Best "level" for hospital and NICU
Level 1 hospital: good. Teaching hospital with multiple care pathways and can handle multiple patients.
NICU: level 3 is the best
Open critical care unit
-multiple staff is coming and going, physicians, ancilary staff, nurses, all managing a patient
-most typically used
closed unit (ICU)
certain staff including an intensivist who managed your patient. Great, unless the intensivist missing something, or something special happens that's not in the intensivists realm of specialty.
Biggest problems for critical care patients
-they are vulnerable
-complex, multiple-step process
SBAR with another R
Situation, background, assessment, recommendation, and don't forget to recite it back
Two rule challenge
if you call the provider and you don't get a reasonable solution, restate what you think is approrpriate, restate why you think it's appropriate, and if you still don't get what you need, contact another provider
Who makes national patient safety goals
prevent ventilator associated pneumonia
*head of bed elevated 30
*oral care every 2 hours
*sedation vacation every 24 hours
*peptic ulcer prphylaxis within the first 24 hours of mechanical ventilation
*DVT thrombosis w/i 24 hours on vent
prevent central-line associated blood stream infection
improved cognitive and functional outcomes for ICU survivors
-A: airway B: breathing C:coordination D: delirium monitoring E: exercise/early mobility
prevent sepsis & septic shock
The Safe Medical Device Act
Require that hospitals report serious or potentially serious device-related injuries to the U.S. Food and Drug Administration (FDA).
All implantable devices must be documented and tracked with the FDA.
AACN 4 A’s
When you're in a facility and the policies prevent you from doing what you know needs to be done
Personal Moral standard