The Pediatric Cardiac Intensive Care Unit (PCICU) is located on the tenth floor of the North Tower and opened January, 2014. The unit is composed of 23 private patient rooms arranged on the east, west, and north hallways. A central nursing station provides workspace for the health care team.
Clean holdings, soiled holding, nourishment room, and equipment rooms are strategically located on the hallways. A satellite pharmacy located on the 10th floor supports the unit. Each bedspace is constructed with sliding glass entrance doors and charting areas framed with abutted glass. Standard bedside monitoring includes heart rate, respiratory rate, blood pressure, temperature, pulse oximetry, invasive pressures, end tidal CO2, and mechanical ventilation parameters. In addition, advanced monitoring and therapies including extracorporeal membrane oxygenation (ECMO), ventricular assist devices (VAD), total artificial heart (t-AH) devices, brain tissue oxygenation, and regional oximetry are provided as needed. A family room sponsored by Ronald McDonald House is located outside the unit as well as a traditional waiting area 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 PCICU provides intermediate and critical care services for children from the newborn period into adulthood twenty-four hours per day, seven days per week. The multidisciplinary health care team cares for patients with congenital and acquired cardiac diseases and pulmonary pathologies requiring lung transplantation. The most common diagnoses include, but are not limited to, those related to surgical palliation of congenital cardiac malformations, cardiac failure requiring transplantation, and various cardiac arrhythmias. The length of stay is influenced by a complement of patients awaiting heart transplantation, long-term technology dependent patients, and recovery of pre and post-operative surgical patients.
The routine referral base extends throughout the Southeast. Patients are admitted by the Congenital Heart Center service.
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 PCICU role specific job descriptions identify the patient populations, clinical parameters monitored, safety precautions initiated, and emergency events encountered.
Health Care Team
A multidisciplinary approach is utilized to provide intensive and comprehensive care. Multidisciplinary, comprehensive care of our patients and families is provided by Surgery, Medicine, Nursing, Interventionists (Cardiac Catheterization, Cardiac Electrophysiology), Social Work Services, Child Life, Case Management, Pastoral Care, Food and Nutritional Services, Clinical Pharmacists, Physical/Occupational/Rehabilitative Therapists, 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. Weekly multidisciplinary conferences provide a forum for sharing assessments and planning care needs for patients. These discussions provide the data for a more in-depth look at short and long term goals for each patient.
Nursing leadership 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 support technicians. Additional staff who provide support to the PCICU include pediatric clinicians, transplant coordinators, and ARNPs who work with pediatric critical care medicine, cardio-thoracic surgery, and transplant patients. Respiratory and ventilator care is provided by respiratory therapists.
Registered nurses in the PCICU 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 Technicians 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 technicians include having a positive attitude toward family-centered care.
The nursing care provided to patients utilizes a total patient care approach, with the RN assuming care for the patient. The unit is staffed by a charge nurse on all shifts. The charge nurse is a staff registered nurse who is in charge of bed assignments, staffing needs, crisis interventions and the general work flow on the unit.
Nursing Care is provided for acutely and chronically ill patients as described in the Hospital Plan for Nursing Care. The skill mix in PCICU is 100% Registered Nurse-licensed staff supported by a fixed support technician staff. The usual nurse: patient ratio is 1:1 or 1:2 for ICU patients and 1:3 for IMC patients. Patient care assignments are made each shift by the charge nurse, with input from the staff nurses, based on nursing competency and expertise. Additional unit-based considerations for staffing include:
- amount of patient/family teaching needs and degree of complexity
- amount of child/parental anxiety
- impact of complex social situations
- stability of the child
- number and complexity of medications, treatments, and procedures
- amount of supervision required for children without family members in attendance
- procedural sedation procedures
- requirement of the RN to accompany the patient off the unit for tests/procedures
Additional staffing needs are met in the PCICU as described in the Hospital Plan for Nursing Care. The need for extra shifts/overtime is determined by the Nurse Manager or designee.
Scheduled time off for unit management and for unit staff is coordinated such that patient care is not compromised. Requests are reviewed by the Nurse Manager or designee prior to approval. Staff attendance at meetings, educational offerings, and other activities are coordinated so that the patient care coverage is continuous, as reflected on the shift assignment sheets.
Assignment sheets are completed every shift to designate patient care assignments. Assignment sheets will contain the following information:
- Date and shift.
- Person in charge.
- Identification of staff by title, i.e. RN, Support Technician, Sitters, etc.
- Patient assignment.
- Any changes in patient assignment.
- Resource/preceptor for orientee or float personnel, if other than the charge.