Harbor:Right level of care: Difference between revisions
| Line 21: | Line 21: | ||
* Nursing interventions '''q4 hrs''' (vitals, labs, POC testing) | * Nursing interventions '''q4 hrs''' (vitals, labs, POC testing) | ||
* Nursing ratio 1:4 | * Nursing ratio 1:4 | ||
* Non-titrated IV meds: Adenosine IV, amiodarone IV/gtt, fosphenytoin IV, hydralizine IV, insulin | * Non-titrated IV meds: Adenosine IV, amiodarone IV/gtt, fosphenytoin IV, hydralizine IV, insulin IVP only for hyperkalemia; labetalol IV, Lovenox IV, metoprolol IV, Precedex, Vasotec IV. Drips include non-titratable amiodarone, bumex, lasix, integrilllin, insulin. DKA patients requiring active drip titration will require a higher level of nursing intervention, | ||
*Allows for HR 40-115 (120 if Afib), RR between 8 and 28, Sys BP 90-210 and MAP>65, up to 6L oxygen via NC, Na between 130 and 160 and nursing interventions | |||
*CPAP, BIPAP, chronic vent OK | |||
*Excludes alcohol withdrawal patients on CIWA protocol which will require a 1:3 unit. | |||
==PCU/SDU<ref>Chappell 12/18, Hospital Policies 307 & 325M</ref>== | ==PCU/SDU<ref>Chappell 12/18, Hospital Policies 307 & 325M</ref>== | ||
Revision as of 03:01, 23 September 2020
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[1]
- Goal of our observation/Short Stay is admission avoidance
- All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs
Ward[2]
- Unmonitored
- Stable Patients
- Nursing interventions q4 hrs (vitals, labs, POC testing)
- Nursing ratio 1:5
- 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[3]
- Continuous cardiac and pulse ox monitoring
- Stable patients
- Nursing interventions q4 hrs (vitals, labs, POC testing)
- Nursing ratio 1:4
- Non-titrated IV meds: Adenosine IV, amiodarone IV/gtt, fosphenytoin IV, hydralizine IV, insulin IVP only for hyperkalemia; labetalol IV, Lovenox IV, metoprolol IV, Precedex, Vasotec IV. Drips include non-titratable amiodarone, bumex, lasix, integrilllin, insulin. DKA patients requiring active drip titration will require a higher level of nursing intervention,
- Allows for HR 40-115 (120 if Afib), RR between 8 and 28, Sys BP 90-210 and MAP>65, up to 6L oxygen via NC, Na between 130 and 160 and nursing interventions
- CPAP, BIPAP, chronic vent OK
- Excludes alcohol withdrawal patients on CIWA protocol which will require a 1:3 unit.
PCU/SDU[4]
- Continuous cardiac and pulse ox monitoring
- Nursing interventions q2 hrs (vitals, suctioning, labs, POC testing)
- Nursing ratio 1:3
- 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[5]
- Actively managed ventilators
- Nursing interventions q1 hr (vitals, labs, POC testing)
- Nursing ratio 1:2 or 1:1 depending on instability
- Actively titrated Drips: Cardene, Nipride, pentobarbital IV, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors