Stepdown anyone?

[Ari RN, BSN, RN]

Hi:

I don't mean to sound like an idiot but what the heck does stepdown mean?

(ex: Cardiac stepdown or Neuro ICU stepdown)

Thanks

[RN4NICU, LPN, LVN]

Stepdown is stable enough to not need to be in ICU, but unstable enough to still require a close eye. (A 1:4 ratio would be more appropriate than a 1:6-7 ratio, in other words).

Cardiac stepdown usually means monitored bed - Post CABG out of CVICU, post-MI that did not require titrating drips (which would go to CCU), post-angioplasty, that kind of thing. Neuro stepdown may mean that the ICP monitor is out, but the patient still requires neuro checks (don't know, our hospital didnt have a stepdown for neuro). Some stepdown units (particularly trauma stepdown) take care of ventilated patients that do not require titrating drips (titrating drips w/ hemodynamic monitoring, invasive ICP monitoring, and balloon pumps seems to be the most common things to keep people in the ICU).

Hope that helps ya. :)

[Tweety, BSN, RN]

Our neuro stepdown is 4:1 nursing. They are on q2h assessments and vital signs. They aren't intubated, but need to frequent monitoring to go to the regular floor. Right now it's the only stepdown we have. The unit I'm transferring to is going to start up a trauma step-down unit to ease the bed crunch in trauma ICU. Same thing 4:1 ratios, simple drips and no vents. :)

[purplemania, BSN, RN]

Stepdown units can be scary because it is easy to think the patient is on the road to recovery (after all, they were transferred OUT of ICU). But some patients crash and go right back to ICU. Our Unit cares for vent patients, while the regular floors do not. So that is one big difference.

[Ari RN, BSN, RN]

I really appreciate the comments. I understand now what Stepdown means.

Isn't learning great? Thanks again you 3.

[Katnip, RN]

The stepdown I just came from had 1:3 up to 1:4 depending on the acuity of the patient. We had vents, we did cardiac drips that required titrating, though they were a bit more stable than CCU.

We took post surgical patients who were moderately stable, took neuro patients who needed frequent neuro checks. Took in the acute alcohol withdrawals, post-surgical sleep apnea pts, all the DKAs, and stuff like that.