Start Date: 09/25/2022

End Date: 12/24/2022

Status: Open

Total Positions: 5

Skill: RN Telemetry

Duration: 13 - Weeks

Location: NY - St. Peter's Hospital

Shift Start Time: 19:00:00

Shift End Time: 07:30:00

Description:
Type of Patients Served

4Pavillion (4 PV) is a 39-bed telemetry unit that serves patients requiring cardiac care. Services provided include inpatient comprehensive care to a population consisting of heart failure, AMI, unstable angina, syncope, cardiac dysrhythmias, drug toxicity, pulmonary edema, CVA, TIA and post-intervention patients. The patient focused care model is utilized for patients remaining on 4P from admission to discharge.

Ages of Patients Served
The primary population of 4P includes the adult and geriatric population.

Current Services for Patients and Patients’ Families:

Frequent Procedures, Processes, Services
• Cardiac Monitoring
• Procedures: Cardiac catheterization patients, PM/ICD placement, and ablations
• IV anti-dysrhythmia medications

Scope and Complexity of Patient’s Care Needs
4P serves as a place for monitoring and care of patients with cardiac disease processes that have the potential for physiological instability. The level of care on 4P is a higher level of care than that available on the medical-surgical units.

Criteria for Entry to Services
A. Cardiac System:
1. Low-probability myocardial infraction; rule out myocardial infarction
2. Hemodynamically stable myocardial infarction
3. Any hemodynamically stable patient without evidence of myocardial infarction but requiring temporary or permanent pacemaker
4. Mild-to-moderate heart failure with shock
5. Hypertensive urgency without evidence of end-organ damage
6. Unstable angina
7. Endocarditis/Myocarditis/Pericarditis/Coronary Insufficiency
8. Evaluation for Coronary Artery Disease (CAD)
9. Acute Coronary Syndrome, hemodynamically stable
10. Patients having received interventional/diagnostic procedures
B. Pulmonary System:
1. Hemodynamically stable patients with evidence of compromised gas exchange and underlying disease with the potential for worsening respiratory insufficiency who require frequent observation and/or nasal continuous positive airway pressure
2. Patient who require frequent vital signs or aggressive pulmonary physiotherapy


C. Neurologic Disorders:
1. Patients with stroke who require frequent neurologic assessments or frequent suctioning or turning
2. Patient with chronic but stable neurologic disorders, such as neuromuscular disorders, who require frequent nursing intervention
D. Drug Ingestion and Drug Overdose
1. Any patient requiring frequent neurologic, pulmonary, or cardiac monitoring for a drug ingestion or overdose who is hemodynamically stable
E. GI Disorders
1. GI bleeding with minimal orthostatic hypotension responsive to fluid therapy
2. Variceal bleeding without evidence of bright red blood by gastric aspirate and stable vital signs
3. Acute liver failure with stable vital signs
F. Endocrine
1. Diabetic ketoacidosis patients requiring frequent injections of regular insulin during the early regulation phase after recovery from diabetes ketoacidosis
2. Thyrotoxicosis, hypothyroid state requiring frequent monitoring
G. Surgical
1. The postoperative patient who, following major surgery, is hemodynamically stable but may require fluid resuscitation and transfusion due to major fluid shifts
H. Miscellaneous
1. Appropriately treated and resolving early sepsis without evidence of shock or secondary organ failure
2. Patients requiring closely titrated fluid management. Acceptable IV infusions, but not limited to:
• Dopamine (maximum 5 mcg/kg/min)
• Nitroglycerin
• Milirone
• Cardene (not requiring continuous titration)
• Integrillin
• Cardizem
• Amiodarone
• Lidocaine
• Lasix infusion
• Dobutamine
3. 23 Hour cardiac-observation patients

? The attending physician has the authority to make the ultimate decision as to the appropriateness of admission.
? Conflicting problems in treatment and/or management regarding patients and/or policies of the unit will be referred to the Directors of Critical Care, who will have the final decision.

Hours of Operation- 4 Pavilion is operational 24 hours a day, seven days a week.



Methods Used to Assess Patient/Patient Population Care Needs

Processes:
Evidence based assessment tools will be utilized in the assessment and evaluation of patient care needs. An individualized plan of care will be implemented upon admission and continuously updated to meet changes in the patient’s condition.


Methods Used to Determine Extent to Which Patient Needs are Met and Services Adjusted
Services:
Care will be provided to patients and patient families that include physiological, psychological, spiritual, and social needs in a collaborative team approach.

Staffing

Budgeted
Optimal staffing is achieved by established staffing patterns, which provide an optimum number of hours of care per patient day.

Minimum
A staffing plan is developed to include the number and mix of staff, provide a minimum number of hours of care per patient day to meet anticipated needs of the patient.

Qualifications of Staff

Registered Nurse
• Current Basic Life Support
• Successful completion of unit specific orientation and Cardiac workshop (within 6 months of hire).
• Advanced Cardiac Life Support (within 6 months of hire)
• Annual Cardiac Competency Validation
A. Respiratory Therapist:
• Current Basic Life Support
• Successful completion of Core Orientation
B. Patient Care Associates
• Successful completion of orientation program
• Current Basic Life Support
• Annual Competency Validation
• Successful completion of Basic Cardiac Dysrhythmias Course if appropriate for HC coverage.
C. Information Associate:
• Successful completion of the orientation program



Methods used to adjust staffing

Staffing on 4P will be adjusted every shift and at peak activity times based on changes in the census and/or acuity. It will be the responsibility of the charge RN to determine the appropriate changes, calling on the Nurse Manager/ Supervisor for assistance.


Goals of Department/Unit
• Provide quality patient care
• Maintain a collaborative multi-disciplinary approach to care utilizing the patient care focused care model
• Maintain overall positive patient outcomes
• Decrease length of stay while maintaining a high standard of quality



Methods for Communication, Collaboration, and Funtional Relationship with Other Departments and Services
Services
A. Internal: In order to provide for collaborative informed participation of all staff members within 4P, unit staff meetings are held monthly. Additionally, Management, Leadership, and unit Quality Improvement Committee meetings are held monthly as needed. There are several communication boards and communication books strategically located within each unit, in the break room to provide posting of notices, unit specific needs/information and educational information. Also provided within the communication books are mandatory reviews, meetings and QI information. Notices for all meetings are posted or communicated by e-mail.

B. External: Communication is accomplished through collaborative programs within the Cardiac Center. Communication between the Cardiac telemetry units occurs at monthly meetings. Communication occurs between the Cardiac telemetry units, other units within Patient Care Services, and other hospital departments, including divisional and hospital based committees is also a means of communication. Senior rounding occurs monthly on each unit with Staff, this