Published Oct 2, 2001
I work in a community hospital in Pediatrics... we get some very inappropriate adult (over flow) patients whether our peds census is up or down- all depends on the rest of the hospitals census what they do to us... is there any regs protecting the children of what kind of adult patients can be there? I live in NJ... Was wondering what kind of guidelines others have tht take over flow adults... I have read some on here already but wanted to see if there are any regulations I can take back to my job......
It's a great question and I am sorry to say that I do not have an answer for you but only another question.
I work on the cardiac ward at a pediatric hospital which will soon be doing the occasional adult heart surgery. These surgeries will be done to repair congenital heart defects (replacing parts or repairing missed or previously done heart surgeries from childhood). I'm trying to keep an open mind; however, I am finding this difficult to do.
My biggest concerns are: how this will be received by the children's families, and most importantly, child safety. I know if my child were on the ward, I would not want an adult sleeping in the same room. I may be overreacting but there are a lot of pedophiles and disturbed people out there. Who's going to watch these children? Many parents do not stay with their child and I'm not able to sit with my patients continuously for 12 hours.
I also think that an adult recovering from heart surgery would not want to share a room with crying babies or energetic toddlers.
My question to you is: with the exception of your inappropriate adults, how effective/ineffective is having children and adults on the same ward at your health care facility, and how is it received by all parties (parents, patients and staff?
Also, do they share rooms or do the adults get there own room?
Unfortunately, we do not have the space or funding to provide private rooms for the adults.
I hope you have found an answer to your post, and if I hear anything regarding liablity etc, I will let you know. I would also appreciate any comments to my posting.
I don't know the regs either, but I also was working on a Community Hosp. peds unit when I got a VERY inappropriate patient about 3 years ago. It was summertime, and we had a low census. The ER reported that this 79 year old woman they wanted to send me simply had a fever and was slightly anemic. Well she came over with O2, horrible-sounding lungs, disoriented,etc etc. I told the Nsg Supervisor that I was not comfortable having such a patient on my unit and that I felt something more was wrong with the patient. She didn't give me much room to argue, and I was a new grad, so nothing happened. I got off 4 hours later, and when I came back that night I found out that she was now in the ICU in CHF. This patient died 2 days later. !!!!!!!
Our pediatric unit has private rooms for the kids and some semiprivate rooms that adults go in or teenagers or if need the rooms for more children... never do we mix a child with an adult ... the parents of the children do not like that we have adults on the same floor (nor do we) the adults are very demanding and take away form our kids... I know with the low census of pediatric admissions that adults need to be to a degree but it doesn't stop when we have kids, we still get sent adults...
We are no longer able to accept adult pts on our peds unit that have MRSA or VRE. A peds pt that was only a few days ols accuirred one of these infections.
Welcome to the jungle
I've been in nursing for over 20 years, and haven't found anything about "regulations", as this is pretty institution-dependent. Our PICU really has a battle with this, as they are connected to the Burn unit (which takes all burns regardless of age, pedi burns do not go to PI), which is connected to the SICU. Traumas get admitted to SICU, teens go either to PICU or SICU depending on surgeon preference and bed availability. If PICU is not full and admissions needs an adult bed, guess where they go? At another Level I center in the city, PICU does NOT EVER take adults--period. (Which is how I think it should be). Last winter, RSV and other illnesses were very rampant in this area, and we had peds. cases spread all over the hospital:eek: That was quite an experience for everyone involved--hope this winter is not quite so crazy.
We had a brief interlude a few years ago when a new nursing manager set her foot down and told administration PICU would not take adult patients. At that time, the unit was in a different area of the hospital than it is now; when the new unit was built as an extension of SICU and Burn, the gig was up. Also, that manager has not been with the institution for quite some time; the subsequent managers since then were not as successful in keeping the same demand.
I'm sorry I don't have any good suggestions, but thought you'd like to know you weren't alone.
I currently manage a mixed unit of pediatric and adult inpatients and outpatients. The adults we accept are mainly surgical, and of low acuity. Our unit standards states: "Due to 3 Tower's primary patient type (pediatric) and smaller number of staff, it is necessary to assign combative, agitated, disoriented/confused, demented, destructive and/or aggressive adult patients to another unit." Although it is not written in our standards, we don't accept adult patients with greater than one system problem, or if they require more than one nurse for activity. We are very aware of our limitations for adults due to number of staff, our competencies, as well as having pediatric patients nearby (Our peds are down a separate hall).
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