Harbor:Right level of care: Difference between revisions

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===RIGHT LEVEL of CARE===
''These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment''[[:File:1 - Right Level of Care Flowchart final 2018 tabloid view.pdf]]
These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment.  [[:File:1 - Right Level of Care Flowchart final 2018 tabloid view.pdf]]


* Observation
==Observation==
** Goal of our observation unit is admission avoidance
* Goal of our observation unit is admission avoidance
** All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs
* All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs


* Ward
==Ward==
** Unmonitored
* Unmonitored
** Stable Patients
* Stable Patients
** Nursing interventions q4 hrs (vitals, labs, POC testing)
* Nursing interventions q4 hrs (vitals, labs, POC testing)
** Chronic CPAP or Nasal BiPAP (with pulm fellow approval)
* Chronic CPAP or Nasal BiPAP (with pulm fellow approval)
** Palliative/comfort care admissions, including vented comfort care patients
* Palliative/comfort care admissions, including vented comfort care patients
** OK on ward:  NG tube, chest tube, peritoneal dialysis
* OK on ward:  NG tube, chest tube, peritoneal dialysis
** Meds:  Ativan IV q6, Bumex, CaCl, digoxin IV, Dilantin IV, Dilaudid IV, heparin IV,  Lasix, potassium IVPB  
* Meds:  Ativan IV q6, Bumex, CaCl, digoxin IV, Dilantin IV, Dilaudid IV, heparin IV,  Lasix, potassium IVPB  
** FUTURE POSSIBILITY (currently 1 per day when boarding >5 obs patients):  DHS empaneled OBS-level patients
* FUTURE POSSIBILITY (currently 1 per day when boarding >5 obs patients):  DHS empaneled OBS-level patients


*Telemetry
==Telemetry==
** Continuous cardiac and pulse ox monitoring
* Continuous cardiac and pulse ox monitoring
** Stable patients – same level of nursing care as ward
* Stable patients – same level of nursing care as ward
** Nursing interventions '''q4 hrs''' (vitals, labs, POC testing)
* Nursing interventions '''q4 hrs''' (vitals, labs, POC testing)
** Non-titrated IV meds:  Adenosine IV, amiodarone IV/gtt, fosphenytoin IV, hydralizine IV, insulin gtt (IVP only for hyperkalemia; DKA patients require a higher level of nursing intervention), labetalol IV, Lovenox IV, metoprolol IV, Precedex, Vasotec IV   
* Non-titrated IV meds:  Adenosine IV, amiodarone IV/gtt, fosphenytoin IV, hydralizine IV, insulin gtt (IVP only for hyperkalemia; DKA patients require a higher level of nursing intervention), labetalol IV, Lovenox IV, metoprolol IV, Precedex, Vasotec IV   


*PCU/SDU
==PCU/SDU==
** Continuous cardiac and pulse ox monitoring
* Continuous cardiac and pulse ox monitoring
** Nursing interventions '''q2 hrs''' (vitals, suctioning, labs, POC testing)
* Nursing interventions '''q2 hrs''' (vitals, suctioning, labs, POC testing)
** ''Non-titrated'' IV vasoactive drips approved for PCU: Cardizem, Esmolol, NTG gtt  
* ''Non-titrated'' IV vasoactive drips approved for PCU: Cardizem, Esmolol, NTG gtt  
** Respiratory txs q2 hrs
* Respiratory txs q2 hrs
** BiPAP
* BiPAP
** Mechanical ventilation with FiO2<40% and infrequent ABG/vent adjustments
* Mechanical ventilation with FiO2<40% and infrequent ABG/vent adjustments
** OK:  subdural drains, special peritoneal dialysis, procedural sedation
* OK:  subdural drains, special peritoneal dialysis, procedural sedation
** '''NOT allowed''':  temp pacer, ''active chest pain'', significant dysrhythmia or acute ''ischemic EKG changes'', significant pulmonary edema
* '''NOT allowed''':  temp pacer, ''active chest pain'', significant dysrhythmia or acute ''ischemic EKG changes'', significant pulmonary edema


*ICU
==ICU==
** Actively managed ventilators
* Actively managed ventilators
** Nursing interventions '''q1 hr''' (vitals, labs, POC testing)
* Nursing interventions '''q1 hr''' (vitals, labs, POC testing)
** Actively titrated Drips: Cardene, Nipride, pentobarbital IV, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors
* Actively titrated Drips: Cardene, Nipride, pentobarbital IV, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors


Chappell 12/18, Hospital Policies 307 & 325M
Chappell 12/18, Hospital Policies 307 & 325M
==See Also==
*[[Harbor:Operations manual]]
==References==
<references/>
[[Category:Admin]]

Revision as of 21:04, 7 January 2019

These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgmentFile:1 - Right Level of Care Flowchart final 2018 tabloid view.pdf

Observation

  • Goal of our observation unit is admission avoidance
  • All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs

Ward

  • Unmonitored
  • Stable Patients
  • Nursing interventions q4 hrs (vitals, labs, POC testing)
  • Chronic CPAP or Nasal BiPAP (with pulm fellow approval)
  • Palliative/comfort care admissions, including vented comfort care patients
  • OK on ward: NG tube, chest tube, peritoneal dialysis
  • Meds: Ativan IV q6, Bumex, CaCl, digoxin IV, Dilantin IV, Dilaudid IV, heparin IV, Lasix, potassium IVPB
  • FUTURE POSSIBILITY (currently 1 per day when boarding >5 obs patients): DHS empaneled OBS-level patients

Telemetry

  • Continuous cardiac and pulse ox monitoring
  • Stable patients – same level of nursing care as ward
  • Nursing interventions q4 hrs (vitals, labs, POC testing)
  • Non-titrated IV meds: Adenosine IV, amiodarone IV/gtt, fosphenytoin IV, hydralizine IV, insulin gtt (IVP only for hyperkalemia; DKA patients require a higher level of nursing intervention), labetalol IV, Lovenox IV, metoprolol IV, Precedex, Vasotec IV

PCU/SDU

  • Continuous cardiac and pulse ox monitoring
  • Nursing interventions q2 hrs (vitals, suctioning, labs, POC testing)
  • Non-titrated IV vasoactive drips approved for PCU: Cardizem, Esmolol, NTG gtt
  • Respiratory txs q2 hrs
  • BiPAP
  • Mechanical ventilation with FiO2<40% and infrequent ABG/vent adjustments
  • OK: subdural drains, special peritoneal dialysis, procedural sedation
  • NOT allowed: temp pacer, active chest pain, significant dysrhythmia or acute ischemic EKG changes, significant pulmonary edema

ICU

  • Actively managed ventilators
  • Nursing interventions q1 hr (vitals, labs, POC testing)
  • Actively titrated Drips: Cardene, Nipride, pentobarbital IV, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors

Chappell 12/18, Hospital Policies 307 & 325M


See Also

References

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