FenRN

Prior to our director our 1:1 assignments were made up in conjunction with the clinical supervisor or team leaders and the doctors. Agreeably this means some "softer" patients may be made 1:1 but if there's even talks that a patient should be it's worth considering. We have the acuity tool our director put out that we use now but it never went through any committee or approval before she wheeled it out. Under the current one a patient needs to be on 4 gtts being titrated frequently to meet 1:1 status basically (for standard ICU purposes, CABG post-ops, certain procedures etc are still 1:1). Under this acuity though we've had a patient on a rotoprone and CRRT that was 2:1 which is kind of scary and ridiculous. Back to the hemodynamically unstable...that's what she's trying to have us come up with a definition as it's a term used in her acuity that isn't clearly defined in lots of cases (other then 4gtts being titrated but I think that's setting the bar a bit high personally). She won't really budge unless we have a source saying it can mean less then that and that's the trouble I'm running into is many different places/organizations use the term but don't clearly define it (it is hard to define and varies from patient to patient so I can see why) but it leaves us in a bind with this staffing acuity that's just way out of whack. We had a nurse a month ago with a rotoproned patient who required to be taken off and bagged multiple times with a donor patient who required very frequent interventions. Well thanks all for the help.

Hello all, My unit is re-doing our 1:1 criteria (new director). The director wants us to help with this and there's been debate over an exact definition of hemodynamically unstable. Some bring info from the SCCM, some AACN, ASA, etc. She's doing this for our all of our units as well which adds some barriers as we have a Trauma, Shock, Medical, Cardiac ICU and each of those patient populations can come with their own definitions of instability that don't necessarily transfer over to another population. Has anyone gone through this type of remodeling or does anyone know of a source for a pretty inclusive definition of hemodynamically unstable? (we suggested that we should just gather the info, meet with out medical director and come up with one that we can all agree on but apparently that's not going to happen...it's been rather frustrating to say the least haha). Thanks for any help or suggestions.