Medical Intermediate Care — Unit 72

Unit UF 72, Intermediate Care Unit (IMC), is a 24-bed inpatient intermediate care unit located on the 7th floor in the Patient Services Building, North Tower. The unit consists of all private IMC capable rooms including 2 negative pressure isolation rooms. Monitoring of patients include 24 Philips bedside monitors each capable of monitoring ECG, NIBP, invasive pressure monitoring, temperature and oxygen saturation. All monitoring parameters are transmitted via hardwire to the central station having capability to print ECG rhythm strips. The unit provides treatment for non-intubated patients requiring complex stabilization and care. Care is provided 24 hours per day 7 days per week.

Description of Patient Populations

Monitoring capabilities include, but are not limited to: EKG monitoring, invasive hemodynamic monitoring, pulse oximetry, and temperature.  The patient population consists of multiple medical diagnoses including, but not limited to, respiratory distress, pneumonia, COPD, CHF, Liver failure, GI Bleed, Renal Failure, drug overdoses, Alcohol Withdrawal, infectious diseases, cancer, and COVID-19.

Nursing Care

Nursing care is focused on the assessment, diagnosis, monitoring, treatment and evaluation of the acutely and chronically ill complex patients. Special emphasis is placed on the use of critical thinking in the ongoing assessment of the critically ill patient. Nursing activities include respiratory management of patient on BIPAP, CPAP, high flow oxygen and oxymizer, continuous EKG monitoring, invasive and noninvasive blood pressure monitoring and intra-abdominal pressures, arterial and venous oxygenation and capnography, monitoring, rhythm interpretation, fluid and electrolyte monitoring, vasoactive and inotropic therapy, postoperative recovery, specialized wound care, nutritional therapy, medical management, rehabilitation initiation, and comfort/palliative care measures as indicated. Patient and family education and emotional support related to the patient’s condition and treatment is an essential element in the nursing care provided. Nurses utilize a multi-disciplinary plan of care to deliver consistent goal directed care. Patient and family education and discharge planning are also important components of nursing care delivered in the unit. 

Health Care Team

Care is provided to patients 24 hours a day/7 day a week.  Scheduling of rotations is maintained through the Department of Medicine.  

Nursing Management for the unit includes a Nurse Manager, Clinical Leader and Unit Assistant. Department of Nursing Staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and departmental education plan.  Monitor Support Techs provide clerical support and central monitor support for the direct patient caregivers. The Registered Nurse is responsible for guiding care of the patient based upon the individualized care plan. The Patient Care Assistant (PCA) provide direct bedside care: assisting patients with ADL’s including CHG bath, mobility, and Glucometer check. PCA are under supervision of RNs.

Staffing Plan

Nursing care on 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. Monitor support technician coverage is available 24 hours a day.  Skill mix is RN 86% and PCA 15%. Each RN is assigned a maximum of 3 patients depending on acuity. The staffing plan is based on a budgeted HPPD 13.2 acuity of 2.1 and HPWI of 6.2 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 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, and physical care needs)
  • 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 consider the staffing needs of the unit. 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, as reflected on the shift assignment sheets.

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 6 RNs and 1 monitor support technicians and 1 patient care assistants.

The staffing plan is based on a budgeted ADC of 22.6, HPPD of 13.2, THPWI of 6.2, and acuity of 2.1

Staffing Decision Points

When assessing staffing at “break points” take into consideration the following:

  • Planned admissions (hospital to hospital transfers)
  • Skill level of staff
  • Shift involved
  • Acuity of pts (# of 1:1’s and boarders)
  • Available resources (stat nurse, management team members)
  • Float for 4-8 hrs only and reassess
  • Notify Nursing Coordinator if workload changes to negotiate clinical support.

1:1 Patients

  1. Unstable hemodynamic, frequent titration of multiple drips
  2. Post arrest hypothermia patients during cooling and warming phase
  3. Massive GI Bleed or Massive Transfusion of patient
  4. CVVH-D unless stable and could be paired with a more stable patient in close proximity
  5. Pulmonary lavage patients during procedure
  6. Patients requiring specific drug desensitization per order set
  7. Some DKA patients
  8. Patients on proning beds
  9. Hemodynamically unstable patients on ECMO
  10. Patients with ASA desensitization

Updated March, 2021

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