Long term care in PICU

[nurseiam]

We usually have at least one long term resident in our PICU. I am wondering if there are any facilities out there with policies specifically for these patients. We still have nurses that will do q 2 bp's, wake a sleeping baby up for an assessment, RT's that will wake a chronic baby up for trach care..... Thanks

[NotReady4PrimeTime, RN]

On our units there are no hard-and-fast rules. Some of the intensivists will write orders that decrease the frequency of assessments and vital signs but there are a couple who believe that if the kid is in the PICU/PCICU then they are PICU/PCICU patients and require PICU/PCICU-level care. Even when they're not chronically-critical, but are in that there's-no-beds-on-the-floor limbo.

I snickered to myself when I read the "q2 BPs" and I hope you don't take offense... I've lost count of the number of times I've taken report from somebody then gone to check my monitor settings to find that a totally stable, floor-ready, de-lined kiddo is having his BP cuff cycled q15 minutes. The horrified looks I get from some of the attendings when I ask them, "Can you think of any really good reason why Joey in Bed 5 needs his BP monitored q15 minutes? Something I missed in report?" Sadly, I think it's what comes from having new staff oriented to the unit by someone from the group that just finished their own orientation. Eventually the common sense and critical thinking are both lost. Oh, and God help the RT who wakes up a sleeping child for something that can wait.

Sorry I didn't answer your questions...

[meanmaryjean, DNP, RN]

My favorite is the night nurse that checks PUPILS every two hours during the night shift on a chronic kid who's waiting for placement or for home care to be set up. Are you kidding me????????

Sorry, I didn't answer your question either - just the lack of common sense amazes me.

[umcRN, BSN, RN]

We don't have a vent unit so all our long term kids (who usually are trached/vented) stay with us. We just celebrated two first birthday's back to back actually.

Now assessments and monitoring are pt and acuity dependent. If the kid is stable and working on transitioning home then no, usually a doc will write an order for q4 blood pressures, assessments etc. but if that same kiddo comes down with RSV carried in on a family member and gets really sick then standard ICU monitoring will apply. All depends on the acuity of a pt.

Typically though all our kiddos only get hourly vitals unless very unstable, so a kid going to the floor within the next day or two will still get q1 vitals but most people wouldn't wake a stable sleeping toddler in the middle of the night to look at pupils, common sense!