Med Surg Unit Admission Criteria

[kprussner]

I am working on a med surg telemetry unit and we are having a lot of issues with patients being admitted to our floor from ED (or transferred from other specialties) who are inappropriate for our unit. Example- DKA with a blood glucose of 700 who ended up in CCU on an insulin drip within 5 hours of admission to our floor. Another example would be someone who was receiving so many blood products they essentially became a 1:1 patient.

We do not have a union but we have a unit based counsel which I am apart of, and our manager asked the unit based counsel to come up with an admission policy including what we think is appropriate admission criteria for our unit. with lab value parameters ect.

I am looking to see if anyone has med surg admission criteria from their hospital that they would be willing to share for reference?

[Nurse Beth, MSN]

I am working on a med surg telemetry unit and we are having a lot of issues with patients being admitted to our floor from ED (or transferred from other specialties) who are inappropriate for our unit. Example- DKA with a blood glucose of 700 who ended up in CCU on an insulin drip within 5 hours of admission to our floor. Another example would be someone who was receiving so many blood products they essentially became a 1:1 patient.

We do not have a union but we have a unit based counsel which I am apart of, and our manager asked the unit based counsel to come up with an admission policy including what we think is appropriate admission criteria for our unit. with lab value parameters ect.

I am looking to see if anyone has med surg admission criteria from their hospital that they would be willing to share for reference?

Rather than getting locked into specific values and lab parameters, frame it from interventions, acuity and workload.

Here's some examples that exceed MedSurg resources:

Titrating drips, assisted ventilation

Medications not typically given on MedSurg (chemo infusions, vasoactive IV meds)

Interventions > q4hrs (ex., hourly FS, VS, I&O, lab checks)

Unstable GI bleed

Patient with cardiac dysrhythmia that required intervention within last 24 hrs (chronic ectopy OK)

Patient on continuous Bi-pap or Vapotherm

Patient who is declining or at imminent risk of declining

Basically you should be caring for hemodynamically stable patients requiring intervention or assessment not > q2-4 hrs.

Ask your manager for the acuity tool currently used. Med staff will probably need to approve the policy and admin will need to back you up. Consider "negotiating" i.e. if fresh continuous bladder irrigations are admitted to your unit, establish a 1:3 ratio for first 24 hours.

Hope this helps stop the madness :)

[BedsideNurse]

Most inappropriate nurse-patient ratios or inappropriate floor scenarios boil down to bed control/lack of beds and it's basically "too bad" for nursing--and the patient. Parameters can help, but there's a lot of subjectivity and judgment involved so generally if there is a will to get the patient up, there's a way to get them there. We are struggling in CCU with tripling up patients and doubling up when a patient is a 1:1. It's dangerous, and over time it sucks the life out of staff. Good luck where you are.

[Guest374845]

You really ought to be asking why IM or the hospitalist (or whoever manages your floor patients) admitted them to their service in the first place.