Surgical Intermediate Care — Unit 46

Unit 46 is a 24-bed inpatient unit located on the 4th floor of the UF Health HVNM Hospital (East Tower). The unit provides a combination of 12 surgical IMC beds along with 12 heart, vascular, neuromedicine medical surgical beds caring for a variety of patient populations represented in the HVNM hospital. This includes neurosurgery, neurology, cardiology, and cardiac surgery, vascular, thoracic and pulmonary patient populations.

The unit has 24 private rooms with monitoring capabilities at each bedside. There are two isolation rooms available. All bed spaces are equipped with hard-wiring at the bedside and remote alarm capability (monitor and ventilator) to the central nursing station and nursing alcoves. The beds have remote telemetry capability for the medical surgical population which is monitored through telemetry boxes and monitored on Unit 66HVN.

Description of Patient Populations

Patients are admitted to 46 surgical IMC from the operating room, emergency room, and/or general floors or transfers from Unit 47 NMICU, or 87 ICU. Patients admitted to IMC require monitoring and/or interventional therapy at intervals of every 2 hours. For the MS admissions, patients are admitted from the emergency room, cath lab, PACU, hospital to hospital, Unit 77 ICU/IMC, Unit 76 ICU/IMC, Unit 87 ICU/IMC and UF Health clinics. Common conditions include those with a cardiovascular medical – surgical and intermediate care diagnoses including vascular disease, acute coronary syndrome, coronary artery disease, respiratory insufficiencies, thrombolytic therapy, those requiring cardiac catheterization for intervention and/or diagnostic testing. Ages of patients served include adult, middle adult and older adult. Average length of stay is: 3 days.

A team of healthcare workers, physicians (attendings, residents, Interns, specialists, and advanced practice providers), nurses, social workers and ancillary personnel (Support Tech, PCA) work together to provide care for these patients.

Nursing Care

The focus of nursing care is on the assessment, diagnosis, planning, treatment and evaluation of patients requiring acute 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 based on average occupancy of the unit, individual competency and experience. Strategies to ensure adequate staffing include active recruiting, 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. Each surgical and medical service on the unit consists of attending physicians, fellows/chief residents, residents/interns physician assistants, nurse practitioners and medical students. The scheduling of the rotation is maintained through the Department of Surgery/Medicine.

Nursing Management for the unit includes a Nurse Manager, Karen Perrin, MSN, RN, APRN, ANP-BC, Clinical Leader, Katherine Smith, BSN, RN and Unit Assistant, Grace DeJesus. Support technicians provide clerical and mobility support.

Multidisciplinary, comprehensive care of these patients and families is provided by medicine, nursing, respiratory therapy, pharmacy, social work services, case management, pastoral care, food & nutritional services, rehab services, and other health care providers as indicated by the patient’s health status and identified needs.

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 74% and 26% PCA. IMC assignments are up to 3 patients depending on patient acuity. The medical surgical patients are 1:4 or 5.

The staffing plan is based on a budgeted 12.34 HPPD, acuity of 2.0 and HPWI of 6.87. Staffing is reflected in the Targeted Staffing projections in the online staffing system and are based on the census. Additional staffing needs are met on Unit 46 as described in the Hospital Plan for Nursing Care. The Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care and nursing policy, determines the need for extra shifts/overtime.

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 10 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 1/31/2021

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