Harbor:Right level of care: Difference between revisions
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''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]] | ||
==[[Harbor:Observation placement|Observation]] | ==[[Harbor:Observation placement|Observation/Short-Stay Medicine]]== | ||
* Goal of our observation/Short Stay is admission avoidance | * Goal of our observation/Short Stay is admission avoidance | ||
* If a brief additional stay in the ED will prevent admission, consider this option | |||
* 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 | ||
Revision as of 09:06, 28 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/Short-Stay Medicine
- Goal of our observation/Short Stay is admission avoidance
- If a brief additional stay in the ED will prevent admission, consider this option
- All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs
Ward[1]
- 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[2]
- 3W, 4W, 5E, 6W
- 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[3]
- 3W SDU, 4W/5E PCU
- 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[4]
- 3W/5W/6W ICU, 3WCTU, 4WCCU
- 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
See Also
References
Policy 307 Revised 7/2020