What is your hospital's policy regarding Rule-Out MI's? - page 2
I work in a very small rural hospital. . . and we're getting smaller!!! We're in the process of combining the med/surg unit and the ICU/CCU unit so that it's all basically one unit on the same... Read More
Sep 26, '02Joined: May '02; Posts: 399; Likes: 8Originally posted by willie2001
I also work in a small rural hospital.
We admit R/O MI patients to our Med/Surg floor on telemetry if they are pain free and their first set of cardiac enzymes are normal as well as their EKG. If their status changes, they start to have pain or their enzymes go up or their EKG changes, they will go to ICU or transferred to a larger facility for an angiogram. We will not do Nitro drips on med/surg. We will however do IV amiodorone and IV Cardizem on Med/Surg for atrial fibrillation.
How do you not do NTG on med/surg and take amiodarone or cardizem? Why are you doing any of them on med/surg?
The hospital I work at admits all ROMI as 23 hour observation to either the interventional cardiology unit or to the ER overflow if interventional is full. In the ER they use serial cardiac markers--the idea is if all 3 sets of markers are negative there will be no need for serial enzymes q 8 x 3. But we are finding that the enzymes will be positive even if the markers are negative, so we still do serial enzymes on the unit.
Sep 26, '02Joined: May '01; Posts: 12,088; Likes: 15,955You've given me a lot a information which I will share with my nurse manager . . . . after my two week vacation!
As it stands. . . most rule-out MI's are admitted as CCU patients, although many of them could very well have been telemetry patients. I guess my nurse manager is thinking about the times when some of the "Rule-Out's" could have been admitted as a tele patient. . . especially when the hospital is going to cut down the total med/surg/CCU-ICU beds to 15 in about a year's time. If a stable "Rule-Out" is admitted as a telemetry patient and they take a turn for the worse, they will, of course, need to be appropriately re-designated a CCU patient. But with only 4 beds being set aside for this new hospital redesign, 4 ICU/CCU beds can easily be filled. So . . . . what happens when they're filled and we need a CCU because our "rule-out" tele patient "ruled-in" and for whatever reason is now not stable.
Please excuse me. . . I'm just thinking/writing out loud.
Of course, I'm not sure that this new redesign is a good thing all around. However, it seems like it could potentially be potentially dangerous if the hospital decided that, depending on criteria of course, stable "rule-outs" would automatically be admitted as tele patients. For a hospital that wants to be a total of 15 beds, there doesn't seem to be much room for drastic changes in acuity.
Again, I appreciate your collective wisdom. I will convey this information to our restructuring committee.
Sep 26, '02Joined: Aug '01; Posts: 892; Likes: 3Here's what usually happens Ted. If you have the 4 CCU beds filled and the tele R/O goes bad, you can generally switch out the stablest CCU pt.
Re-evaluate and re - prioritize....name of the game in ICU.
Or, Someone calls in a nurse to do 1:1 with the patient who is deteriorating.
Or If they are in the same area, a CCU nurse would take over his care in tele.
Most places go with switching them out..... usually you get at least one out of 4 CCU's that's stable.
Sounds like a good plan you all have going.
Are you going to try for the monitor tech position?
Sep 26, '02Joined: Aug '01; Posts: 892; Likes: 3P.S. CCU is generally pretty quiet once you get the anti-arrhythmics going.... and a little O2 and heparin, etc....
not much action really.
And lucky you...vacationing in this perfect weather.... I am too...in 2 hours !!
Have a wonderful well deserved vacation !!
Sep 26, '02Occupation: CCU RN Joined: Sep '02; Posts: 1,039; Likes: 10okLast edit by New CCU RN on Jan 20, '03
Sep 26, '02Occupation: RN Joined: Nov '01; Posts: 1,418; Likes: 25Ted, I was hospitalized in Dept. last year with c/o CP. The CP was relieved by NTG w/no H/A. I was a 23/hr admit to Med-Surg. Dx: CP, R/O MI. I had a tele pack, serial bloods and serial EKGs. The next mroning I had a Stress Echo that revealed I had a less than 10% chance of cardiac probs. If I HAD been cardiac, the ICU was about 6 doors down, rather like your little hospital.
I can't see tying up critical beds for r/o MI's, unless you have several cardinal s/s. The ER folks generally have a good feel for what is real and what isn't.
Sep 27, '02Occupation: RN Joined: Aug '01; Posts: 2,276; Likes: 42Ted,
The county hospital I work in also has a 4 bed ICU and a general med/surg/tele/peds/ (dump everything floor, but that is a whole other thread ). Anyway our R/O MI's admissions are based on the pt's condition, past hx, labs, ekgs. NTG gtt goes to ICU, regardless. So does Cardizem gtt. If the patient is stable, pain free, and everything else is looking okay they will usually be admitted to M/S. If the enzymes are elevating, chest pain not relieved with Ntg SL, unstable, they will go to ICU. The main problem we run into is one ER physician can be a real jerk and put pts in ICU who could be on M/S and vice versa. (I work on M/S, but help out in ICU as the 2nd nurse occ). I really think this ER doc does it for kicks and giggles. Sometimes if M/S is really busy and ICU doesn't have any pts, some ER docs will tuck them in there for a few hours until all the testing is done or cardiology clears them for tele.
I believe the other factor here is how comfortable is the med/surg staff with R/O MI's? I am comfortable with them, and will not hesitate to have them transferred to ICU if their condition changes. A couple of the M/S nurses I work with aren't as comfortable with these pts and would rather have them in the unit. Is the med/surg staff ACLS certified? Can they recognize changes in the monitor? I am not the best at reading tele's, but I do know the "biggies." Some of this will probably depend on how comfortable the M/S staff is R/O MI's. Let us know what happens.