ICU or stepdown?

[Gldngrl]

Immediate postop pt on Nipride, maybe Esmolol, IVF, IVF replacements for urine, VS q 1 hour, assessments q 4hours, urine output q 1hr and replacements, on monitor, CVP, 40% 02 Face Tent maybe an A-line...question for acuity and patient staffing purposes, is this patient an ICU or stepdown pt? What would this person be in your facility? Thanks.

[K O'Malley]

Definitely ICU!

[rollingstone]

Post-op what? Usually a nipride gtt, A-line, and q1h VS with CVP's would go to ICU where I'm at. Along with all of the IVF replacement to match urine loses sounds like a pt.

[rollingstone]

Meant to say sounds like a busy pt.

[zambezi, BSN, RN]

ICU at my hospital...we wouldnt have nipride, the aline, cvp on the floor at all.

[Elenaster]

Sounds like ICU all the way to me. Nipride gtt, CVP, a-line are all indicators, but the q1hr VS, q1hr UOP, and q4 assessments sounds like too much for a nurse with 3-4 patients.

BTW- a nipride drip would require q15min BPs at my facility.

[Gldngrl]

Thanks for the replies so far...where I work, it's considered a step down pt with a 1:3 ratio and I'm arguing that it's an ICU pt and should have the ratio of 1:2. Just needed validation from other places. Thanks again.

[Tweety, BSN, RN]

ICU here too. Anything that has to be monitored q1h is ICU material IMHO. Our stepdown is q2h. The gtts are a factor too, our stepdown only does certain drips, nipride not one of them. I guess they are thinking since the person isn't ventilated they don't need ICU.

[Gldngrl]

Tweety, if your facility stepdown pts are VS q 2hr, what are the patient ratios? What kinds of gtts does your stepdown have (esmolol, insulin, PGE, fenoldopam, lasix, heparin, ntg?) Thanks

[allele, LPN]

Definite ICU patient in our facility. On the stepdown I work in, we don't do nipride, A-lines or CVP, we do plenty of other gtts, dopa, dobutamine, heparin, insulin, esmolol (although not often, just not a drug our hospital uses much), lasix, etc. A while ago SOMEONE somewhere made the suggestion that we take patients with neo gtts, that did NOT go over well however and was shot down pretty quickly. But the patient you described is an ICU patient all the way, wouldn't be fair to the patient to put them on a unit that can't watch them the way the ICU can. :)

[RNKPCE]

ICU. The only unit that does the drips you mentioned as well as the frequency of vitals and other measurments.

[TiffyRN, BSN, PhD]

I've worked several hospitals and the one where there was a Stepdown it didn't take any drips that required titrating (renal dopamine was fine) and no invasive monitoring (such as swans & A-lines) so the patient you described would be an ICU patient.

However. . .

The last hospital where I worked tele had no stepdown so that patient would have been ICU for sure but. . . It wasn't unusual for there to be several 3 patient assignments in the ICU so there's no guarantee that patient would have been in a 2 patient assignment.