[psnurse]

I have been assigned to root out information on Progressive Care Units to hopefully head off redesign efforts that will upset the apple cart of the nurses working fulltime in one of the units I float to on a regular basis.

Answers to the following questions will be greatly appreciated.

What types of patients are admitted to your PCU? Medical cardiac? Interventional cardiac? Cardiac surgical? Respiratory distress? Vascular surgical? Other types?

Do you titrate vasoactive drips? Any that you aren't allowed to keep on your unit?

Just tele or is some hardwire monitoring available?

Do you take the chronic vent patients?

What is the nurseatient ratio?

Do you use assistive personnel? What kinds?

Do you utilize LPN's? Do you utilize them in an assistive capacity or as primaries?

Do you do conscious sedation in PCU?

Do you have standing admission orders?

Do you have standing ACLS orders?

Do you mix your own drips or are they mixed in the pharmacy?

Do you have written admission criteria? Have copies?

Are elective cardioversions performed in PCU?

Do you pull arterial sheaths in PCU? Who does the actual pulling? What educational requirements must be met?

Any additional information you would like to share about your PCU would be appreciated.

For informational purposes, if you are comfortable doing so, please list the name and general location of your facility.

Thanks for your help.

[CC NRSE]

Hi!

I work at a 480 bed hospital in northwest FL
we have a 20 bed PCU
18 general (sicu,micu,ccu) icu beds and 8 CV (hearts & vascular and also inculding CT) beds

all kinds of pts are admitted to our PCU however, they are limited on gtts, will take most anti arrythmics but usually not antihypertensives (only NTG not being titrated) and no antihypotensives.

swans-- very reare but only if they are pulled back to CVP (usually is better to d/c before transfer -- otherwise they usually come back to the unit)

will take a-line on occasision
central lines are okay.

ALL patients are connected to monitor in the room with cental at the nurses station.

chronic vent patients -- but only if trached

no LPN's-- not sure why, they were two but they got booted to the floor with new management. Were very good nurses had been there a while.

VS usually q 4hrs with 8hr I&O unless otherwise specified. nurse to patient ratio 3/1 with chare taking patients. occassionally take 4 patients. no aides.

consious sedation, yes, usually for cardioversion or maybe central line placement. other than that, patient will go to the unit.

admission orders depends on the kind of patient, ie AMI, CVA we have standing orders (same throughout hospital)

Written admission criteria, cause the MD said so. We are working on that we get lots of pt in the units that shouldn't be there. Usally b/c MD doesn't want to be bothered all night!!!!

ACLS-- we have a code team, a unit nurse ALWAYS responds and is in charge of running until MD arrives

I don't think they have arterial sheaths on PCU but if they do, the specials (procedure) nurse will come back when it is time to be pulled. We don't even pull ours in critical care.

all gtts come from pharmacy

most of our PCU nurses are very limited in their CC experience. usually have come from one of our floors. This is a very
fast paced little unit-- they usually are forced to learn fast or opt to transfer out (d/t stress). However, our critical care units are located pretty close and they usually know and do come to us for questions and advice.

Hope this helps, any other question -- please let me know!!!!

[moonshadeau]

are you referring to a step down intensive care unit when you say progressive unit? I am confused.

[psnurse]

I have heard this type unit called step down, tele, or pcu. We have three levels, ICU, CVU (stepdown), and general med/surg. So I am talking about the one in between.

Let me tell you a little about why I asked.

Currently this unit enjoys a 3:1 staffing ratio, however, there is a plan afoot to change it to 5:1.

That I think would work out well with redesign of the things done in the stepdown area. But I am not sure how it will work out without a population change.

In this step down unit, the patient type varies. There are new strokes without thrombolytics,12 - 24 hours post CABG and valve surg. Thorocotomies, post percutaneous coronary intervention, and chest pains that sometimes work their way into having an MI but don't transfer out. They take chronic vents, trached or still with ETT waiting to be trached. There are those requiring airway observation and respiratory failure. Various arryhythmias, and some rather severe CHF/pulm edema. From time to time the fresh MI is admitted to this unit due to lack of space anywhere else. Also they get new seizures, observation chest trauma, and anyone in the entire place that goes into afib.

The only vasoactive drip I haven't worked with on that unit is Levophed. But Dopamine for B/P support is ok. Nipride for B/P control is ok. Also Primacor, Dobutamine, Cardizem, Amiodarone, NTG, Lido, Pronestyl, Corvert, and just about any other little thing goes. It is acceptable to keep patients on these drips in our step down unit and the drips can be titrated every 15 minutes if required and still meet written admission criteria.

Occasionally there is need to monitor CVP, the old fashioned way. But no other hemodynamic monitoring.

All cardiac monitoring is done with telemetry, and watched at a central station by two people doubling as unit clerks.

They do elective cardioversions, complete with conscious sedation. They also have occasion to do bedside bronchs and TEE's with sedation.

They often receive patients with arterial sheaths in place. These are not connected to any monitoring source so that makes me a little bit nervous, but so far no one has bled to death. Most of those patients also have anti-platelet drugs on board. They do not remove the sheaths themselves, I am often the one that does it for them, but the addition of this task has also been proposed.

Those patients with q1h fingersticks and insulin drip titration? Right in that unit as long as they are not exhibiting neuro changes. But they keep the place smelling nice.

Let's not forget DT's, and OD's. They seem to come often to this unit.

LPN's are utilized as primary nurses, but according to state law, they are required to be directed by an RN. There are usually a couple of techs in the unit. The plan is to increase the nurseatient ratio and use more techs. Which would be fine on some of the walkie talkie rule outs. But I don't see how it is going to work on lots of the other patients.

So this is a survey that I have been asked to put together. It will be presented to the powers that be, in an effort to keep things running smoothly.

Thanks for any help.

[jilpil]

Hello,
I recently have gone to work at a 400+ hospital. They use to have a PCU but now have decided to divide the floor into 2 units.
One is called Monitored Med/Sur and the other floor is Intermediate Care Step Down Unit. Right now both floors continue to get so called PCU patients such as Post Heart Cath's
with sheaths and art lines. We have to pull the sheaths and such. We also get a mixture of Post-op Heart surgeries but not
very many of them. We get patients on Vasoactive, titrating drips.
We also get all of the heart arrhtymias, Renal, any one the doc's
think should be on tele. The nurse patient ratio is !:4 for PCU type patients. 1:5 for others. This place is a big mess and no one knows what they are going to do.

Jil

[benham]

I work on a 32 bed PCU that is divided into 2 floors. We get fresh MIs from ER prior to going to cath lab, post cath lab pt. some with lines in, but most without. our cath lab staff will come back after 2-3 hours most of the time to pull lines,occasionally we get pts. that keep their lines overnight for repeat procedures the next day. We get post CABG pts. from the ICU, some with chest tubes and pacer generators and some without, we also get post valve replacement pts. from ICU. we get alot of rule out MI and general chest pain pts. We have standard chest pain guideline orders, MI guidelines and we also have CABG and valve guidelines that we follow those include lab work and ekgs and such. our docs give us written admit orders. Drips in our unit include Dopamine ( we can't titrate for B/P) Dobutrex, NTG (which we can titrate) Amiodarone, lasix, insulin, Cardizem, heparin, integrilin, reapro. We do use LVN as primary nurses, and we have one tech per floor and we have monitor techs watching the tele for us. gtts. come from pharmacy USUALLY and we do cardioversions, TEE, and bedside bronchs on our unit. nurseatient raito is 1:4
Hope this helps