearly weren't doing. So i ask... what good were they?? I've noticed some out MD's tend to make the EICU the on call MD for the night so that they don't get 0300 "tylenol calls"which is very nice, unless you have RN's who are unable to properly assess a pt, since the RN's and MD's rely on the bedside RN for about 90% of their knowledge of the pt.

    ok
    sorry for the tirade.
    a
  10. by   JustMe
    I've read all your arguments for/against eICU. I guess my observation is this: It seems the eICU works well in high volume facilities like an extra pair of eyes for the nurse (who hasn't had a patient fall out of bed even tho the nurse was right next door?). Also works well for those rural facilites who need the expertise in certain situations. I can also envision eICU on the tele units--after all, the hospitals are becoming one great big ICU now that patients are being sent home so early, or not admitted at all. The only patients in the hospital nowadays are the ones who didn't survive 20 years ago.

    JustMy observations.
  11. by   nrsjo60
    Quote from CVRNof4
    Does anyone work in one of these new parts of the ICU care? Was wondering...looking for opinions of this. Thanks
    Hi, I work in a CVICU that has eICU. There are a team of MDs and Rns at an off site. they can view our pts with a camera on the wall and they can read the chart because it is digitalized. they a can view the pt so close that they can see the size of the pupil..they are extremly helpful especially at noc. We just push a button on the wall and they are right in the room with us so to speak.. they can walk us through a code blue or help us with just about anything...the nurses like them. some of the docs dont trust it yet...joanie in McHenry.
  12. by   duchess_deni
    If used as intended, not a bad resource, I would think--I will have the opportunity to find out beginning of the month--however from ideas coming from our manager like having us walk into the room to do an IV check with these people on the other end of the camera. My concern is how freaking stupid will I look to my patient. They want to use it like big brother watching our every move. We are a unit of experienced ICU RN's and only have two people on the unit with less than 5 years experience. I find it insulting to think that I or any of my colleages can't tell the difference between NS or D5W, give me a break. And yes they can keep an eye on one pt for you if you have another that is not doing well, however they do not take any responsibility for the pt that they are watching so guess what if the pt climbs out of bed and hits the floor it is still my responsibility all they do is tell the pt to "lay back down and don't get out of bed", then call me and if I'm wrapped up with someone unstable and doing multiple interventions I can just see myself telling my crashing pt "just a minute while I take this call". That will work real great. Instead of saving us any time they have come up with multiple "real time" charting that has to be done at the bedside. It takes me longer to do my job running back and forth between my rooms logging on to the computer, flipping through multiple screens to get to the one I need. If our IT dept. made it more user friendly that would be nice, however there are currently no plans to do that.
    So it sounds like labor intensive, instead of labor saving.
    I will try to keep an open mind, however the planning for all this is in the hands of only two of the nurses on our unit, no one else has been asked for ideas on how to make this a smooth change. I have a problem with that.

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