I recently cared for a patient whom was induced in a pentobarb coma while currently on vec. This was a very sick patient.
I'm curious of other hospitals standards for patients in a pentobarb coma, or a patient with a vec gtt. We have standards of care as to how to induce the coma etc., but I'm curious as to if anyone has standards of patient to nurse ratio?
Does anyone here know the standards of care for ICU patients requiring pentobarb comas? I curious as the general census of other hospital ICUs and how they accomadate nurse to patient ratio.
Jun 11, '09
Maybe I wasn't effective in my communication during my original post, which is my fault. On a very simple level I'm curious how hospital ICUs/SICUs/MICUs staff for patients requiring Pentobarb Coma? Currently we tend to maintain a 2:1 ratio, do any hospitals maintain a 1:1 staffing ratio with these patients? I'm having trouble finding the standard, if any, and would even be interested in a link or any information that might guide me in the right direction.
Last edit by standout22 on Jun 11, '09
: Reason: typo
Jun 13, '09
We do 2:1, but we also do 2:1 for CRRT and IABP (albeit the second patient will be "easy.") It is a very rare patient that becomes 1:1 on our floor.
Jun 13, '09
Without some sort of acuity system to measure how much nursing time is being spent on each patient I don't think you can automatically assume, based on one therapy alone, that a patient does or does not require 1:1 nursing care. Pentobarb therapy would include mechanical ventilation so their score would be high and they might need 1:1. As far as CRRT and IABP they might be stable or they might require multiple blood transfusions, electrolyte replacement, inotrope titration, frequent lab draws and other things that would drive up their acuity score. 1:1 is all about acuity.
Jun 14, '09
IMO, as the nurse is responsible for running CRRT and IABP, and as I have never had a CRRT pt not ventilated, and always with electrolyte replacement protocols, etc, it should automatically be 1:1. Are there pt's on CRRT who are not sick? I can't imagine. We only use it when normal dialysis is impossible.
With IABP, at least in our unit (MICU), it's used so rarely, that none of us are comfortable with the machine and spend a good deal fretting. Honestly, we should either see it more than 5 times a year, or have all of them go to SICU, where they normally deal with IABP. It's used on MICU for large MI's mostly, and alsmot all of them are in cardiogenic shock. Not stable.
Jun 18, '09
we don't make pts on pentobarb comas 1:1 automatically no.
work in a busy trauma unit...and sometimes the pts are so sick we have made them 2 nurses to 1 pt!
crrt is always 1:1 in places i've worked
balloon pumps are 1:1 where i've worked, but i'm not sure if this is the norm, not a heart nurse...
Jun 19, '09
The vec patient would still be 1 nurse to 2 patients.
We do 1 nurse to 2 patients with our CRRTs unless it's citrate SLED and then it's 1:1. Our balloon pumps are no different, 1 nurse to 2 patients.
Jun 19, '09
Pent/phenobarb coma does not automatically make a 1:1- nor does vec(most of our intubated pts are vec'd) depending on how "stable" the pt is- they are still 2:1.
On a side note- I think I have only had 1 pt on CRRT not a 1:1- tumor lysis kiddo extubated sittin up in bed talking to me. All baloon pumps are 1:1.
Jun 20, '09
usually if they're paralyzed they're pretty sick already and would already be a 1:1. but most of our post ops are 1:1 intially anyway. CRRT is definitely 1:1. Usually our 2:1 patients are either very stable or ready to be transferred to the floors.
Jun 22, '09
Appreciate the replys. In the hospital I work in we only have 1:1 with CRRT, no other expectoins.
Jun 25, '09
IABPs and CRRTs are definitely 1:1 In addition, codes (only the shift that they coded) are 1:1 and pts who are on hypothermia protocol are generally 1:1-at least for those first 24 hrs of induction.
Jul 2, '09
A pt sick enough to be in a pentobarb coma would always be 1:1 in my unit. Those are the pt's that often get sent for multiple CT's, or require finer tuning as far as their care and physiological controls.
We're 1:1 for most of the sicker patients as it is, though. Pt's that are 2:1 tend to be the ones that are in the recovery/ upswing phase - need to wean off the vent but otherwise less complicated. Pt's with active titrations of pressors, hemodynamic instability, etc would not very often be less than 1:1.
Jul 12, '09
Hospital policy- Pentobarb, IABP, CRRT are all 1:1. They make up the difference in staffing by using resource nurses if needed.
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