Critical Care is a 34 bed unit that specializes in caring for critically ill adult cardiac, neuro, medical-surgical and cardiac surgical patients. Common diagnoses include angina, acute MI, congestive heart failure, respiratory failure, cardiac arrest, sepsis, DKA, GI bleed, MVA, renal failure and stroke. Patients under the age of 16 are not admitted to Critical Care.
Critical Care staff functions as team leaders of the code blue team. Select staff members respond to any code blue called in the hospital excluding the ED, OR and Cath Lab. Critical Care is also part of the Medical Response Team (MRT) that consists of an experienced Critical Care nurse who responds to the MRT along with other disciplines. The purpose of the MRT is to decrease the number of unnecessary admissions to Critical Care, decrease the number of code blues and to decrease the mortality rate throughout the hospital.
Patients are monitored from the bedside and with a central monitor located at the nursing station. Using Epic (our electronic medical record) nurses can easily see vital signs and other patient data that is automatically pulled into the patient’s electronic chart. This process saves time and allows the nurse to spend more time at the bedside. A computer is located inside every patient room with several located at the nurse’s station and on rolling carts. To prevent medication errors and improve patient safety, Critical Care uses electronic bar code medication administration.
Special equipment used in Critical Care includes ventilators, intra-aortic balloon pumps (IABP), continuous renal replacement therapy (CRRT), ICP monitoring, temporary pacemakers and arterial BP monitoring. Supplies are located in convenient areas close to the patient and are standardized among the department. Electronic supply servers called Omnicells are used to track and order supplies as well as medications.
Staffing ratios range from 1:1 to 3:1, depending on patient need and acuity. On average, nurses in Critical Care will be assigned only 2 patients. Patients are cared for 24 hours a day by registered nurses who are assisted by unit clerks and nurse assistants. A clinical supervisor works each shift along with an additional supervisor or relief charge nurse. These leaders do not have patient assignments and are available to participate in MRTs and Code Blues as well as supervise the unit’s daily functions. Critical Care also has a full-time nurse educator, clinical pharmacist and nurse manager dedicated to serving the needs of both staff and patients.
Nurses in Critical Care work 12-hour shifts starting at 7AM or 7PM. A four-week schedule is created by the staff utilizing a self-scheduling model. Nurses are scheduled to work every fourth weekend. When census is low staff may be placed “on call” or given low census, depending on the number of nurses needed for the shift. On-call and low census is rotated among nurses to allow flexibility for those that wish to work rather than be placed on call. Critical Care is a closed unit and does not float to other areas of the hospital.
Critical Care nurses attend specialized classes when hired and on a continual basis. This includes a dysrhythmia course. ACLS must also be obtained within one year of hire. Educational offerings are posted regularly so that nurses can fulfill continuing education requirements. New graduate nurses usually require 12 weeks of orientation under the direction of a preceptor. Experienced nurses usually require less orientation than new nurses. The length of orientation is individualized based on experience and background.
Rather than requiring annual skills testing, Critical Care staff attends bimonthly classes where they treat simulated patients in disease oriented scenarios. Along with providing ongoing critical care education, there is a long term goal of providing the training and education needed to obtain an advanced certification in Critical Care (CCRN). The CCRN is encouraged for all nurses in Critical Care but not required.
To work in open heart recovery nurses are required to work in Critical Care at least 1 year before being trained in that area. Working in Open Heart Recovery is optional. Specialized care such as CRRT, ICP monitoring and IABP may require specific training, classes or orientation time beyond the initial orientation period.
Continuous Quality Improvement
Staff members are active in continuous process improvement initiatives that impact Critical Care and the entire hospital. These committees include teams such as the Skin Breakdown and Prevention team, Critical Care infection prevention team, Foley catheter team, MRT stroke team and more. A major focus in Critical Care consists of the prevention of Ventilator-Associated Pneumonia (VAP) as well as other hospital acquired infections. Staff nurses may be involved with many other initiatives like planning for the new hospital and other organizational initiatives. Unit specific goals are set by the department manager each year and often relate to quality initiatives such as VAP and fall prevention.
The Critical Care performance improvement committee (CCPIC) meets the second Tuesday of each month to discuss pertinent issues related the department. This staff driven committee takes issues from all staff members who may have concerns. The CCPIC meets to resolve any issues as well as provide feedback for new workflows and initiatives for Critical Care.
Critical Care conducts multidisciplinary rounds Monday-Friday on select patients within the unit. Rounds consist of a dedicated Critical Care pharmacist, case management, dietician, infection prevention, pastoral care, respiratory care and the nurse assigned to the patient. Rounding promotes nurse and physician collaboration along with expert consultation from our multidisciplinary team which leads to optional patient outcomes, a decreased length of stay and highly satisfied patients and team members.