Harbor:Right level of care

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

• 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