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 nurse
atient 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.