Della Infotech
SPH/4 BF ICU/RN - Backfill Vesper
Della Infotech, Albany, New York, us, 12237
Type of Patients ServedICU is a 19-bed unit serving acutely or critically ill patients. Services provided include inpatient comprehensive care to patients in need of intensive treatment and monitoring that cannot be provided outside of the ICU. The patient focused care model is utilized with the majority of patients remaining on ICU from admission to transfer to a less acute level of care and/or discharge.
Ages of Patients ServedThe ICU serves primarily the adult and geriatric populations.
Current Services for Patients and Patients' Families:
Frequent Procedures, Processes, Services•Cardiac Monitoring•Pulmonary Artery (PA) Catheter insertion and monitoring•Arterial line and Central Venous Pressure (CVP) monitoring•Therapeutic Hypothermia•Hemodynamically unstable patients requiring hemodialysis or peritoneal dialysis•Mechanical ventilation•Transvenous pacing/external pacing•Continuous Renal Replacement Therapy (CRRT)•Administration of high risk medications.•Hemodynamically unstable patients requiring hemodialysis or peritoneal dialysis•Ventriculostomy & Lumbar drain monitoring & management
Scope and Complexity of Patient's Care Needs
ICU serves as a place for monitoring and care of patients with symptomatic disease processes that are potentially severe, physiologically unstable, and require technical and/or artificial life support. Patient care needs can cover a range from simple medication and treatments to the complex intensive monitoring of unstable patients. Intensive monitoring may include ventilator support, invasive hemodynamic monitoring, and/or active continuous titration of vasoactive medication.
Criteria for Entry to ServicesDiagnosis Model: This model uses specific conditions or diseases to determine appropriateness of ICU admission.A. Cardiac System1. Acute Myocardial infarction with complications2. Cardiogenic Shock3. Complex arrhythmia's requiring close monitoring and intervention4. Acute congestive heart failure with respiratory failure and/or requiring hemodynamic support5. Hypertensive emergencies6. S/P cardiac arrest7. Cardiac tamponade or constriction with hemodynamic instability8. Dissecting aortic aneurysms9. Complete heart block
B. Pulmonary System1. Acute respiratory failure requiring ventilatory support2. Pulmonary emboli with hemodynamic instability3. Patients in an intermediate care unit who are demonstrating respiratory deterioration4. Need for nursing/respiratory care not available in lesser care areas such as floor or intermediate care unit5. Massive hemoptysis6. Respiratory failure with imminent intubation
C. Neurologic Disorders1. Acute stroke with altered mental status2. Coma: metabolic, toxic, or anoxic3. Intra cranial hemorrhage with potential for herniation4. Acute subarachnoid hemorrhage5. Meningitis with altered mental status or respiratory compromise6. Central nervous system or neuromuscular disorders with deteriorating neurological or pulmonary function7. Status epilepticus8. Brain dead or potentially brain dead patients who are being aggressively managed while determining organ donation status9. Vasospasm10. Severe head injured patients11. Patients requiring intracranial pressure monitoring.12. Patients with lumbar drains.
D. Drug Ingestion and Drug Overdose1. Hemodynamically unstable drug ingestion2. Drug ingestion with significantly altered mental status with inadequate airway protection3. Seizures following drug ingestion
E. Gastrointestinal Disorders1. Life threatening gastrointestinal bleeding including hypotension, angina, continued bleeding, or with comorbid conditions2. Fulminate hepatic failure3. Severe pancreatitis4. Esophageal perforation with or without mediastinitis
F. Endocrine1. Diabetic ketoacidosis complicated by hemodynamic instability, altered mental status, respiratory insufficiency, or severe acidosis2. Thyroid storm or myxedema coma with hemodynamic instability3. Hyperosmolar state with coma and/or hemodynamic instability4. Other endocrine problems such as adrenal crisis with hemodynamic instability5. Severe hypercalcemia with altered mental status, requiring hemodynamic monitoring6. Hypo or hypernatremia with seizures, altered mental status7. Hypo or hyper magnesium with hemodynamic compromise or dysrhythmias8. Hypo or hyperkalemia with dysrhythmias or muscular weakness9. Hypophosphatemia with muscular weakness
G. Surgical1. Surgical patients requiring hemodynamic monitoring/ventilatory support or extensive nursing care
H. Miscellaneous1. Septic shock with hemodynamic instability2. Hemodynamic monitoring3. Clinical conditions requiring ICU level nursing care4. Environmental injuries (lightning, near drowning, hypo/hyperthermia)5. New/experimental therapies with potential for complications
The ICU intensivist will make the ultimate decision as to the appropriateness of admission.
Conflicting problems in treatment and/or management regarding patients and/or policies of the unit will be referred to the Chief of Critical Care, who will have the final decision.
Hours of Operation- ICU is operational 24 hours a day, seven days a week.
Methods Used to Assess Patient/Patient Population Care Needs
Processes:Evidence based assessment tools (i.e. pain, sedation, etc.) will be utilized in the assessment and evaluation of patient care needs. An individualized plan of care will be implemented upon admission and continuously updated to meet changes in the patient's condition.
Methods Used to Determine Extent to Which Patient Needs are Met and Services Adjusted
Services:Care will be provided to patients and patient families that include physiological, psychological, spiritual, and social needs in a collaborative team approach.
Staffing
BudgetedOptimal staffing is achieved by established staffing patterns, which provide an optimum number of hours of care per patient day.
MinimumA staffing plan is developed to include the number and mix of staff, provide a minimum number of hours of care per patient day to meet anticipated needs of the patient.
Qualifications of Staff
A. Registered Nurse•Current Basic Life Support•Successful completion of unit specific orientation and Cardiac/Critical Care course (within 6 months of hire).•Advanced Cardiac Life Support (within 6 months of hire)•Annual Cardiac and Critical Care Competency Validation•Continuous Renal Replacement Therapy (CRRT), and Therapeutic Hypothermia classes and competency evaluation.B. Respiratory Therapist:•Current Basic Life Support•Successful completion of Core OrientationC. Patient Care Associates•Successful completion of orientation program•Current Basic Life Support•Annual Competency ValidationD. Information Associate:•Successful completion of the orientation program
Methods used to adjust staffingStaffing in ICU will be adjusted every 4 hours, and prior to end or beginning of shift based on changes in the census and/or acuity. It will be the responsibilities of the charge RN to determine the appropriate changes, calling on the Nurse Manager/ Supervisor for assistance.
Goals of Department/Unit•Provide quality patient care.•Maintain a collaborative multi-disciplinary approach to care utilizing the pa
Ages of Patients ServedThe ICU serves primarily the adult and geriatric populations.
Current Services for Patients and Patients' Families:
Frequent Procedures, Processes, Services•Cardiac Monitoring•Pulmonary Artery (PA) Catheter insertion and monitoring•Arterial line and Central Venous Pressure (CVP) monitoring•Therapeutic Hypothermia•Hemodynamically unstable patients requiring hemodialysis or peritoneal dialysis•Mechanical ventilation•Transvenous pacing/external pacing•Continuous Renal Replacement Therapy (CRRT)•Administration of high risk medications.•Hemodynamically unstable patients requiring hemodialysis or peritoneal dialysis•Ventriculostomy & Lumbar drain monitoring & management
Scope and Complexity of Patient's Care Needs
ICU serves as a place for monitoring and care of patients with symptomatic disease processes that are potentially severe, physiologically unstable, and require technical and/or artificial life support. Patient care needs can cover a range from simple medication and treatments to the complex intensive monitoring of unstable patients. Intensive monitoring may include ventilator support, invasive hemodynamic monitoring, and/or active continuous titration of vasoactive medication.
Criteria for Entry to ServicesDiagnosis Model: This model uses specific conditions or diseases to determine appropriateness of ICU admission.A. Cardiac System1. Acute Myocardial infarction with complications2. Cardiogenic Shock3. Complex arrhythmia's requiring close monitoring and intervention4. Acute congestive heart failure with respiratory failure and/or requiring hemodynamic support5. Hypertensive emergencies6. S/P cardiac arrest7. Cardiac tamponade or constriction with hemodynamic instability8. Dissecting aortic aneurysms9. Complete heart block
B. Pulmonary System1. Acute respiratory failure requiring ventilatory support2. Pulmonary emboli with hemodynamic instability3. Patients in an intermediate care unit who are demonstrating respiratory deterioration4. Need for nursing/respiratory care not available in lesser care areas such as floor or intermediate care unit5. Massive hemoptysis6. Respiratory failure with imminent intubation
C. Neurologic Disorders1. Acute stroke with altered mental status2. Coma: metabolic, toxic, or anoxic3. Intra cranial hemorrhage with potential for herniation4. Acute subarachnoid hemorrhage5. Meningitis with altered mental status or respiratory compromise6. Central nervous system or neuromuscular disorders with deteriorating neurological or pulmonary function7. Status epilepticus8. Brain dead or potentially brain dead patients who are being aggressively managed while determining organ donation status9. Vasospasm10. Severe head injured patients11. Patients requiring intracranial pressure monitoring.12. Patients with lumbar drains.
D. Drug Ingestion and Drug Overdose1. Hemodynamically unstable drug ingestion2. Drug ingestion with significantly altered mental status with inadequate airway protection3. Seizures following drug ingestion
E. Gastrointestinal Disorders1. Life threatening gastrointestinal bleeding including hypotension, angina, continued bleeding, or with comorbid conditions2. Fulminate hepatic failure3. Severe pancreatitis4. Esophageal perforation with or without mediastinitis
F. Endocrine1. Diabetic ketoacidosis complicated by hemodynamic instability, altered mental status, respiratory insufficiency, or severe acidosis2. Thyroid storm or myxedema coma with hemodynamic instability3. Hyperosmolar state with coma and/or hemodynamic instability4. Other endocrine problems such as adrenal crisis with hemodynamic instability5. Severe hypercalcemia with altered mental status, requiring hemodynamic monitoring6. Hypo or hypernatremia with seizures, altered mental status7. Hypo or hyper magnesium with hemodynamic compromise or dysrhythmias8. Hypo or hyperkalemia with dysrhythmias or muscular weakness9. Hypophosphatemia with muscular weakness
G. Surgical1. Surgical patients requiring hemodynamic monitoring/ventilatory support or extensive nursing care
H. Miscellaneous1. Septic shock with hemodynamic instability2. Hemodynamic monitoring3. Clinical conditions requiring ICU level nursing care4. Environmental injuries (lightning, near drowning, hypo/hyperthermia)5. New/experimental therapies with potential for complications
The ICU intensivist will make the ultimate decision as to the appropriateness of admission.
Conflicting problems in treatment and/or management regarding patients and/or policies of the unit will be referred to the Chief of Critical Care, who will have the final decision.
Hours of Operation- ICU is operational 24 hours a day, seven days a week.
Methods Used to Assess Patient/Patient Population Care Needs
Processes:Evidence based assessment tools (i.e. pain, sedation, etc.) will be utilized in the assessment and evaluation of patient care needs. An individualized plan of care will be implemented upon admission and continuously updated to meet changes in the patient's condition.
Methods Used to Determine Extent to Which Patient Needs are Met and Services Adjusted
Services:Care will be provided to patients and patient families that include physiological, psychological, spiritual, and social needs in a collaborative team approach.
Staffing
BudgetedOptimal staffing is achieved by established staffing patterns, which provide an optimum number of hours of care per patient day.
MinimumA staffing plan is developed to include the number and mix of staff, provide a minimum number of hours of care per patient day to meet anticipated needs of the patient.
Qualifications of Staff
A. Registered Nurse•Current Basic Life Support•Successful completion of unit specific orientation and Cardiac/Critical Care course (within 6 months of hire).•Advanced Cardiac Life Support (within 6 months of hire)•Annual Cardiac and Critical Care Competency Validation•Continuous Renal Replacement Therapy (CRRT), and Therapeutic Hypothermia classes and competency evaluation.B. Respiratory Therapist:•Current Basic Life Support•Successful completion of Core OrientationC. Patient Care Associates•Successful completion of orientation program•Current Basic Life Support•Annual Competency ValidationD. Information Associate:•Successful completion of the orientation program
Methods used to adjust staffingStaffing in ICU will be adjusted every 4 hours, and prior to end or beginning of shift based on changes in the census and/or acuity. It will be the responsibilities of the charge RN to determine the appropriate changes, calling on the Nurse Manager/ Supervisor for assistance.
Goals of Department/Unit•Provide quality patient care.•Maintain a collaborative multi-disciplinary approach to care utilizing the pa