Stepdown / IMU

I work at a medium size hospital and I am in the critical care float pool. Occasionally I float to the intermediate care / stepdown unit. My history is in the SICU so everytime I go over there it is kind of a shock.

It is a 14 bed unit with a ration of 1:3 or 1:4.

Patient's are not on a monitor but sometimes have tele and/or have continuous pulse ox on them. Vitals are done every 4 hours.

Is this normal for other IMU/stepdown units? Patients not being on monitors and only doing vitals Q4

Is there a difference between IMU, stepdown, and progressive care? My facility uses the terms interchangeably.

I just don't think the unit is safe.

Any research or guidelines for IMU/PCU/stepdown units you are aware of?

Are your concerns the patients not being on telemetry, the frequency of vitals, or the patient to nurse ratio? In my stepdown floor we have fluctuating ratios meaning that certain criteria determine the nursing to patient ratio. As far as patients on telemetry we do have the odd patient that is not on telemetry, but those patients are usually from a different service and overflow from other floors. As far as vitals, q4 is our standard. Additionally I don't really see a difference between IMU/PCU/Stepdown, aside from "true stepdown" patients being a nurse to patient ratio of 1:3. Each floor is likely different in their criteria for that though.

I work at a medium size hospital and I am in the critical care float pool. Occasionally I float to the intermediate care / stepdown unit. My history is in the SICU so everytime I go over there it is kind of a shock.

It is a 14 bed unit with a ration of 1:3 or 1:4.

Patient's are not on a monitor but sometimes have tele and/or have continuous pulse ox on them. Vitals are done every 4 hours.

Is this normal for other IMU/stepdown units? Patients not being on monitors and only doing vitals Q4

Is there a difference between IMU, stepdown, and progressive care? My facility uses the terms interchangeably.

I just don't think the unit is safe.

Any research or guidelines for IMU/PCU/stepdown units you are aware of?

Stepdown is going to vary where ever you go. Our SD is a 6 bed unit, which is not enough for our hospital, and is staff by 2 RN's and 1 Tech/CNA. The ratio is 3 to 1 and every pt is on continuous CM and Pulse Ox. Our SD unit has become more of an LTAC before the LTAC which includes a lot of chronic trach vents.

I think IMU/PCU/Stepdown are pretty much the same thing. In my PCU, the ratio is 1:4. Most patients are on tele, and have Q4 vitals. If someone requires closer monitoring than that, they probably shouldn't be in the PCU. We occasionally have Med-Surg/Acute Care overflow -- ratio of 1:5, VS Q8.

I work in the IMCU. It's a 1:4 ratio. Vitals q4. Most patient on tele but occasionally one isn't (usually med-surg overflow, or patients who have stabilized enough and are near discharge). We do some drips (such as nitro, dobutamine, lasix, amio, diltiazem, milrinone) but no pressors. No vents.

In my experience the difference between IMCU, stepdown, progressive care, or telemetry isn't usually significant. But at our hospital we only have the IMCU and a cardiovascular stepdown.

Our levels of care that I'm aware of :

Critical Care: q1h or more frequent interventions. Ratio 1:1 or 1:2 depending on acuity.

Stepdown/PCU: Vitals q2h, labs q2h prn, q2h neuros if needed. Can take Cordis/Introducer but not swan ganz catheters, can titrate low-dose neo, nitro, dopa, insulin, cleviprex gtts, can have arterial lines. Everyone absolutely on continuous telemetry and pulse oximetry. Ratio is a strict 1:3 (my point here is there is HUGE variation between hospitals about what type of tubes/lines/drains/drips are taken on units so a simple ratio/what your intermediate care happens to be called isn't necessarily enough for comparison)

Telemetry: Vitals q4h or q8h, depending on patient/their orders. All on telemetry, can be on continuous pulse ox if ordered, can have heparin/amio/diltiazem/nitro (for CP only, not titrating to BP), neuros/labs/interventions cannot be required more often than q4h. These floors tend to be more loose about letting patients remove heart monitor or other equipment for walks, bathroom trips, etc. Ratio is ideally 1:4, usually 1:5-6 on day shift and 1:7-8 on nights