Cardiac Care — Unit 66

Unit 66 is a 24-bed inpatient medical/surgical cardiac unit located on the 6th floor, section 6 of the HVNM. The unit consists of 24 private rooms with two negative pressure isolation rooms. Monitoring capabilities include continuous telemetry monitoring and continuous pulse oximetry for all 24 patients. Average bed occupancy is 90%. The unit also provides continuous remote telemetry monitoring for 88 patients requiring telemetry on other medical-surgical units.

Description of Patient Populations

Patients admitted to Unit 66 arrive from Admissions as scheduled appointments, Emergency Department, Units 76 ICU/IMC and 77 ICU/IMC, Shands UF Clinics and hospital-to-hospital referrals. Patients admitted to the unit are those with a cardiac medical – surgical diagnosis including those requiring cardiac catheterization for intervention and/or diagnostic testing. Ages of patients served include adult, middle adult and older adult. The average length of stay is 3.41.

Nursing Care

The focus of nursing care is on the assessment, diagnosis, planning, treatment and evaluation of patients requiring acute care. The Unit 66 role specific job descriptions identify the patient populations/common diagnoses served, equipment utilized, skills required to perform treatments/procedures, clinical parameters monitored, safety precautions initiated, and emergency events encountered. Nursing activities consist of: pain management including patient controlled analgesia and catheter analgesia; wound management including Vacuum Assisted Closure Systems, JPs, Duvals; respiratory management including pulse oximetry, oxygen therapy, chest tubes, and tracheostomies; cardiac management including telemetry and epicardial pacing; nutritional management including TPN, NG-tube/G-tube/J-tube feedings; assessment and management of abdominal/GI drainage systems including G-tubes, J-tubes, ostomies, NGs; medication management including immunosuppression and inotropic, antiarrythmic and electrolyte infusions; blood product infusions; safety precautions and patient/family education and support.

Healthcare Team

The cardiology and cardiothoracic services consists of attending physicians, fellows, chief residents, residents, interns, Physician assistants, ARNPs and medical students. The Department of Medicine or Department of Cardiothoracic Surgery maintain the schedule of rotations. Case Managers and Transplant Coordinators serve as liaisons between the Cardiology staff and multidisciplinary team, providing continuity of care for patients from admission through clinic follow-up. Available support services for patients include Pharmacy, Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutrition Services, Enterostomal Therapy as well as Patient and Family services. To foster collaboration the nursing staff participate in daily service rounds.

The nursing management structure consists of a Nurse Manager and Clinical Nurse Leader with support from a Unit Assistant. Department of Nursing staff provide training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the departmental education plan. Registered nurses and Patient Care Assistants provide nursing care. Monitor support technicians provide cardiac monitoring and clerical support for the direct patient caregivers as well as mobility assistance for the patients. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan.

Staffing Plan

Nursing care on Unit 66 is the total patient care nursing delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance. The patient care assistant (PCA) assignments are under the direct supervision of a Registered Nurse. Monitor Support Techs provide cardiac monitoring coverage 24 hours/day. Skill mix is 77% RN and 23% PCA. The predominant staffing ratio of nurses to patients is 1:4-5 on days/evenings/nights. The Charge Nurse (CN) on days, evenings and nights does not usually take a patient assignment. On all shifts, the CN is available to all staff for consultation and assistance in providing patient care. Each shift the CN makes patient care assignments, as descried in the Hospital Plan for Nursing Care. When making patient bed assignments patient safety concerns, patient/family requests, monitoring capabilities, and skills required are considered. Sitters provide 1:1 observation for patients requiring increased observation due to personal safety concerns. Sitter requests are coordinated through the Central Staffing Office.

The unit-staffing plan is based on a budgeted 9.72 HPPD, 6.80 HPWI and acuity 1.43 and adjusted for the skill mix as identified above. National benchmarks and historical unit acuity data determine budgeted HPPD. To account for special circumstances that increase patient acuity, daily staffing is adjusted based on unit census and feedback from charge nurses. The Hospital Plan for Nursing Care describes how to meet additional staffing needs. The Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care and the nursing policy, determine the need for extra shifts/overtime.

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 5 Registered Nurses, 2 PCAs and 2 Monitor Support Techs.

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.

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