ICU use as a PACU

[okihusker]

I work in an a multiservice ICU at a Navy Hospital , which is also utilized as the step down unit, to include Peds, Neuro Surgery, CCU, Oral Maxillary Facial, and General Surgery. We get flooded with tons of bogus admissions to include routine elective surgeries. If a routine surgery is being admitted to our ICU, we are expected to recover the patient. The orders will read admit ICU, condition: stable. These patients have no invasive caths or ETT. The PACU admits to sitting on their ass for most of thew day. The rational for us recovering these patients are "They are you patient." "...continuity of care." I expressed that I feel this is dangerous because I have other patients to attend to in the ICU that have cardiac issues and airway issues. Myself and the ICU staff continually tell our management we can not guarentee 1:1 observation during the phase one recovery per ASPAN stadards. However, we have gotten no where with management and we feel this is due to not compromising the luxury of the surgical dept (Club Med). In fact, this is a violation of our ICU protocol and the rationale for this is "We signed it without reading it so we could get the SOPs done ASAP." Does anyone know id JCH or a lawsuite or standard that dictactes ICU recovering patients or the recovery of patients applied to mu situation?

[cactus wren]

Sorry, I sure don`t, but would like to see if they exist....our 4 bed unit also gets patients right off the table, and at times we also aren`t able to a 1:1 for recovery time..........last Friday did have the OR nurse do recovery as we had a code just as the patient rolled in..She ended up staying with patient for 1 1/2 hours as we were just too busy to take report.....and she was not pleased........:chuckle as they had a case waiting for the nurses to start........Many of our admits are orthos with an epidural...we get them until the cath gets pulled, usually 24 hours.....Have argued that we are not able to do PACY stuff every time, and it depends on who is doing the case( nurse wise) on how much static we get......It seems that especially on weekends, that we get a lot of patients who don`t meet criteria for admission because the callout crew doesn`t want to stay to do recovery.....Admin backs up OR, They bring money in, ICU~ costs money......

[whipping girl in 07, RN]

The only patients we recover in ICU are our open hearts, which are one-to-one until extubated anyway.

That sounds like a real PITA. I feel for ya.

[Ted]

My really small, rural hospital has one full-time dedicated PACU nurse who works only Mondays-Fridays, 8:00 am to 4:00 pm. Our happy little 5 bed (soon to be 4 bed) ICU/CCU does all of the rest of the PACU's during the evening and night shifts (and weekends too).

Interestingly, the OR is located on the 1st floor. The ICU/CCU is located on the 2nd floor. . . through the med/surg unit and down the hallway from the elevators!!!! Can't tell you how many times I received a patient: 1) with and O2 nasal cannula not connected to the O2 tank; and 2) the patient NOT on the cardiac monitor (interestingly, all ER cardiac/ICU patients come up the same route with a portable cardiac monitor on). . . and 3) the similar number of times incident reports were filed because of #1 and #2. I guess hold habits are hard to break. . . on many levels. . . .

Oh yea, the 1:1 thingy for all PACU patients. . . . sigh. . . . a high percentage of time, rest assured, but not every time. . . . . . . sigh. . .

I'd love to start a forum on small . . . really small rural hospitals. . . .

Cheers!

Ted