Should this patient be in ICU??

[TigerGalLE]

Hello everyone. I work on a med surg floor. We usually have 6 patients per nurse. Today I was receiving a patient from another medical floor in the hospital due to the fact that the patient would be on an insulin drip. My medical floor accepts insulin drips for some reason. The only floors that accept insulin drips are ICU, CCU, telemetry, and my med-surg floor (we are actually renal/respiratory).

So when a patient is on an insulin drip they get Q 1 hour SQBS checks. This patient was admitted yesturday to that medical floor because she came into the ER via ambulance with a SQBS of 13 and was unconscious. She was recently discharged from the hospital 1 week ago after a long complicated hospital stay. She was in the hospital previously with UTI with group D enterococcus sepsis, diabetic ketoacidosis, GI ileus which resulted in a colostomy and an MI. This go round she was admitted with UTI and hypoglycemia. Apparently she is a very brittle diabetic and today her blood sugars where in the 500s. Due to her high BS they wanted to put her on an insulin drip. She was also growing gram neg rods in her urine, her BP was running 100/50, her PT was >63 INR > 6.8.

Anyways I tried to fight this transfer. Asking them to please send the patient to ICU due to being transferred with 3 pages of orders including 3 units FFPs, NS bolus of 1 liter, Mg bolus, insulin drip with Q 1 hour checks. They said she was too hemodynamically stable to be in ICU... But to be put on a med surg floor when I have 5 other patients? She was already oozing from her central line site and her previously stuck sites. She was slightly hypotensive and when she got on the floor i never even had to start the insulin drip because when I checked her sugar it was 123. All the insulin they had already given her was catching up with her..

I know they say she is "hemodynamically stable." But if there is an ICU bed, why not put her there where she can be closely monitered?? I know her sugar will bottom out tonight. Am I wrong in this situation? I just feel like she was a ticking time bomb.

Tiger

[leslie :-D]

the charge couldn't have taken this pt?

leslie

[NurseyPoo7]

the charge couldn't have taken this pt?

leslie

Ha, tell that to my unit.

The other day (Yes, DAY shift) I worked and we had 3 nurses on our unit, 15-17 patients on our census, I think... one nurse had to be charge, and she had her own group. Plus, we are supposed to be doing primary care with 5-7 patients!

[leslie :-D]

Ha, tell that to my unit.

The other day (Yes, DAY shift) I worked and we had 3 nurses on our unit, 15-17 patients on our census, I think... one nurse had to be charge, and she had her own group. Plus, we are supposed to be doing primary care with 5-7 patients!

no, i certainly understand that many cn's have their own workload.

but-

there are some who stay stuck to the nurse's station and could feasibly take on a pt or two, in a pinch.

so, i'm just asking...

not expecting.

leslie

[NurseyPoo7]

no, i certainly understand that many cn's have their own workload.

but-

there are some who stay stuck to the nurse's station and could feasibly take on a pt or two, in a pinch.

so, i'm just asking...

not expecting.

leslie

Oh, I see what you were trying to say. I thought you were responding to someone who earlier had wrote the charge should've taken it. I thought you were saying the charge nurse shouldn't/couldnt have taken the pt.

Sorry!

[Ahhphoey]

I think this patient would have been in ICU at at least one of the 2 hospitals I work at. One hospital does not have a real stepdown unit as it is just opening and they haven't trained any stepdown nurses yet. We get these types of patients all the time in the ICU at that hospital. The other hospital is a Level 1 trauma center with multiple stepdown units along with 1:3-4 staffing ratios. I think there is a good chance that patient would have been on a step-down unit at that hospital. Also, I've worked at several hospitals and all of them allow insulin drips on regular floors; it just depends on the particular order set used. Either way, seeing as the OP does not have a step-down unit at that hospitla, that patient should have been in ICU.

[BelleKat, BSN, RN]

There wasn't anything stable about her,she just got bumped out of the unit by someone else.She might have been the most "stable" one in the ICU but she wasn't appropriate for a med/surg floor by any stretch of the imagination.

[Reno1978, BSN, RN]

That patient doesn't sound appropriate for a medical floor. Especially with q1h fingersticks. When are the other patient's going to get some attention?

My one pet peeve about Insulin gtts is having to do q1hr glucose checks. I think its pointless. q2hr is enough. Why constantly chase the the blood sugar. In my ICU we never do q1hr, its always q2hr

I thought the exact same thing. Although, we do have one insulin protocol that does change to q1h checks, but it's only when the blood sugar drops below the desired range and it's only until it's back in range and it goes back to q2h.