PS1006 SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY TITLE: ADMISSION/DISCHARGE CRITERIA: CARDIOVASCULAR THORACIC STEP DOWN UNIT (CVTSDU) EFFECTIVE DATE: REVISED DATE: POLICY TYPE: (Cardiac) 8/03 1/19 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING NURSING CARE 1 of 5 Job Title of Reviewer: PURPOSE: POLICY STATEMENT: PROCEDURE: Director, Cardiovascular Thoracic Step Down Unit To determine criteria and properties for admission to the cardiac progressive units. To determine criteria for discharge from cardiac progressive care units. The following criteria will be used by the medical and nursing staff in making decisions regarding the admission and/or discharge of patients from the Cardiovascular Thoracic Step Down Unit. Admission Criteria: 1. Patients will be admitted to the Cardiovascular Thoracic Step Down Unit according to the established criteria. In the event a patient needs to be admitted to CVTSDU and all beds are occupied, an attempt will be made to identify patients meeting CVTSDU discharge criteria and transfer/discharge the most stable patient in that unit. Decisions will be made by consensus of the primary nurse and attending physician. The Medical Director will be contacted if resolution of patient placement requires his intervention. 2. In the event the physical assessment, physiological monitoring, and acuity level no longer indicate a need for CVTSDU nursing care, the patient shall be evaluated for transfer/discharge. 3. Cardiovascular IV meds are given on the CVTSDU per SMH Nursing Department Policies 126.155 and 126.156. 4. Patients needing Contact Precautions (such as MRSA, VRE, or C. difficile) will be accepted in accordance with policy 00.IFC.22 Special Precautions; Isolation of Patients using Contact, Droplet and/or Airborne Precautions. These patients will be placed in private rooms. If high census suggests the need to co-hort patients of like organisms, consult the Infection Prevention & Control Department prior to placement. 5. The criteria for patient admission and discharge criteria include:
2 of 5 Pre and Post Cardiac Surgery 1. Patient pre CABG or valve replacement/repair Patients post CABG, valve replacement transferred from the ICU s and 1. Patient able to return to ADL s or able to return to ADL s with Home Health assistance. 2. Ready to transfer to rehab or ACLF. a. Dysrhythmias are controlled. 3. VSS x 24. 4. Lab work stable. b. Hemodynamically stable 5. Rhythm stable x 24. 2. Post CABG, valve repair or replacement patients with temporary pacemakers. 3. Minimally invasive surgical and hybrid repair; percutaneous therapies Acute Coronary Syndrome with unstable angina Acute cardiac dysrhythmias or heart blocks Congestive heart failure acute event 1. Patient has EKG changes consistent with ischemia. 2. Patient is experiencing signs/symptoms of coronary ischemia. 3. Positive cardiac enzymes 1. Dysrhythmia, heart blocks or syncope requiring observation, intervention and/or treatments 2. Patient is hemodynamically stable. 1. Acute respiratory distress with symptoms of hypoxia. 2. Elevated BNP 3. Requiring IV therapy and/or IV diuretic therapy 1. EKG without acute changes. 2. No signs or symptoms of coronary ischemia for 24. 4. Negative cardiac enzymes. 1. Dysrhythmias or heart block stable for 12-24 2. Vital signs stable x 24 1. Absence of signs and symptoms of hypoxia or arrhythmia. 2. IV therapy has been weaned off and patient stable. 3. Stable BNP or return to baseline
3 of 5 Post catheterization including post carotid stent patients Cardiac syncope 1. Post cath patients with abnormal results. 2. Abnormal EKG changes. 3. Dysrhythmias 1. Symptomatic syncope documented or suspected. 1. No bleeding from cath puncture site X 4. 2. Ambulates without chest pain or bleeding. 3. No EKG changes or abnormal cardiac enzymes X 12. 4. Rhythm and vital signs are stable without IV antiarrhythmic agents 5. Neurologically stable x 4 6. Vascular checks stable x 4 1. Rhythm stable X 24 2. VSS for 24. Thoracic Surgical Patients (with or without epidural) or Vascular Surgical Patients (with or without epidural) 1. Patient pre vascular or thoracic surgery for same day or next day per bed utilization. 2. Patients post vascular or thoracic surgery that are transferred from the PACU or ICU and a. Dysrhythmias are controlled b. Hemodynamically stable 1. Patient able to return to ADLs with or without Home Health assistance. 2. Ready to transfer to rehab or ACLF. 3. VSS x 24. 4. Rhythm stable x 24. 5. Neurologically stable overnight 6. Vascular checks stable x 4
4 of 5 Patients who require Pacemaker/ICD or have malfunction New Insertion Suspected malfunction Adjunctive pharmacologic therapy 1. Rhythm stable 2. Stable post-procedure X 24. RESPONSIBILITY: REFERENCES: AUTHOR(S): ATTACHMENT(S): It will be the responsibility of the CVTSDU director to inform the staff of this policy and assure compliance. SMH Nursing Policy. Administration and Nursing care of Adult Patients on Specific IV Medications (126.155). Titrations of Selected Pharmaceuticals for Critical Care Areas, Hemo, PACU, ECC, Cardiac Care, and the Meckler (126.156). SMH: Author. Cynthia Carr, MSN, RN, Clinical Manager, Cardiovascular Thoracic Step Down Unit Elizabeth Blaisdell-Breault, BSN, RN, NPD, 7CYT None
5 of 5 APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Date 1/4/19 Julie Polaszek, Director, Cardiac Committee/Sections (if applicable): Clinical Practice Council 1/3/19 Vice President/Administrative Director (if applicable): Name and 1/10/19 Name and Connie Andersen, Vice President/Chief Nursing Officer