Burn Center/ENT/Plastics — Unit 2425

The NT2425 is verified by the American Burn Association and the American College of Surgeons as a Burn Center.  Coordinated inpatient and outpatient services are provided.  NT2425 is located in the North Tower on the fourth and fifth wings of the second floor.

All intensive (ICU), intermediate (IMC), and medical-surgical (MS) adult burn patients, as well as complex wound patients from the Burn, Otolaryngology (ENT), and Plastic Surgery services are housed on the unit.  Intubated/critical pediatric patients are accommodated in the Pediatric Intensive Care Unit located on the tenth floor and step-down for pediatric burn patients is accommodated on the fourth floor of the North Tower Children’s Hospital.  Inpatient and outpatient Burn Service surgical procedures are scheduled Monday through Friday in the North Tower Main Operating Room adjacent to the unit, but may be scheduled at alternate times as needed.  Evaluation and wound care for adult Burn Service outpatients in the acute phase of a minor burn or rehabilitation phase of a major burn is scheduled on Monday, Tuesday, Wednesday, or Thursday, but may be seen at alternate times as needed.  Pediatric burn outpatients are scheduled on Wednesdays.  NT2425 encompasses a twenty-seven bed all isolation room inpatient unit and a five bed outpatient clinic.  All inpatient bed spaces have ICU capable monitoring systems and remote alarms via a central system located at the nurse stations throughout the unit.  Within the confines of the unit, treatment areas for hydrotherapy and outpatient clinics are provided.

The average length of stay on NT2425 is 4.8 days and the average daily census is 21.99.  The Adult Burn Service average length of stay is 10.38 and the average daily census is 15.3.  The ENT Service average length of stay is 3.99 days and the average daily census is 8.32, but at this time the unit accommodates a maximum of 6 ENT patients per day unless census allows for additional.  The Plastic Surgery Service average length of stay is 5.25 days and the average daily census is 4.57 days, all levels of care are accommodated on the unit as patient census allows.  Nursing staff working on NT2425 provide quality patient care to the patient populations on the unit through utilization of the nursing process 24 hours per day, seven days per week.

Description of Patient Populations

The NT2425 unit/role specific job descriptions identify the patient populations/common diagnoses served, the equipment utilized, the skills required to perform treatments and procedures, the clinical parameters monitored, the safety precautions initiated, and the emergency events encountered.  (See attached)

Nursing Care

The nursing management structure consists of a Nurse Manager, a Clinical Leader, and a Financial Coordinator.  Department of Nursing staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job description and the Departmental Education Plan.  Registered nurses who have received specialized training in the Burn Service Operating Room procedures assist with surgical procedures performed on pediatric (>16 years), young adult, middle adult, and older adult patients in collaboration with a Major OR circulator, surgeons, anesthesiologists, and Major OR scrub techs.  Registered nurses who have received specialized training provide care for patients during the Adult and Pediatric Outpatient Burn Clinic. Collaboration with physicians, occupational therapy and/or physical therapy, Child Life, and other consult services also occurs during clinic times.  The nurse is responsible for guiding care of the patient based upon an individualized plan.  Registered Nurses provide nursing care. Monitor Support Techs provide ECG monitoring, clerical support, and mobility assistance for the direct patient caregivers on NT 2425.  Patient Care Assistants assist with wound care, activities of daily living, mobility, point of care glucose testing, and vital signs for the Registered Nurses on NT2425.

Health Care Team

The interim Medical Director is a Burn Surgery attending and an associate professor of the Department of Surgery at UF.  The Medical Director and attending physicians on the Burn, Acute Care Surgery, ENT, and Plastic Surgery services may admit patients to NT2425.  Burn and ENT Advance Practice Providers (APPs) serve as liaisons between the medical staff and the multidiscipline team, providing continuity of care for adult and pediatric patients from admission through clinic follow-up.  Burn Critical Care APPs serve as liaisons between the critical care attending, surgical services, and multidiscipline team for ICU and IMC level patients.  Surgical and anesthesia fellows, residents, and medical students rotate through NT2425 on the Burn, Acute Care Surgery, Anesthesia Critical Care, Medical Critical Care, ENT, and Plastic Surgery services.  The services consist of attending physicians, fellows/chief residents, residents, interns, ARNPs/physician assistants and medical students who provide medical care 24 hours per day, seven days per week. Scheduling of rotations is maintained through the Department of Surgery, the Department of Anesthesia, and the Department of Medicine.  Attendings, fellows, residents, and APPs on the Anesthesia Critical Care service and fellows on the Medical Critical Care service collaborate on the care of those patients requiring ventilator management and stabilization. Multidiscipline collaboration is ongoing, but also formally takes place on daily service rounds and weekly grand rounds.  Available support services for NT2425 include: Respiratory Therapy, Physical Therapy, Occupational Therapy, Speech Therapy, Nutrition Services, Pharmacy Services, Respiratory Care Services, and Patient and Family Services.  The nurses also work closely with pastoral services, and consult services to meet patient care needs.

Staffing Plan

Nursing care on NT2425 is based on the total patient care nursing delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance.  Monitor Support Tech coverage is provided 24 hours/day.  Skill mix is 80/20% RN/Tech.  The predominant staffing ratio of nurses to patients is 1:1-1:3 on day/nights.  The Charge Nurse (CN) on days and nights primarily does not take a patient assignment.  There are two Burn Resource RNs on dayshift and one Burn Resource RN on night shift to facilitate wound care, procedures, admissions, and postops.  On all shifts, the CN is available to all staff for consultation and assistance in providing patient care.  Patient care assignments each shift are made 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/family requests, and skills required.  Patients requiring 1:1 observation due to personal safety concerns are assigned sitters.  Sitter requests are coordinated through the Central Staffing Office.

The staffing plan is based on a budgeted 15.28 HPPD, 5.97 HPWI and acuity of 2.56 and adjusted for the skill mix as identified above.  The staffing grid is based on the budgeted HPPD and HPWI.  Adjustments to this grid are made based on acuity. Additional staffing needs are met on NT2425 as described in the Hospital Plan for Nursing Care. The Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care and the nursing policy determines the need for extra shifts/overtime.

In the event of an emergency such as severe weather conditions or other disasters, the minimum amount of staff required to safely operate up to 75% capacity would be 11 Registered Nurses and 1 Support Tech.

Requests for Paid Time Off (PTO) are reviewed on a case by case basis and will take the staffing needs of the unit into account. 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.

Revision Date: 01/21

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Jennifer Zimmerman, RN, explaining to a parent and her daughter how to use a bedside asthma action plan.