Medical Intermediate Care — Unit 11-4

11-4 IMC at UFHealth Shands is a 24-bed unit located on the 11th floor of Shands North Tower. 11-4 IMC consists of 24 large, private rooms.

Monitoring of patients include in room Hewlett Packard bedside monitors each capable of monitoring ECG/telemetry, invasive pressure monitoring (Arterial Lines), temperature, blood pressure and oxygen saturation. All monitoring parameters are transmitted via hardwire to the central station having capability to print ECG strips using a strip printer and other parameters using a laser printer. 11-4 IMC provides treatment for patients requiring complex stabilization and care.

Description of Patient Populations

The 11-4 IMC provides intermediate care for adult high-risk medical and surgical patients. Common medical diagnoses include respiratory failure (i.e., COPD exacerbation, asthma and pneumonia), non-invasive ventilator support (BiPAP, CPAP) sepsis with/without multi-system failure, GI bleed, infectious diseases, cardiac and hypertensive emergencies, renal failure, endocrine dysfunction including diabetic ketoacidosis, thrombolytic drug therapy, and vasoactive drug therapy. Common surgical diagnoses include resections of cancers of the respiratory tract, feeding tube placements and amputations.

Patients are admitted from the Emergency Department to the IMC, referred from other hospitals, transferred from med-surg units requiring a higher level of care or who have had a worsening in condition, and patients requiring complex cardiovascular or pulmonary management and intervention.  A team of healthcare workers, physicians (Attendings, Residents, Interns and specialists), nurses, social workers and ancillary personnel work together to provide this excellent care and service.

Nursing Care

Nursing care is based on the total patient care delivery model with co-worker assistance that is focused on the assessment, diagnosis, planning, treatment, and evaluation of patient’s frequent intervention in treatment.  Nursing activities include hemodynamic monitoring, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management, specialized wound care, nutritional therapy, medication management, and comfort/sedation measures.

The nursing patient care focus model is centered on patient and family education/emotional support related to the patient’s condition and treatment, which is an essential element in the nursing care provided.

A Charge Nurse is present each shift (see staffing model below). Clinical Manager and Clinical Leader prepare the staffing schedule and staffing is planned based on average occupancy of the unit, individual competency and experience.  Strategies to ensure adequate staffing include encouraging overtime work, use of CSO staff, and use of agency staff.  Meetings, staff education, activities, etc. are factored into the scheduled staffing.

Health Care Team

Care is provided to patients 24 hours a day/ 7 days a week.  Scheduling of rotations is maintained through the Department of Medicine.  Medical coverage is provided by the patient’s primary care team as well as opportunities for consultation groups.  Department of Nursing Staff and unit management provides training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and departmental education plan.

Staffing Plan

Nursing care on the IMC is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance.  The Patient Care Assistant (PCA) is assigned under the direct supervision of the Registered Nurse.  Skill mix is RN 80% and 20% PCA.  IMC assignments are up to 3 patients depending on patient acuity.  The staffing plan is based on a budgeted 14.53 HPPD, acuity of 2.23 and HPWI of 6.1. Adjustments to staffing are reflected in the Targeted Staffing projections in Concerro and are based on the census and acuity of classified patients (QuadraMed Classification System).

On all shifts, the Charge Nurse (CN) is available to all staff for consultation and assistance 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, monitoring capabilities, and skills required for care delivery.

Patient bed assignments are made by the CN and are based upon patient safety concerns, monitoring capabilities, and skill required as well as Admit/ Discharge Criteria per Unit.

Additional unit-based considerations for staffing needs include:

  • Complexity of the patient’s condition (frequency of procedures, emotional needs, physical care needs that are reflected in the Quadramed acuity system.
  • Technology required
  • Relevant safety and infection control issues
  • Previous day’s assignment to provide continuity of care
  • Staff supplement/float RNs will not be assigned patients who are outside their competency/skill level
  • Patient transport requirements

Requests for Scheduled 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.

In the event of an emergency such as severe weather conditions or other disaster, the minimum amount of staff required to safely operate up to 75% capacity would be 12 Registered Nurses, 2 PCAs and 1 Support Tech.

Staff attendance at meetings, education offerings, and other activities are coordinated so that patient care coverage is continuous, as reflected on the shift assignment sheets.  Staff are encouraged to trade shifts for day-to-day STO needs after the deadline for requests has occurred.  Trades should not incur overtime.

Revised 2/02/21

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