Medicine — Unit 11-5

Unit 11-5 is a 24-bed adult inpatient medical-surgical unit located on the eleventh floor of the North Tower.  The unit is comprised of twenty-four private rooms, including two negative pressure isolation rooms. Monitoring capabilities include continuous pulse oximetry on the unit and remote cardiac telemetry monitoring from Unit 64. Patients requiring close monitoring are assigned near the nursing station.

Description of Patient Populations

Patients admitted to unit 11-5 are medical-surgical patients requiring inpatient hospitalization and care. The unit primarily serves medicine patients (including Medicine Red, Medicine GI, MHS, FAM, MGO, MOR, MGR, MBL). Patients include unit-unit transfers (e.g., from intensive care units or the intermediate care units), clinic transfers, admissions from the Emergency Department, and hospital-to-hospital transfers. Common admitting diagnoses include chronic obstructive pulmonary disease (COPD), diabetes, acute infections, pancreatitis, liver disease, gall bladder disease, morbid obesity, pneumonia, sickle cell crisis, end stage renal disease and other medical conditions.

Nursing Care

Nursing care is focused on the assessment, diagnosis, planning, intervention, and evaluation of the medical patient from admission to discharge. Emphasis is made on the holistic delivery of care and focuses on the importance of a head to toe assessment. Patients and family are given emphasis as recipients of education and teachings as well as their collaboration in the delivery of their care. Nursing activities comprise of: pain management including patient controlled analgesia; ambulation and/or physical activity (ROM-active or passive); wound management including Vacuum Assisted Closure Systems, JPs, Duval drains; 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

Patient care on 11-5 is a collaborative approach in the progression of care with the intent of decreasing length of stay and improving patient outcomes. Multidisciplinary collaboration is emphasized between the nurses, physicians, social services, rehab services and nutrition services with the intent to safely plan and progress discharge planning at the time of admission leading to the day of discharge. Interdisciplinary resources that are available on Unit 11-5 include: Respiratory Therapists, Physical and Occupational Therapists, dietitian, TPN nurse, WOCN nurses, rapid response teams (STAT nurses), Patient-Family Services, IV nurse, and Pastoral Services.

The management team comprises of the Nurse Manager and the Clinical Leader, with support provided by the Unit Assistant under the supervision of an Associate Vice President of Nursing Services. The Nursing staff is provided with opportunities for training and learning experiences to enable competency as defined by the role in the job description and departmental education plan. There is an emphasis towards advancement of degrees as well as national certifications. Registered Nurses (RN) and Patient Care Assistants (PCA) provide nursing care.  Support Techs (ST) provide clerical support and help guide patient mobility.  The RN is responsible for guiding care of the patient based upon an individualized plan.  PCA and ST meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for the Provision of Nursing Care.

Staffing Plan

Nursing care on 11-5 MS is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with co-worker assistance. The PCAs are assigned patients under the direct supervision from the nurse. Clerical coverage (support tech) is available 24/7. Skill mix is 75% RN, and 25% PCA. The predominant staffing ratio of nurses to patients is 1:4-5 on days and 1: 4-5 on nights.  The Charge Nurse (CN) occasionally takes a reduced patient assignment as needed. 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 sitters (1:1 observers) for violent or non-violent reasons & Baker/Marchman Acts are coordinated thru the Central Staffing Office. Additional considerations for staffing include: complexity of the patient’s condition (frequency and length of time for procedures, physical care needs) as reflected in the Quadramed system, infection control issues, continuity of care, and transport requirements

Unit staffing is based upon budgeted nursing hours per patient day (HPPD) which is formulated using national benchmarks and historical unit acuity data.  Daily staffing is adjusted based on unit census and  feedback from charge nurses to account for special circumstances that increase patient acuity, such as the need for a sitters, increased number of 1:1 patients, etc. Additional staffing needs are met on Unit 11-5 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.

Requests for scheduled Paid Time Off (PTO) 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 include overtime.

Staff attendance at meetings, education offerings, and other activities are coordinated to prevent any interruption in patient care.  A staff huddle is held at every shift change, and is the primary form of information dissemination. Huddles are attended by all on-going and off-going personnel, as well as management (when present).

Reviewed & revised: 1/6/2021

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