My unit is re-doing our 1:1 criteria (new director). The director wants us to help with this and there's been debate over an exact definition of hemodynamically unstable. Some bring info from the SCCM, some AACN, ASA, etc. She's doing this for our all of our units as well which adds some barriers as we have a Trauma, Shock, Medical, Cardiac ICU and each of those patient populations can come with their own definitions of instability that don't necessarily transfer over to another population. Has anyone gone through this type of remodeling or does anyone know of a source for a pretty inclusive definition of hemodynamically unstable?
(we suggested that we should just gather the info, meet with out medical director and come up with one that we can all agree on but apparently that's not going to happen...it's been rather frustrating to say the least haha).
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
When I first started in the Level II Trauma/Surgical/Cardiac ICU. Anyone on an IABP was to be 1:1. Anyone on CVVH was 1:1, FRESH post-op Open hearts were 1:1 the first 12-16hrs. NOT anymore. My last shift there, I had a pt with BOTH an IABP AND on CVVHD!! they were doubling up ballon pump pts and CVVHD pts.
Sometimes, I'd have THREE pt's with one on a balloon pump!! One night my IABP pt rolled OUT of bed! Why? because I was settling my THIRD patient, a fresh MI who was life flighted to our facility from an outlying hospital...the IABP pt was down the hall where I couldn't keep my eye on him...that was common. Hey, I'm human, I can't be in two places at once...luckily balloon pump guy was ok. Im glad I don't have to deal with that kind of stress anymore!
Specializes in Surgery, Trauma, Medicine, Neuro ICU.
Our only "hard" 1:1 are CRRT, IABP and fresh heart for the first 6 hours. That one time we did the guy on ecmo and nitric (niiiiiiiiightmare!!!) he was a 1:1. Our soft 1:1 are brand new organ donors (like, first 4 hours when you're hanging a million drips, sending a million labs and doing a million procedures), bad trauma/sepsis/fail patients. Like bad. And even then...you probably have another patient that someone else is watching for you.
For perspective- I'm in a 36 bed mixed medical/surgical/trauma/CV/neuro ICU at a level 1 trauma center in a large city. We see some jacked up stuff. It's awesome!
Esme12, ASN, BSN, RN
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