Unit UF 72, Medical Critical Care Unit (MCCU), is a 24 bed inpatient adult intensive and intermediate care unit located on the 7th floor in the Patient Services Building, North Tower. The unit consists of all private ICU capable rooms including 2 negative pressure isolation rooms. Monitoring of patients include 24 Philips bedside monitors each capable of monitoring ECG, NIBP, invasive pressure monitoring, temperature, CO2 and oxygen saturation. Additional monitoring capability for invasive pressures and continuous cardiac output via Edwards FloTrac/EV1000 monitoring. All monitoring parameters are transmitted via hardwire to the central station having capability to print ECG rhythm strips. The MCCU provides treatment for patients requiring complex stabilization and care. Care is provided 24 hours per day 7 days per week.
Description of Patient Populations
The MCCU provides intensive and intermediate care nursing for high-risk medical patients. Common diagnoses of patients in the MCCU include respiratory failure (i.e., COPD exacerbation, asthma, cystic fibrosis, bacterial and viral pneumonia), multi-system failure / sepsis, GI bleed, infectious diseases, endocrine dysfunction including diabetic ketoacidosis, post cardiac and respiratory arrests, and cancer. Patients on this unit include adults and older adults. Average length of stay in the MCCU is (?) days.
Patients are admitted from the Emergency Department, referred from other hospitals, transferred from med-surg units due to worsening condition and increase in level of monitoring and/or care required, and patients requiring complex cardiovascular or pulmonary management and intervention. A team of healthcare workers, admitting Attending physicians, Fellows, Residents and Interns as well as specialists as requested by the medical teams, nurses, social workers and ancillary personnel work together to provide this excellent care and service.
Nursing care is focused on the assessment, diagnosis, treatment, evaluation, and monitoring of the critically ill adult patient. Special emphasis is placed on the use of critical thinking in the ongoing assessment of the critically ill patient. Nursing activities include hemodynamic (arterial, central venous pressure, pulmonary artery pressures, intra-abdominal pressures, arterial and venous oxygenation and capnography) monitoring, rhythm interpretation, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management in both mechanically- ventilated and spontaneously-breathing patients, postoperative recovery, specialized wound care, nutritional therapy, medical management, rehabilitation initiation, and comfort/palliative care measures as indicated. Patient and family education and emotional support related to the patient’s condition and treatment is an essential element in the nursing care provided. Nurses utilize a multi-disciplinary plan of care to deliver consistent goal directed care. Patient and family education and discharge planning are also important components of nursing care delivered in the unit.
Health Care Team
The Medical Director of MCCU is a physician who is board-certified in pulmonary medicine. The faculty and residents provide 24-hour medical care of the ICU patients 7 days per week. Scheduling of rotations is maintained through the Department of Medicine. Multidisciplinary, comprehensive care of patients and families is provided by medicine, nursing, social work services, case management, pastoral care, food & nutritional services, pharmacy, rehab services, cardiopulmonary services, and other health care providers as indicated by the patient’s health status and identified needs.
Nursing management for the unit includes registered nurses in the positions of Nurse Manager and Clinical Leader. The Department of Nursing staff is provided training experiences to attain and maintain competence as defined by the unit and role specific job descriptions and departmental education plan. Support techs provide clerical support for the direct patient caregivers and function as a unit-based mobility team encouraging and assisting with early mobility. The Registered Nurse is responsible for guiding care of the patient based upon the individualized plan. Nursing care delivered by Patient Care Assistants is coordinated under the direction of the Registered Nurse.
Nursing care on MCCU is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance. Unit support tech coverage is available 24 hours a day. Skill mix is RN 100%. Each RN is assigned 1-2 ICU or IMC patients. On all shifts, the Charge Nurse (CN) is available to all staff for consultation and assistance in providing patient care. Patient care assignments are made each shift by the CN, as described in the Hospital Plan for Nursing Care. Patient bed assignments are made by the CN and are based upon patient safety concerns, monitoring capabilities, and skills required for care delivery. Additional unit-based considerations for staffing needs include:
- Complexity of the patient’s condition (frequency of procedures, emotional needs, and physical care needs which are reflected in the QuadraMed system)
- Technology required
- Relevant safety and infection control issues
- Previous days assignment to provide continuity of care
- CSO/Best shift/float RN’s will not be assigned patients who are outside their competency/skill level
- Patient transport requirements
The staffing plan is based on a budgeted ADC of 22, HPPD of 15.45, THPWI of 5.97, and acuity of 2.59 and adjusted for the skill mix as identified above. Adjustments to staffing are reflected in the Targeted Staffing projections defined by staffing grid loaded into the ShiftWizard scheduling system.
Additional staffing needs are met as described in the Hospital Plan for Nursing Care. The Nurse Manager or designee, in accordance with the Hospital Plan determines the need for extra shifts/overtime for nursing care.
In the event of an emergency such as severe weather conditions or other disaster, the minimum amount of staff required to safely operate up to 75% capacity would be 16 Registered Nurses and 2 Support Tech.
Requests for Paid time off (PTO) will be reviewed on a case by case basis and will take into account the staffing needs of the unit.
Staff attendance at meetings, education offerings, Council meetings and other activities are coordinated so that patient care coverage is continuous. Staff is granted time for educational programs by requesting Administrative Leave for off unit continuing education activities. Mandatory programs sponsored by the unit are given during shift hours or staff is paid to attend.
Staffing Decision Points
When assessing staffing at “break points” take into consideration the following:
- Planned admissions (hospital to hospital transfers)
- Skill level of staff
- Shift involved
- Acuity of pts (# of 1:1’s and boarders)
- Available resources (stat nurse, management team members)
- Float for 4-8 hrs only and reassess
- Notify Nursing Coordinator if workload changes to negotiate clinical support.
- Unstable hemodynamic, frequent titration of multiple drips
- Post arrest hypothermia patients during cooling and warming phase
- Massive GI Bleed or Massive Transfusion of patient
- CVVH-D unless stable and could be paired with a more stable patient in close proximity
- Pulmonary lavage patients during procedure
- Patients requiring specific drug desensitization per order set
- Some DKA patients
- Patients on proning beds
- Hemodynamically unstable patients on ECMO
- Patients with ASA desensitization
Updated March, 2021