mini unit with many issues

[CCPam]

Hi Everyone,

I'd like to bounce this one off of you all and see what your suggestions are.

Since June 06 we have "inherited" a 4 bed mini "icu" that is a satellite from our 9 bed unit Neuro icu. There were several issues brought up to the administration before we moved in and the list of concerns keep growing! Here's just a few of the concerns.

We are budgeted to staff with one icu tech, who also doubles as the clerk...their role is complicated by the work of 2 jobs and only 2 other RN's to help. I can't imagine how they (the techs) cab do either job well, especially in a code situation! The unit is a good 100 yards around the corner and down the hall. If an emergency comes up then the charge nurse is responsible to come down and help (no assignment). It is customary to move the sicker patients to the main unit (unneccessary moving of patients and utilization of housekeeping to clean those rooms) for improved monitoring and support from ancillary staff. Often we don't have even emesis basis for patients with post of nausea and vomiting. I was told there wasn't room for them! I responded...I bet housekeeping will love patient's barfing in the garbage can! Also, there is 1 bathroom to use as a hopper and for other ambulatory patient's to use. The unit is super small. Often patient's families cannot even stay in the room with a vent, CPAP or CCTV-so, they sit in the aisle--it literally only fits one person! The rooms are divided by curtains, no walls or doors and is extremely noisy just with normal conversation...imagine the patient going through delerium tremors screaming and call you every name in the book! Would it be a hippa violation as the patient next to you can hear doctors/team rounds reading vitals, discussing diagnosis, etc. Ok, I'm hoping you get the idea. What are your ideas about this? We have a "town hall meeting" in Jan. with the chairman of the neurosurgery department and I'd like to be ready for it! I'd like to see this unit be turned into more general care beds!

Thanks again for your insights!

CCPam

[DDRN4me]

My sil was recently in a similar unit. we were fortunate that he had no roommate for most of his stay. While the care was absolutely wonderful; the space was an issue. if he had more than one visitor ( almost died so there were many) we were encroaching on the hallway and the next bed space. had he been vented it would have been worse. I am not sure if there was anything that could have been done to alleviate this.. I think that the unit was just originally a couple of double bed rooms and a closet; I think that if another one was built it should have more private rooms ; you could hear the team working on any one of the four pts in both sides at any time; as well as conversations with docs, etc.

hope this helps a little!! sometimes the pts perspective helps advocate for what you need

Mary

[Zookeeper3]

We had an open bay unit (small 7 beds). We couldn't have any family during shift change because they'd hear everything. Maintaining isolation (contact, enteric) was marked with masking tape on the floor. Family members did hear everything, for sensitive times, we rotated family so they did not overlalp. supplies were in a closet a bit down the hall.

It was a challenge. The one tech was also a monitor tech and secretary (jack of all trades). Just the same, a nurse from another unit assisted in a code.

This was cardiothoracic surgery. It worked in this crazyness, we didn't know better untill we moved to a real unit. It can and did work. good luck.

[RNperdiem, RN]

I'm guessing that this unit is from another, much older era. An era of not enough, or oddly placed public sinks, patients divided by curtains, a lack of toilets and showers, lots of wards and semi-private rooms, nursing stations not big enough to do charting in with all the space the computers have eaten up. It is difficult to renovate, and I mean really renovate old spaces for various engineering reasons.

The nurses working in newly built buildings and additions should count their blessings.

[Ahhphoey]

I would hate to work in an environment like that. No offense. I've only been in ICU for about 2.5 years and all the units I've worked in have all private rooms, so I had not idea any ICU would be set up like you've described. I think protecting privacy and preventing the spread of infectious diseases would be your greatest arguments at the town meeting. I've seen patients literlally squirt liquid BM across a room when trying to get on a bedpan or to the commode as well as blood, uring, emesis, and whatever other body fluid splashed all over floors, curtains and even the ceing on several occasions. That is just disgusting to have critically ill patients in rooms separated by curtains only. Honestly, I don't even like the idea of semi-private rooms in general. Also, not that this is the biggest deal, but I would hate to be a patient there and have to smell...well, you know smelly things from the other "rooms" or have them smell my indiscretions Good luck with your town meeting though. It's been proven and written about, though, that when patients are more comfortable and content, stress decreasees and thus promotes healing.