The Neuromedicine Intensive Care Unit is a 24-bed inpatient unit located on the fourth floor in the Heart Vascular Neuromedicine Building. The unit consists of twenty-four private rooms with monitoring capabilities at each bedside. There are two isolation rooms available.
All bed spaces are equipped with hard-wiring at the bedside and remote alarm capability (monitor and ventilator) to the central nursing station and nursing alcoves. Monitoring capabilities include continuous 5-lead electrocardiogram, pulse oximetry, capnography, invasive and non-invasive hemodynamics, 2-lead electroencephalogram, full channel (16) digital electroencephalogram with remote capability as clinically indicated. The patients are not segregated to an area based on ICU or IMC level of care. Care is provided 24 hours per day, 7 days per week. Average bed occupancy is 22 patients.
Description of Patient Populations
Patients are admitted to the Neuromedicine Intensive Care Unit (NMICU) from the Operating Room, Emergency Department, and/or general floor for continued cardiovascular, respiratory, or neurological monitoring, postoperatively following moderate to complex neurosurgical procedures, from the Emergency Department, as a neurosurgical or neurological referral from another hospital, or preoperatively for evaluation and treatment. Patients admitted to NMICU require monitoring and/or interventional therapy at intervals ranging between 1 to 2 hours. The neurosurgical population includes patients status post craniotomy and/or interventional radiological procedures and include diagnoses such as aneurysms, arterio-venous malformations, central nervous system neoplasms, traumatic brain injury, spinal cord injury and hemorrhagic stroke. The neurological population includes patients diagnosed with ischemic stroke, neuromuscular diseases and/or disorders, neurological infections and/or status epilepticus. Adolescents of greater than 40 kilograms, young, middle, and older adults are admitted to the unit. The average length of stay index is 0.89.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring intensive and intermediate care. Nursing activities include hemodynamic (arterial, central venous pressure, intracranial pressures, pulmonary artery pressures, intraabdominal pressures, arterial/venous oxygenation, and capnography) monitoring, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management in both the mechanically-ventilated and spontaneously-breathing patient, neurological monitoring and treatment (including two-channel electroencephalogram setup and basic rhythm interpretation, bispectral index, burst suppression with barbiturate coma, and peripheral nerve stimulation for neuromuscular blockade), postoperative recovery, specialized wound care, nutritional therapy, medication management, and comfort/sedation 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.
Health Care Team
The medical director of Neuromedicine Intensive Care Unit is from Neurological Critical Care Service, Department of Neurology. The Neurological Critical Care medical director is board-certified in neurology and neurological critical care. The Neurocritical Care faculty, fellows, and residents in conjunction with the patient’s Neurosurgical Service faculty, fellows, and residents provide 24-hour care, 7 days per week for the NMICU patients. Multidisciplinary, comprehensive care of these patients and families is provided by medicine, nursing, respiratory therapy, pharmacy, social work services, case management, pastoral care, food & nutritional services, rehab 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 one Clinical Leader. Unit staff includes registered nurses and support technicians.
Registered nurses on NMICU 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 include a positive attitude toward family-centered care and open visitation, and the ability, willingness, and interest to work with the age-appropriate 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 the support techs include having a positive attitude toward family-centered care.
Nursing care on NMICU is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance. Support Tech coverage is available 24 hours a day. Skill mix is 100% RN; no assistive staff. The predominant staffing ratio of nurses: patients is 1:1 or 1:2. Occasional changes in ratios, 2:1 or greater, are accommodated based on the prescribed level of care and ongoing needs of the patient. The staffing plan is based on a budgeted 17.4 HPPD, acuity of 2.57 and HPWI of 6.77. A staffing plan based on the budgeted HPPD, acuity, and HPWI is reflected in the targeted staffing projections (in Shiftwizard) and are based on the census and acuity of classified patients (Quadramed Classification System).
Patient care assignments are made each shift by the Charge Nurse, as described in the Hospital Plan for Nursing Care. Additional unit-based considerations for staffing needs include:
- Impact of complex family/social situations
- Off-unit requirements
- Continuity of care needs
Additional staffing needs are met on NMICU as described in the Hospital Plan for Nursing Care. The need for extra shifts/overtime is determined by the Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care.
Requests for Scheduled Time Off (STO) will be reviewed on a case by case basis and will take into account the staffing needs of the unit. Requests are granted only if minimum staffing numbers are maintained with coverage that does not incur overtime.
Staff attendance at meetings, education offerings, and other activities are coordinated so that patient care coverage is continuous, as reflected on the shift assignment sheets.
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 13 registered nurses and 1 support tech.