Pediatric Intensive Care Unit
Description of Unit
The PICU is located on the tenth floor in the south wing of the Patient Services Building. The unit is composed of 24 private rooms with glass-sliding doors that join each pair of rooms, except for two individual rooms specifically built to house patients who require extracorporeal membrane oxygenation. The mean occupancy rate for PICU is 81.91 with an average daily census of 19.6 patients. A central core support area houses office and storage space, on call rooms, nutrition area, and a 24-hour satellite pharmacy. Four of the 24 bedspaces are designed for strict and respiratory isolation with negative airflow. The remaining bedspaces are equipped with clean/neutral airflow. Each bedspace is constructed with glass-sliding entrance doors and charting areas framed with abutted glass. Each bedspace is visible from one or more vantage points from the two nursing stations and medication preparation areas. Bedside monitoring including heart rate, respiratory rate, blood pressure, temperature, and pulse oximetry are standard. Expanded monitoring of invasive pressures, end tidal CO2, and mechanical ventilation are also available as the patient’s condition warrants. In addition, advanced monitoring including brain tissue oxygenation and regional oximetry are provided as needed. A family room sponsored by Ronald McDonald House is located just outside the unit to provide families with a place to relax, prepare and eat meals, contact family members, and sleep in the hospital if necessary.
Description of Patient Populations
The Pediatric Intensive Care Unit at UF Health Shands Children’s Hospital provides critical care services for children from the newborn period through twenty-one years of age twenty-four hours per day, seven days per week. The referral base extends from southern Georgia to Miami. Patients are admitted by a variety of pediatric medical and surgical subspecialties. The medical subspecialties include, but are not limited to, Cardiology, Critical Care Medicine, Endocrinology, Gastroenterology, General Pediatrics, Genetics, Hematology-Oncology, Immunology, Infectious Diseases, Neonatology, Neurology, Pulmonary, and Renal. The surgical subspecialties include, but are not limited to, Cardio-thoracic surgery, Neurosurgery, Orthopedics, Otolaryngology, Pediatric surgery, Plastic surgery, and Urology.
The nursing staff is committed to family-centered and innovative patient care through the assessment, diagnosis, planning, treatment and evaluation of: pain, fluid and electrolyte abnormalities, hemodynamic instability, alteration in neurologic status, respiratory compromise, impairment in skin integrity, developmental delay, and family anxiety related to the intensive care experience. The PICU role specific job descriptions identify the patient populations, clinical parameters monitored, safety precautions initiated, and emergency events encountered.
Health Care Team
The multidisciplinary health care team cares for the entire spectrum of pediatric diseases, including congenital, acquired, and injury-related. The average length of stay is 6.01 days. The length of stay is influenced by a complement of long term technology dependent children and overnight recovery patients. Seasonal illnesses are common. The most common medical diagnoses include asthma, pneumonia, respiratory distress, seizures, altered level of consciousness, toxic ingestions, heart failure and/or arrhythmias and sepsis. Frequently encountered surgical diagnoses and procedures include surgical correction of congenital heart disease, multiple trauma, head trauma, various surgeries related to cancer, Nissen fundoplication, direct laryngoscopy and bronchoscopy for diagnostic and therapeutic purposes, pectus excavatum repair, spinal fusion, craniotomy for tumors, and exploratory laparotomy for gastrointestinal tract obstruction. In addition, patients are admitted following liver transplantation and care is provided for children who have undergone heart, lung, or bone marrow transplantation.
A multidisciplinary approach is utilized to provide intensive and comprehensive care. The Pediatric Critical Care Medicine team provides primary or concurrent care for all PICU patients 24 hours per day/7 days per week. The medical direction for the PICU is provided by the Division Chief of Pediatric Critical Care Medicine. Multidisciplinary, comprehensive care of pediatric intensive care and intermediate care unit patients and families is provided by Medicine, Nursing, Social Work Services, Child Life, Case Management, Pastoral Care, Food and Nutritional Services, satellite-based Pharmacists, and other health care providers as indicated by the patient’s health status and identified needs. A hospital-based school teacher from the Alachua County School Board is available during the school year to work with children requiring repeated or extended hospitalizations. Bi-weekly multidisciplinary rounds provide a forum for sharing assessments and planning care needs for each patient. Care conferences are held as a result of these discussions for a more in-depth look at short and long term goals.
Nursing management for the unit includes registered nurses in the positions of Nurse Manager and Clinical Leader.
Registered nurses deliver autonomous, accountable total nursing care to all patients on a 24-hour/7 days per week basis and are assisted by patient care assistants. Additional staff who provide support to the PICU include pediatric clinicians, transplant coordinators, and ARNPs who work with pediatric critical care medicine, cardio-thoracic surgery, pediatric neurology, neurosurgery, pediatric hematology-oncology, and transplant patients. Respiratory and ventilator care is provided by respiratory therapists trained in pediatrics.
Registered nurses in PICU meet the basic requirements for Registered Nurse staff and function in accordance with the unit-based job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for registered nurses to prepare them to care for critically ill children are met through an extensive orientation program. Following orientation, specific additional educational objectives are met by the end of the probationary period and annually. Nurses are expected to demonstrate a positive attitude toward family-centered care, and the ability, willingness, and interest to work with the age-appropriate and developmental needs of patients.
Support Techs meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for support techs include having a positive attitude toward family-centered care.