Thoracic & Vascular Surgical Intensive Care Unit — Unit 87

The Unit 87 Thoracic & Vascular Surgical Intensive Care Unit is a 24-bed inpatient unit located on the 8th floor in the East Heart/Vascular/Neuroscience Tower. The unit consists of twenty-four private rooms with bedside monitoring, bedside computer documentation, and barcode scanning capabilities for labs and medications.

There are two negative laminar airflow isolation rooms.  All bed spaces are equipped with hard-wired clinical monitoring with central remote alarm capability (monitors and ventilator) to the nursing station and adjacent nursing alcoves. Bedside monitoring capabilities include continuous 5-lead electrocardiogram, pulse oximetry, capnography, and invasive/ non-invasive hemodynamics. Care is provided 24 hours per day, 7 days per week.

Description of Patient Populations

Patients are admitted to Unit 87 Thoracic & Vascular Intensive Care (TVICU) following moderate to complex surgical procedures, as a surgical referral from outlying hospitals, or preoperatively for evaluation and treatment. Patients may also transfer from the Emergency Department, procedural areas and from the med/surg floor when increased need for continuous cardiovascular, respiratory, or other acute intervention arises. The surgical patient populations include, but are not limited to, post-surgical procedures pertaining to the following: Abdominal aortic aneurysm repair, vascular bypass surgery, lung resection, tracheal and esophageal repair, and lung transplantation. Surgical adolescent, adult and geriatric patients are the acceptable patient population.

Patients may be treated for a variety of comorbidities in addition to their acute states.  Often interventions are ordered and focus on patients in states of septic, hypovolemic, hemorrhagic and/or cardiogenic shock. Common medical procedures and therapies performed in the unit include: arterial, central venous, and pulmonary artery line placement, chest tube placement and removal, intubation and extubation, temporary cardiac pacing, mechanical ventilation, continuous renal replacement therapy (CRRT), hemodialysis, percutaneous tracheostomy, hypothermia/temperature management for patients s/p cardiac arrest and cannulation for extracorporeal membrane oxygenation (ECMO).

Nursing Care

Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring intensive, preoperative and post-operative surgical care with emphasis on thoracic and vascular surgery. Nursing activities include hemodynamic (arterial, central venous pressure, pulmonary artery pressures, intra-abdominal pressures, arterial/venous oxygenation, and capnography) monitoring, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management in both the mechanically-ventilated and spontaneously-breathing patient, massive volume resuscitation, postoperative recovery, specialized wound care, nutritional therapy, medication management, and comfort/sedation 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. Family engagement is highly encouraged during interdisciplinary patient rounds. Additional unit requirements for registered nurses include competencies in temporary epicardial pacing, PA catheter removal, pleural chest tube removal, CRRT, and ECMO.

Health Care Team

The Medical Director for Unit 87 is a Transplant Pulmonary Attending physician. The Critical Care Medicine (CCM) faculty, fellows, residents, and advanced practice providers (APP), in conjunction with the patient’s surgical service faculty, fellows, residents, and APPs provide 24-hour care, 7 days per week for Unit 87 TVICU surgical patients. Multidisciplinary, comprehensive care of these patients and families is provided by medicine, nursing, respiratory therapy, pharmacy, dietary, 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, comorbidities, chronic and acutely identified needs.

The nursing management for the unit includes an MSN prepared registered nurse in the position of Nurse Manager and Clinical Leader with support from a Unit Assistant and Nurse Educator. The management team provides training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the departmental education plan. A shared governance approach allows for a decentralized focus to leadership through the collaboration of a Unit Practice Council (UPC), the Nurse Educator, and formal leadership staff to provide support and motivation. Unit staff includes registered nurses and unit support techs.

Registered nurses on Unit 87 TVICU not only meet the basic requirements for Registered Nurse licensure, but they must also function in accordance with the unit-based job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for registered nurses include a positive and hospitable attitude that contributes toward a healthy work environment among colleagues and a patient centered, family-oriented atmosphere that welcomes visitation that contributes to healing. National certification is highly encouraged and expected.  After substantiation, certification is supported by the institution financially through reimbursement of testing costs.

Support techs meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for Nursing Care.  Additional unit requirements for the support techs include having a positive attitude toward family-centered care displayed in a healthy work environment.

Staffing Plan

Nursing care on Unit 87 TVICU is based on the total patient care delivery model with coworker assistance. Support tech coverage is available 24 hours a day. Skill mix is 100% RN. The staffing ratio of nurses to patients is 1:1 or 1:2 based on the prescribed level of care and ongoing needs of the patient. The staffing plan is based on a budgeted HPPD (21.85), and adjusted for average census (22.2), acuity, and HPWI (6.94).

Patient care assignments are made each shift by the Charge Nurse, as described in the Hospital Plan for Nursing Care. Additional unit-based considerations for staffing needs include:

  • Impact of complex family/social situations
  • Off-unit requirements for procedural transports and assistance
  • Continuity of care needs
  • Experience and competency level of RN staff assigned

Additional staffing needs are met on Unit 87 TVICU as described in the Hospital Plan for Nursing Care.  The need for extra shifts/overtime is determined by the Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care.

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.

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 disasters, the minimum amount of staff required to safely operate up to 75% capacity would be 13 registered nurses and 2 support techs.

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