Harbor: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 judgmentFile:1 - Right Level of Care Flowchart final 2018 tabloid view.pdf

Observation[1]

  • 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[2]

  • 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[3]

  • 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[4]

  • 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[5]

  • 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

See Also

References

  1. Chappell 12/18, Hospital Policies 307 & 325M
  2. Chappell 12/18, Hospital Policies 307 & 325M
  3. Chappell 12/18, Hospital Policies 307 & 325M
  4. Chappell 12/18, Hospital Policies 307 & 325M
  5. Chappell 12/18, Hospital Policies 307 & 325M

Authors:

Ross Donaldson