Post CABG patients

[Brorn]

I work on a cardiovascular unit. We take amiodarone drips, Cardizem drips, heparin, post heart cath, etc. We are now taking first day post op CABG patients and still carrying a 6 to 1 nurse/patient ratio. Is this a standard practice? What is the practice at your hospital?

[Been there,done that, ASN, RN]

It's been awhile since I was a cardiovascular nurse. CABG patients remained in ICU until the chest tubes were removed, and they were off the vent for 24 hours, usually 2 - 3 days. I am surprised the surgeons agreed to move their patient's out so quickly.

It sounds like 6:1 was already stretching it to max. Add a fresh CABG to the mix and it's a recipe for disaster.

Corporate health care is going too far this time.

[Wile E Coyote, ASN, RN]

4:1 max for cardiac stepdown, IMO. The first or first few times a big pt condition change is missed, I foresee the surgeons raining on Admin's parade. Cardiac surgery outcomes are HEAVILY scrutinized. STS dings a surgeon for not meeting POD#1 serum glucose targets...consider what a few 'failure to rescues' do to their stats.

[cleback]

In my hospital, the floors get them with chest tubed and pacertainly wires still in place. The max ratio for days and PMs is 4 to 1. 6 to 1 seems high.

[nutella, MSN, RN]

I work on a cardiovascular unit. We take amiodarone drips, Cardizem drips, heparin, post heart cath, etc. We are now taking first day post op CABG patients and still carrying a 6 to 1 nurse/patient ratio. Is this a standard practice? What is the practice at your hospital?

That sounds too high for the expected acuity.

I worked in several hospitals and the common ratio in those hospital for step down level is 1:3.

I worked on med/surg tele that was basically taking step down patients but they did not label it officially step down unit and got away with a 1:4 ratio - the patients could have cardiac drips and chest tubes but not pacer wires for example.

CABG care has also changed somewhat the last decade with changes in how the perfusionist runs the machine and the standard of early extubation now. But - in total it is still an area where you need to have step down staffing like 1:3 imo to set everybody up for success. The patient has to get out of bed, they have to do IS, pain control, learn how to cough/move after the sternum was opened. There can be complications. For cath lab patients you need to check the pulses, the risk of bleeding....

I would ask the manager why they did not adjust the ratio and if the patient population justifies the creation of a step down unit with better ratios.

One argument is that if the nurse is unable to provide the care that those patients need - the overall outcome could be bad for the patient resulting in less quality of patient care. If management does not change anything make sure that all of you voice concerns in writing if applicable to higher ups and start to keep a running list with problems that happened because of staffing. Also, I would have a low threshold in that case to submit incidents reports to ensure that leadership realizes that problems are happening.

Sometimes the best way to advocate for better ratios is through the surgeon as they have a high interest that their patients are doing well after surgery and are well taken care of.