Unit 67 Cardiovascular/Lung Transplant Unit is a 24-bed inpatient unit located on the 6th floor of the Heart, Vascular and Neuromedicine Hospital of Shands UF. The unit includes twenty-four medical/surgical private rooms, including two negative airflow rooms. Capability exists to monitor all patients in the unit with remote cardiac telemetry and continuous pulse oximetry. The station for this service is located on Unit 66 (Heart, Vascular and Neuromedicine Hospital). Care is provided 24 hours per day, 7 days per week. Average bed occupancy is 92%.
Description of Patient Populations
Patients are admitted to Unit 67 following operative procedures of the vascular, cardiothoracic systems and lung transplant services. The services of Unit 67 have a strong statewide referral base accepting patients as scheduled admissions, hospital-to-hospital transfers as well as admitting patients from the Emergency Department for acute illnesses. Common medical diagnoses include: Coronary Artery Disease, Acute Coronary Syndrome, Congestive Heart Failure, Pneumonia, respiratory insufficiencies, renal failure, diabetes, and thrombolytic drug therapy. The unit cares for both adult and geriatric patients and has an average length of stay 3.31 days.
Nursing care is based on the total patient care model with holistic delivery of care and focuses on the importance of a head to toe assessment. A charge nurse is present on each shift. Unit management prepares the schedule with the assistance of a team consisting of unit staff nurses. Daily staffing levels are planned based on average daily census. Meetings, staff education, performance improvement activities, etc. are factored into the scheduled staffing.
Patient and family members are relied on as partners for patient education and teaching as well as their collaboration in care delivery. Education includes teaching about: pain control, ambulation and/or physical activity (ROM-active or passive), provision of nutrition through assistance of feedings or through parenteral or enteric feedings through an nasogastric tube (NGT) or Dobhoff tube (DHT), infection control, administration of medications, and basic skin care.
Nursing staff assesses and manages wound care therapies (including Vacuum Assisted Closure (VAC) Systems, Jackson-Pratt, Duvol drains); respiratory management, (including pulse oximetry, oxygen therapy and chest tubes) and cardiac management (including remote telemetry). Nursing also assesses and manages patient nutritional and medication management which include Total Parenteral Nutrition (TPN), NGT/Gastric tube/Jejunal-tube feedings as well as abdominal/gastrointestinal drainage systems including Gastric tubes, Jejunal tubes, and stomas/ostomies.
Health Care Team
Each surgical and medical service on the unit consists of attending physicians, fellows/chief residents, residents/interns physician assistants, nurse practitioners and medical students. The scheduling of the rotation is maintained through the Department of Surgery. Case Managers serve as liaisons between the surgical, medical staff and multidisciplinary team, providing continuity of care for surgical patients from admission to clinical follow-up. Available support services for Unit 67 patients include Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutrition services, enterostomal therapy, and diabetic education through a Certified Diabetes Educator. A collaborative care model consists of nursing staff, medical staff, patient and family services personnel, rehabilitation services staff (PT, OT, RT) and dieticians providing an interdisciplinary communication approach to facilitate patient wellness.
The nursing management structure consists of a Nurse Manager and Clinical Leader, with administrative and clerical support from the Unit Assistant. Department of Nursing staff is provided 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 (PCA) provide nursing care. Unit Support Technicians provide clerical support for the direct patient caregivers as well as serve as patient mobility assistants. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan. Nursing care delivered by the PCA is coordinated under the direction of the Registered Nurse.
Nursing care on Unit 67 is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care). The Patient Care Assistant is assigned under the direct supervision of the Registered Nurse (RN). Support Tech coverage is frequently available 24 hours a day. Skill mix is 75% RN and 25% PCA. The predominant staffing ratio of nurses to patients is 1:4-5. The Charge Nurse (CN) frequently does not take a patient care assignment. On all shifts, the CN is available to provide staffing assistance, resourcing and consultation 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, patient or family requests, monitoring capabilities, medical diagnosis and required skills.
Patients requiring sitters (1:1 observers) for violent or non-violent reasons & Baker/Marchman acts are coordinated thru the Central Staffing Office. The skill mix of the staff working on the shift as well as the level of experience and expertise is considered by the CN prior to filling in the shift assignments.
The staffing plan is based on a budgeted 9.40 HPPD, 6.35 HPWI, and acuity of 1.48 and adjusted for the skill mix as identified above. Staffing is reflected in the Targeted Staffing projections in the online staffing system and are based on the census and acuity of classified patients (Quadramed). Additional staffing needs are met on Unit 67 as described in the Hospital Plan for Nursing Care. The Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care and nursing policy, determines the need for extra shifts/overtime.
Requests for Scheduled Paid 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.
The minimum number of staff for emergency unit coverage is (2) RN’s on each shift.
January 07, 2021