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The adult Critical Care Department at Palmdale Regional Medical Center is located on the first floor with 24 private rooms. The expected average daily census is 20. Three nursing stations within the unit serve the needs of all personnel, including nursing staff, physicians, and any ancillary staff performing duties on the unit. Each nursing station is assigned to care for the needs of 8 patient rooms. The Critical Care Department operates continually, 24 hours per day, seven days per week.
2. Population Served:
Population served is comprised of adult and geriatric patients with an occasional clinically appropriate adolescent patient.
Patients may be admitted to the Critical Care Unit for the following general categories but not limited to: congestive heart disease, myocardial infarction, diabetes, sepsis, stroke, coronary artery disease, chronic obstructive pulmonary disease, and pneumonia. Surgical patients may include spinal fusion, carotid endarterectomy, nephrectomy, craniotomy, thoracotomy, complicated bowel surgeries, and open heart surgery cases. Admissions to the age group of 14 or under are excluded from this Critical Care Unit. Occasionally the clinically appropriate adolescent patient may be admitted.
Procedures performed within the Critical Care setting are, but not limited to: Thoracentesis, paracentesis, dialysis, chest tube insertion, central venous catheter insertion, arterial line insertion, Swan Ganz thermaldilution catheter insertion, temporary transvenous pacemaker insertion, ventriculostomy, percutaneous tracheostomy, bronchoscopy, esohpogealgastroduodenoscopy, colonoscopy, cardioversion, and insertion of Intra-aortic balloon pump. Critically injured burned patients will be excluded from admission to this critical care unit.
3. Admission and Discharge General Criteria:
• Cardiac instability, failure, emergencies
• Hemodynamic instability
• Severe respiratory compromise; ventilatory support
• Neurological instability
• Life threatening drug ingestion
• Life threatening gastrointestinal hemorrhage; advanced hepatic failure
• Endocrine instability
• Septic shock
Discharge criteria involves resolution or reversal of these conditions
The Critical Care Unit is an Open Unit in which approximately 80% of all patients are cared by Intensivists and/or Specialties. Patients that are admitted to the Critical Care Unit will be assessed by the attending and/or consulting physician as soon as possible. If the patient is hemodynamically unstable, the patient will be seen by attending and/or consulting physician within 4 hours of admission. The Critical Care Unit is overseen by a Medical Director who is guided by Medical Staff Rules and Regulations.
E. CARE DELIVERY MODEL:
The delivery model in the Critical Care Unit is Primary Care. The Acuity Evaluation Guide is used to determine the acuity level of each patient. These acuity levels are assessed by the Charge RN per shift which determines the level of care required for each patient . The acuity levels in the Critical Care Unit are Levels VII, VIII, and IX. Assignments are determined by the acuity of the patient and skill level of staff. *See attached staffing grid for reference. Mandated nurse-to-patient ratios are maintained at one registered nurse to every two patients, unless the acuity of the more unstable patient, such as one on the intra-aortic balloon pump, requires a one-on-one staffing ratio. Minimum staffing is two RNs. Registered nurses are scheduled for 12-hour shifts, beginning at 7:00 am and 7:00 pm
2. Critical Care Order Sets:
Are available for admissions, mechanically ventilated patients, Sedation for Mechanically Ventilated Patients, Pain Management for Mechanically Ventilated Patients, IV Insulin Therapy, Care of the Post Operative Open Heart Patient, and Ischemic Stroke Order Set
3. Transport of patients:
An ACLS certified RN, emergency medication tray, and portable monitoring system for continuous hemodynamic monitoring and cardiac evaluation will accompany patients transported for tests or procedures outside the Critical Care Unit.
G. EQUIPMENT DESCRIPTION:
Equipment used by the nursing staff in the Critical Care Department includes:
• Cardiac monitors
• Special beds
• Glucose meters
• Portable Doppler pulse detector
• Emergency crash cart with Zoll Defibrillator,
• Pyxis machine
• Transvenous pacemaker
• Intra-aortic Balloon Pump
• Nurse Call Light System
• Nerve Stimulator
• Bair Hugger
• Cooling/heating blankets
• Intra-aortic balloon pump
The use of the equipment is as directed by the manufacturer's recommendation and according to the User's Manual for each piece of equipment. These manuals are available to staff in the Critical Care Department.
H. STAFF COMPETENCIES:
1. The method and identification of determining annual competencies for the Critical Care Unit is done by the following:
• Written skills assessment during new hire orientation
• Demonstrated skills observed by a preceptor upon hire
• Annual written and demonstrated skills assessment validated by peers and experts.
• Annual completion of tests and discussions on high-risk, low-volume skills as identified for the Critical Care Unit.
• Identified through Remote Data Entry reports
• New Protocols
• Initial Critical Care competencies are inherent within the nurses' Critical Care Course which is required to be completed within one year of working in Critical Care
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