Higher patient load, higher acuity, and adverse events

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I work in a 30 bed Progressive care unit with 10 of our beds being licensed for ICU patients. Our administration has been proposing increasing our nurse to patient ratios from 1:3 to 1:4 or even 1:5 at night and on weekends. As of now, we are lucky to have 8 RN's and 2 CNA's on days and 7 RN's and 1 CNA that doubles as our clerk at night. We share an RT with 3 other 30 bed units at this time, and sometimes a physician can be more than 30 minutes away from the bedside due to ER needs and other floor needs. Our patient population's include but aren't limited to CHF exacerbation, COPD exacerbation, Acute SIRS patient's, Acute GI bleeds, HTN crisis with drip titration (Nitro, Nicardipine, Esmolo), patient's in acute NSTEMI pre and post cath, POD 1 open hearts, we are the overflow for the Neuro and Burn ICU, we get many surgical complications DOS or POD 1 patient's with o2 general requirements up to 60% FIO2 and to 100% for up to 8 hours or even continuous BIPAP, vascular emergencies on heparin or argatroban pre and post op,LTC vent patients (with stable trach), we see many drug and ETOH overdose patient's that "Bare close monitoring," acute and chronic liver and renal failure patients, and our bread and butter seem to be insulin drips (acute DKA and HHNKA). We also routinely have at least 1-2 cardizem or dopamine drips on the floor at any given time. All of our patient's are on Tele, but we do not have a monitor tech, so we are responsible for also being aware of the monitors at all times. Our charge Nurse position is being phased out, and even they are taking 3-4 patients every shift at this time. Has anyone seen any resent research regarding increased CAUTI, CLAB, SSI, VAPS, falls, readmissions, or sentinel events related to increasing patient ratios and increased acuity? I'd like to be able to review and discuss this literature with our administration to help support our adverse feelings about proceeding with the ratio increase.

Specializes in Critical Care; Cardiac; Professional Development.

Time to go.

As far as charting the actual number of times a doc is called/paged, there is no need to spell it out so bluntly. The time given already does this.

1630 - Paged Dr X re: potassium level of 6.4. Awaiting return call.

1648 - Paged Dr X Re: potassium elevation. Awaiting call back.

1712 - Paged Dr. X re: potassium elevation. Charge nurse Nancy Nurse notified of elevated level and inability to reach Dr X. Alternative number provided and call attempted. Message left requesting return call.

1724 - Vfib on tele noted with conversion to asystole. Code Blue enacted. Message left at both numbers for Dr X. Patient transferred to ICU Bed 6.

2100 - Dr X returns call. Updates on patient condition and changed location provided. Call transferred to receiving nurse in ICU.

blah blah blah. Obviously these notes would be more detailed. Just trying to provide an example that the number of calls and timeline is easily followed without the implied criticism overt numbering communicates. The more factual and objective your notes the less likely it is you can be found liable in any way.

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