cvsicu bedside patient report

Do nurse bedside shift studies on patient experience with care report limitations?

The majority of the studies on nurse bedside shift report that discuss patient experience with care have limitations.

How do you write a bedside report on a patient?

It should start outside of the patient's room covering the general information history what's occurred, then kind of go through a head‐to‐toe assessment of what's going on. Then you go into the room and you can finish the bedside report at the bed, looking at all of the things that you might have noted.

What do bedside shift reports tell us?

Bedside shift reports: what does the evidence say? Bedside shift reports are viewed as an opportunity to reduce errors and important to ensure communication between nurses and communication. Models of bedside report incorporating the patient into the triad have been shown to increase patient engagement and enhance caregiver support and education.

Why can't nurses monitor two (2) patients in The CVICU?

When cardiac patients were admitted to the CVICU unit there was a standing order for continuous monitoring for these patients. However, nurses could only monitor two (2) patients since the nurses’ telemetry screens only provided split-screen data for two patients in each of the patient’s separate rooms.

Handoff from the Anesthesiologist to the Intensivist in the CVICU

There’s no better way to build rapport and confidence amongst a team than direct communication between healthcare professionals. To read the body language of your colleague and interact with them after the patient arrives in the CVICU from the OR is key. Some hearts are routine and the dynamics are a bit more nonchalant.

Learning to Use the Swan-Ganz (Pulmonary Artery) Catheter

I will get to my personal breakdown on this but, for the moment, these authors did a better job than I ever could at breaking down the pulmonary artery catheter. Feel free to download these papers as they are free and a fantastic resource.

Goal-Directed Hemodynamic Therapy

There are different ways in the literature describing how you can provide goal-directed hemodynamic therapy (GDHT). Goal-directed hemodynamic therapy can be defined as the use of cardiac output or similar parameters to guide intravenous fluid or inotropic therapy.

Giving too much fluid is bad

Haase-Fielitz et al. published a single-center, prospective cohort study with 282 patients where they wanted to see how certain interventions affected the incidence and severity of acute kidney injury.

What is the ballpark amount of fluids cardiac surgery patients receive in the post-op period?

We’ve all seen patients receive liter after liter of fluids to make the blood pressure pretty in the resuscitation of cardiac surgery patients in the CVICU.

Guidelines for Perioperative Medication Management

Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, Dunning J, Gudbjartsson T, Linker NJ, Sandoval E, Thielmann M, Jeppsson A, Landmesser U. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018 Jan 1;53 (1):5-33. doi: 10.1093/ejcts/ezx314.

Why do CVICU Patients develop acute kidney injury?

Sirvinskas et al. noted that acute kidney occurs in about 8% of patients who undergo cardiopulmonary bypass and have bad kidneys to start and then 3-4% of the normal kidney population. Overall 5-30% of patients develop AKI. Other factors include:

What is the CVICU?

Staff in the CVICU, sometimes called the CTICU (cardiovascular thoracic ICU), care for critically ill patients with cardiac, thoracic and vascular conditions.

What does a CVICU nurse do?

CVICU nurses assess and provide care for patients dealing with cardiothoracic conditions and diseases. They’re constantly evaluating their patients since the patients are usually extremely sick and can take a bad turn at a moment’s notice.

Characteristics and traits of a strong CVICU nurse

A lot of nurses can perform the functions of working in that kind of environment, but what does it take to thrive? Especially when first starting out, you have to get comfortable with being uncomfortable. The acuity of CVICU patients is high, and there’s always going to be things you don’t know.

What is rewarding and challenging about CVICU nursing?

The challenge of managing such critical patients is one of the rewarding parts of CVICU nursing, according to Karbach. “The amount of numbers you need to remember and the correlation between those numbers and clinical picture make each patient a complex puzzle that when solved, can hopefully get them out of the ICU,” Karbach says.

How to become a CVICU nurse

The first step on the road to becoming a CVICU nurse is to become a registered nurse (RN). To become an RN, you’ll need a degree—either an Associate’s Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN)—and meet all other requirements for state licensure. Once licensed, you’ll be qualified to apply to a variety of nursing positions.

Is CVICU nursing in your future?

CVICU nursing is unique in the acuity of the patients but also the dramatic recovery that CVICU nurses get to witness and the healing they play a big role in. If you’re up for those extremes, the CVICU might be the right fit for you.

What happened to Nurse Griffin?

Nurse Griffin believed it was her professional responsibility to safeguard all her patients. For her actions, Nurse Griffin was terminated. Ms. Griffin filed a Florida Whistle-Blower Act lawsuit in Broward County, Florida.

What is the suit against the Florida Hospital for failing to monitor cardiac patients?

The suit alleges that failing to continuously monitor elderly cardiac patients constituted “neglect of an elderly person or disabled adult under Florida law.” In addition, the suit indicates that the hospital required Ms. Griffin to sign an electronic medical record claiming cardiac patients were continuously monitored when the hospital knew that was not true. The suit asserts that the falsification of medical records was done to receive federal funds in violation of Federal law. Finally, the suit contends that the hospital received Medicare payments when it failed to meet a “minimum nurse-patient ratio of one nurse to two patients” that must be obtained under Federal regulations.

How much has HCA paid out?

Over the last 20 years, HCA has reportedly paid out close to 2 billion dollars in criminal and civil damages, penalties, fines, settlements, etc. for various fraudulent or illegal schemes. While there is extensive press coverage on these lawsuits and penalties, here is one report. NY Times on HCA False Claims.

Why is there no continuous monitoring for a third patient?

For the third cardiac patient, no continuous monitoring could occur due to the technical limitation of the split-screen that only serves two patients . In addition, as a back-up, the hospital did not provide full-time staff at the CVICU nurse’s station to monitor telemetry for all CVICU patients.

Is Westside Regional ER assigned high acuity patients?

A nurse working in the Westside Regional ER has reported to Hospital Watchdog being assigned three high acuity patients (needing a high level of care). These patients were scheduled to be transferred to an ICU as soon as beds were available.

Did Nurse Griffin get fired?

Hospital Watchdog has been informed by another nurse from Westside Regional that after Nurse Griffin was fired the hospital changed its policy and now continuously monitors all patients in the CVICU. Though Nurse Griffin was fired, it appears her advocacy had a significant impact.

Is Nurse Griffin substantiated with medical records?

Comment: The two case examples provided by Nurse Griffin are not substantiated with medical records or other documentation. However, there are CMS Statement of Deficiency reports describing circumstances where ICU nurses were unaware of their patients deteriorating vitals due to a lack of proper monitoring.