[richtam97]

Hi

My unit will be undergoing some changes soon. I'm on the Practice Council and was wondering if anyone would be interested in sharing information on how their Cardiac Tele Unit and/or Cardiac Stepdown Units operate.

Any information or direction would be greatly appreciated. Our next meeting is Feb 19 and I'm responsible for doing a little research.

Thanks!

[Miami NightNurse]

Are you asking what kind of patients each takes? What kind of training is needed?

[richtam97]

Originally Posted by AlexisRN46

Are you asking what kind of patients each takes? What kind of training is needed?

Yes...What kind of patients and what kind of care your unit provides...how do you operate.

[Miami NightNurse]

We have a 51 bed Cardiovascular/Telemetry Unit, atleast 10 of those beds are stepdown(CVS)On the regular tele we take MI's, Cardiac Cath, PTCA with stents unless they are on Reopro or Integrillin and a Femoral approach was used-then they go to CVS, Patients on external Pacemakers- like 3 deg AV Block patients, 24 hr post op CABG or Valve Replacement patients. On the regular Tele we take Dobutrex,Natrecor Cardizem, Lidocaine; Reopro and Integrillin pre Cardiac cath or post if Radial approach was used. In the CVS unit we take patients with A-Lines, 24 hr post Open Heart with Mediastinal Chest Tubes, post Carotid Endarterectomy, post op Vascular patients- Fempops, Lysis, Endovascular AAA Repair all go to CVS for the first 24 hours then they go out to the regular telemetry floor. In CVS we have hardwire Vital sign machines that are portable and can be wheeled from one room to the other. Also in CVS we take Dopamine, Nitroglycerine, Primacor and Amiodarone Drips. Amiodarone Drips can go on the regular telemetry floor if patient is stable. To work in CVS unit they usually like experienced Nurses back there who have been through a special training program to work back there. We will be doing Aquaphersis in CVS- we all been trained to do it but so far no doctor has ordered it. We haveone charge Nurse for the entire floor and she must be CVS trained. On day shift there are also 4 Patient Care Facilators. On the telemetry part of floor 7a-7p shift nurse get 5-6 patients with a nurses aide and 7p-7a nurses get 7 with a nurses aide. In the CVS unit we usually get 3 patients on each shift with a nurses aide

[richtam97]

Thank you...your information is extremely helpful; sounds like we are a CVS unit already.

Originally Posted by AlexisRN46

We have a 51 bed Cardiovascular/Telemetry Unit, atleast 10 of those beds are stepdown(CVS)On the regular tele we take MI's, Cardiac Cath, PTCA with stents unless they are on Reopro or Integrillin and a Femoral approach was used-then they go to CVS, Patients on external Pacemakers- like 3 deg AV Block patients, 24 hr post op CABG or Valve Replacement patients. On the regular Tele we take Dobutrex,Natrecor Cardizem, Lidocaine; Reopro and Integrillin pre Cardiac cath or post if Radial approach was used. In the CVS unit we take patients with A-Lines, 24 hr post Open Heart with Mediastinal Chest Tubes, post Carotid Endarterectomy, post op Vascular patients- Fempops, Lysis, Endovascular AAA Repair all go to CVS for the first 24 hours then they go out to the regular telemetry floor. In CVS we have hardwire Vital sign machines that are portable and can be wheeled from one room to the other. Also in CVS we take Dopamine, Nitroglycerine, Primacor and Amiodarone Drips. Amiodarone Drips can go on the regular telemetry floor if patient is stable. To work in CVS unit they usually like experienced Nurses back there who have been through a special training program to work back there. We will be doing Aquaphersis in CVS- we all been trained to do it but so far no doctor has ordered it. We haveone charge Nurse for the entire floor and she must be CVS trained. On day shift there are also 4 Patient Care Facilators. On the telemetry part of floor 7a-7p shift nurse get 5-6 patients with a nurses aide and 7p-7a nurses get 7 with a nurses aide. In the CVS unit we usually get 3 patients on each shift with a nurses aide

[Spatialized]

Our unit sounds very similar to "AlexisRN46". But here goes:
We're a 46 bed cardiac/cardiac surgery unit. Our motto pretty much is: if they've got a heart they can come to us. That said we get pre/post PCI - with Reopro, Integrillin et. al., pull venous and arterial sheaths, pre/post op CABG/valve surgery - usually POD#1 18-24 hours out with chest tubes, external pacers, get the LOLs with A-Fib with RVR (and dementia), CHFers, sternal wound infections, complex post-surgical patients with a need for cardiac monitoring, geri-psych , rule-out MIs, chest pain admits, pacers and AICD placements, post-EPS patients with/without ablation, dialysis patients, Tikosyn and Sotalol load patients, plus more than our fair share of medical overflow patients. We also run Amiodarone, Cardizem Lasix, Heparin, Nitro, Dopamine, Dobutamine, Integrillin, Reopro, Milrinone, Esmolol, Nisertitide and Natrecor drips, some of which are titratable by nursing based on parameters - nitro, heparin and cardizem.
We're in the process of splitting into 2 sub-units, a tele floor and a cardiac step-down unit. SDU will get the fresh hearts, the intervention patients, the sheaths etc. The tele floor will get everyone else. Days our staffing is 3-4:1 with aides for all 46 beds, very busy with admits and discharges - it's not unheard of for a nurse to discharge all their patients and get a whole new hand in one 12 hour shift. Nights we run 4:1, occ. 5:1 with 2 aides for the entire floor. They're telling us that the SDU will be 3:1 at all times.
We have unit specific teaching, like 12-leads, arrhythmia interpretation, use of the temporary external pacemakers, sheath pulling, and protocols. We're tested every year to make sure we current. Every nurse on the unit is ACLS certified, new grad have up to 6 months (for nights to get certified).
I think that sums it up...
Cheers,
Tom

[Miami NightNurse]

Originally Posted by Spatialized

Days our staffing is 3-4:1 with aides for all 46 beds, very busy with admits and discharges - it's not unheard of for a nurse to discharge all their patients and get a whole new hand in one 12 hour shift. Nights we run 4:1, occ. 5:1 with 2 aides for the entire floor. They're telling us that the SDU will be 3:1 at all times.

Tom, Your floor sounds just like ours except your staffing ratios sound much better!!! I'm Jealous. What state are you in? I havn't seen much Tikosyn lately-Thank God it always made me nervous. Are you doing Aquapheresis? They trained us all to do it, they bought the machines and so far no doctor has ordered it.

[Spatialized]

No Aquapheresis, yet. I've got a funny feeling that after the slpit they may try to bring it on. NM wants to make CHF a core focus of the non-SDU portion. So we'll see. As for ratios, I think it was a combination of nurse advocacy and physician pressure, but am not sure. I can't imagine having more than 5 on nights, even with my own aide. That is one big difference I think (I could be totally wrong). Each aide has 23 beds to care for. For us it's pretty much primary nursing, we do near everything and sometimes many of us believe we should get the CNAs hourly rate as well.
I don't mind Tikosyn, but for some reason Sotalol kind of freaks me out...don't know why.

Cheers,
Tom

[Miami NightNurse]

They tried to bring the aquapheresis on our floor in the stepdown portion but the Doctors aren't going for it-why I don't know. We get 7 patients at night alot and the tech has 12-13. We only had 6 before we got new management. So it's pretty rough especally with all that goes on with a 24hr post open heart and to top that off most of our patients think they are in a fancy hotel, our hospital encourages that image.

[richtam97]

Thanks you two - I can't tell you how much your first hand info is helping me out!

Tam