Step down differs from Tele..How?

Specialties Cardiac

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Hi all,

I got a position at a Tele unit but some times it was referred to a step down unit. I thought it was was not the same. Can some one please tell me the exact difference though? Thanks so much:heartbeat

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Specializes in Cardiac Telemetry/PCU, SNF.
Hi all,

I got a position at a Tele unit but some times it was referred to a step down unit. I thought it was was not the same. Can some one please tell me the exact difference though? Thanks so much:heartbeat

I guess in some places it is semantics, except I've never thought it so. As an example, here's what we have. Upstairs is a 20+ tele unit, down is a 20+ step down unit.

Tele Patients: post-pacer, medical needing cardiac monitoring like a-fib after surgery, renal pts. with high K, stable CVAs, CHFers needing a tune-up. post-CABG sternal wound infections, GI bleeds, plus anything else they want to throw our way, 'cause, "they need tele." 4:1, team nursing concept, jokingly referred to as "nursing home tele".

Step-down: fresh hearts - usually POD 1, post-PCI w/wout intervention w/wout sheaths, EPS, complex medical/surgical patients, unstable arrhythmias, evolving MIs, CVA, anyone on a non-titrated drip (kind of a misnomer, but for argument) and soon BiPap and home/stable vents. 2-3:1 primary nursing, usually sicker than upstairs, but in our case, more cardiac focused.

In theory, step-down is for folks who no longer need ICU (or in our case, no longer sedated, paralyzed and intubated), but are not quite ready to be on a regular floor. Usually they have a higher acuity, lower ratios and sicker folks. Granted, this is a lot of generalization, but from what I've seen and heard, it seems to ring pretty true.

Hope this helps.

Tom

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Specializes in MPCU.

At my job, they call us a step-down unit because we float to the CCU.

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thanks:up:

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Specializes in ER, ICU, Neuro, Ortho, Med/Surg, Travele.

I'm sure that that it differs from region to region or even hospital to hospital. I has been my experience that it dependes on what if any drips and be hung, if they can be titated, and if the patients are on remote tele boxes or on monitors. Too often I think that really doesn't matter, an open bed is an open bed. How often is the acuity of the patient taken in to consideration? I my most recent facility, physican will admit to CCU or ICCU(our stepdown) because they don't want to get phone calls over what they consider little things. Very often nurses from over floors get pulled to our stepdown unit and they hate it. They are uncomfortable with the acutiy of our patients. All we can do is be supportive and help them as much as possible.

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Like others have said, it seems to vary from region to regon. I have been working ona "step-down" tele unit for 3 months now. I am told the difference between us and the PCU (progressive care unit) is that we can't hang certain drips.......we can hang cardizem, but I think the one we can't hang is dobutamine? Could be wrong.....I'm a failry new nurse..............just over a year now. We can titrate cardizem down, but not up. there are a few other things we cant do but really the drips is the biggest difference between the units. We can any patient that "needs tele." We even get nosebleeds!!!!!!!!!! Ya...the doc wants to monitor his heart for 24 hours! Mostly we get the CHFers, pneumonia, AMIs, etc.........I love it but it is crazy busy! Our average stay is 2.5 days..........constant transfers to med-surg and admissions, occassionally transfer to ICU.......learning alot

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