Pediatric General Floor Criteria

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Hey guys! I feel like the unit that I work on is constantly pushing the boundaries of what is safe for our Pediatric patients. It is a general pediatric floor. It is NOT a Children's Hospital and has very few specialties available to consult for patients. The closest Children's Hospital is an hour and a half away.

If you are a peds nurse in a PICU, Step Down, or general floor and have established criteria for what is permitted on the floor would you mind sharing what your hospital allows? I keep asking for something in writing that gives specifications on when a child should be transferred to a higher level of care (Intermediate Care, PICU), but I'm getting nowhere.

Some examples...are the following allowed on your floor?

Kids needing chest tubes (no pulmonologist that sees kids and very limited surgeons willing to see children)

New onset diabetics (no diabetic educator available)

Respiratory distress/high flow nasal canulas/oxygen limits before transfer

Neonates with respirations around 100 with RSV

Infants with Pertussis and periodic apnea

Ect...

Just trying to get some concrete boundaries for better patient safety. I have had to transfer 4 kids in the last 3 days that I felt weren't stable enough for the floor, but feel it's so often a battle with pediatricians. Thanks for your input

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