Hospitalist Medicine — Unit 75

75 MS is a 36-bed inpatient adult medical unit located on the north wing of the seventh floor in the Patient Services Building. The unit consists of 12 private rooms, including 2 negative isolation rooms, and 12 semi-private rooms. The two isolation rooms were constructed with negative air flow capabilities. Capability exists to monitor patients with continuous pulse oximetry to a central monitor in the nursing station as well as remote telemetry monitored by unit 64.  The average bed occupancy is 76% (decrease due to COVID-19).

Description of Patient Populations

Patients are admitted to Unit 75 MS with general medical conditions that require in-patient hospitalization. The unit serves a home base for the hospitalist Services. The services of Unit 75 Medicine have a strong statewide and South Georgia referral base accepting patients as hospital-to-hospital transfers and admissions from the Emergency Department.  Common admitting diagnoses include chronic obstructive pulmonary disease (COPD), diabetes, acute infections, pancreatitis, gall bladder disease, morbid obesity, pneumonia, sickle cell crisis, end stage renal disease and COVID-19 (March 2020 unit became designated med/surg COVID unit).  Average length of stay for patients is 6.24.

Nursing Care

Nursing care is based on the total patient care model which focuses on assessment, diagnosis, planning, treatment and evaluation of cardiac and medical patients from admission to discharge with emphasis on cardio-pulmonary assessment, airway management, patient/family education and support, and initiation of the rehabilitation process. The 75 Medicine unit/role specific job descriptions identify the patient populations/common diagnoses served, equipment utilized, competences required to perform treatments/procedures, monitoring of clinical parameters, initiation and maintenance of safety precautions, and emergency events encountered. Nursing activities consist of: pain management including patient controlled analgesia; wound management including Vacuum Assisted Closure Systems, JPs, Duval drains; respiratory management including pulse oximetry, oxygen therapy and chest tubes; cardiac management including  telemetry; nutritional management including TPN, NG-tube/G-tube/J-tube feedings; assessment and management of abdominal/GI drainage systems including G-tubes, J-tubes, ostomy care, NGTs; medication management, safety precautions and patient/family education and support.

Health Care Team

The Hospitalist Service provides care for the patient population on unit 75.  Patient Care Resource Managers and Case Managers serve as liaisons between the Hospitalist medical staff and multidisciplinary team, providing continuity of care for medical patients from admission to outpatient follow-up.  Available support services for Unit 75 Medicine patients include: Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutrition Services, Wound and Ostomy care, as well as Patient and Family services. Collaboration on the unit is fostered by daily patient care conferences attended by nursing staff, medical staff, Patient and Family Services personnel and additional disciplines as needed.

The nursing management structure consists of a Nurse Manager and Clinical Leader with support from a Unit Assistant.   Department of Nursing staff provides training experiences to attain and maintain competences as defined by the unit/role specific job descriptions and the departmental education plan. Registered Nurses, Patient Care Assistants, and Support technicians provide care for all patients.  Support technicians provide a dual role in their responsibilities such as clerical support for the direct patient caregivers and directing the mobility program on the unit. The Registered Nurses are responsible for coordinating the care of the patient(s) based upon an individualized plan of care.

Staffing Plan

Nursing care on Unit 75 Medicine is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care).  The Patient Care Assistants (PCA) is assigned under the direct supervision of the Registered Nurse (RN).  Unit Support Tech coverage is available 24 hours a day.  Skill mix is 70% RN, and 30% PCA. The predominant staffing ratio of nurses to patients is 1:4 on days and 1:4 on nights.  The Charge Nurse (CN) occasionally takes a reduced patient assignment. On all shifts, the 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, patient/family requests, monitoring capabilities, and skills required.  Patients requiring 1:1 observation as a result of safety concerns are assigned sitters.  Sitter requests are coordinated through the Central Staffing Office.

The staffing plan is based on a budgeted 9.25 direct HPPD, 6.38 HPWI, and acuity of 1.45 and adjusted for the skill mix as identified above.  Staffing Grid based on the budgeted HPPD, acuity, and HPWI is identified below. Adjustments to this grid are reflected in the Targeted Staffing projections in Concerro and are based on the census and acuity of classified patients (QuadraMed Classification System).  Additional staffing needs are met on Unit 75 Medicine 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 additional shifts/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 8 Registered Nurses, 2 PCA’s and 1 Support Techs.

Requests for Scheduled Paid 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 to prevent any interruption in patient care.

Reviewed & Revised 2/1/2021

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