Start Date: 09/18/2022

End Date: 12/17/2022

Status: Open

Total Positions: 1

Skill: RN Step Down

Duration: 13 - Weeks

Location: NY - St. Peter's Hospital

Shift Start Time: 07:00:00

Shift End Time: 19:30:00

Description:
Type of Patients Served
Progressive Cardiac Care Unit (PCCU) is a 10-bed telemetry unit that delivers care to patients whose needs fall along the less acute end of the critical care continuum utilizing a patient focused care model. Progressive care patients are moderately stable with less complexity, require moderate resources and require intermittent nursing vigilance or are stable with a high potential for becoming unstable and require an increased intensity of care.

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


Current Services for Patients and Patients’ Families:

Scope and Complexity of Patient’s Care Needs

The PCCU is a place where specialty-educated and trained nurses combine the knowledge and skills of assessment, surveillance, and provision of complex nursing care to provide high-quality patient care. The level of care in PCCU is a higher level of care than that available on standard cardiac telemetry or medical surgical units. Expected length of stay for patients in the PCCU is 24 to 48 hours.

Frequent Procedures, Processes, Services
• Cardiac Monitoring
• Arterial and Central Venous Pressure Monitoring

Criteria for Entry to Services
• Patients experiencing a cardiac disease process including one or more of the following conditions:
A. Cardiac System:
1. Cardiac medication (beta blocker, digoxin) related overdose
2. Hemodynamically stable myocardial infarction
3. Hemodynamically stable complete heart block
4. Any hemodynamically stable patient without evidence of myocardial infarction but requiring temporary or permanent pacemaker
5. Symptomatic heart failure
6. Hypertensive urgency without evidence of end-organ damage
7. Unstable angina
8. Unstable Endocarditis/Myocarditis/Pericarditis/Coronary Insufficiency
9. Evaluation for Coronary Artery Disease (CAD)
10. Acute Coronary Syndrome, hemodynamically stable
11. Patients having received interventional/diagnostic procedures such as valvuloplasty and pericardial drain placement
12. Patients requiring cardiac intravenous infusions with or without invasive hemodynamic monitoring
B. Pulmonary System:
1. Patients with established cardiac disease process with evidence of compromised gas exchange and underlying disease with the potential for worsening respiratory insufficiency who require high-flow oxygenation or non-invasive continuous positive airway pressure and/or invasive hemodynamic monitoring.
C. Neurologic Disorders:
1. Patients with an established cardiac disease process experiencing stroke and requiring frequent and/or invasive hemodynamic monitoring
D. Endocrine
1. Patients with an established cardiac disease process experiencing requiring constant intravenous infusion if insulin.
E. Surgical
1. The postoperative patient with an established cardiac disease process who, following major surgery, requires fluid resuscitation, and/or transfusion, due to major fluid shifts.
2. The postoperative patient with an established cardiac disease process who, following surgery, requires invasive hemodynamic monitoring.
F. Miscellaneous
1. Patients requiring closely titrated fluid management. Acceptable IV infusions, but not limited to:
• Dopamine
• Nitroglycerine
• Integrilin
• Angiomax
• Cardizem
• Amiodarone
• Lasix infusion
• Bumex infusion
• Dobutamine
• Lidocaine
• Milirinone
• Beta blocker
• Cardene
• Insulin
• Neo-Synephrine
2. Examples of appropriate PCCU admissions include, but not limited to:
• STEMI
• Any ACS requiring higher level of care
• Decompensated heart failure or requiring pressers or inotropes
• Bradycardia requiring higher level of care
• Ventricular arrhythmias requiring higher level of care
• Aortic balloon valvuloplasty
• Pericardial drain
• Hypertensive urgency or emergency
• Endovascular aneurysm repair (EVAR)
• Post cardiac and vascular surgery

? The Cardiologist has the authority to make the ultimate decision as to the appropriateness of admission to PCCU.
? Conflicting problems in admission, treatment and/or management regarding patients and/or policies of the unit will be referred to the Chief of Cardiac medicine or designee, who will have the final decision.


Hours of Operation- The Progressive Cardiac Care Unit (PCCU) 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
Staffing Plan
Optimal staffing of the PCCU is achieved by established staffing patterns, which provide a minimum number of hours of care per patient day. See staffing plan for Progressive Cardiac Care Unit (PCCU).

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Qualifications of Staff
Registered Nurse
• Current Basic Life Support
• Advanced Cardiac Life Support (within 6 months of hire)
• Successful completion of unit specific orientation, Cardiac/Critical Care course, and hemodynamic monitoring course (within 6 months of hire).
• Annual Cardiac Progressive Care 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
C. Information Associate:
• Successful completion of the orientation program


Methods used to adjust staffing
Staffing on the PCCU will be adjusted every shift and at peak activity times based on changes in the census and/or acuity. It will be the responsibilities of the charge RN to determine the appropriate changes, calling on the Nurse Manager for assistance when appropriate (the Nurse Manager having the ultimate responsibility).

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