Re: admission criteria

[Guest guest]

Does anyone have a p/p reguarding the admission to your unit. I am the manager

of a small unit that has L & D, post-partum, antenatal, gyn post-op and level II

nursery. Recently we have had admissions of USA, GI bleed, nursing home

patients,ect, because the hospital is full and we have the only beds!! I'm

told we have no choice by the DON, and adm., I've discussed the risk factor

however it seems to fall on deaf ears! Therefore will take this to the medical

committee and need some guidelines if any of you use any. Also what if your

unit is full and you have a OB come in....are they held in ER until bed

available...someone moved? who do you move ect.....any thing you have will be

of help...any suggestions to get adm. to listen re: risk involved with nurses

taking care of unfamiliar patients also.

Thanks ....Willie

[Guest guest]

We have an agreement in our 280 bed hospital (150 births/month) that we will

take hysters, chole pts, GU (Stamey procedures), breast (lumpectomies,

mastectomies, reductions) when our census permits and the " house " is getting

full. We never take anyone over age 70 because our unit is old and there is no

capability for telemetry. We also float to the floors when their census is up

and ours is down. I think I prefer to have the patients on our floor than to

float our nurses out. There is something about being with your peers while

you care for these other types of patients. Good luck with administration.

They don't seem to get it. A nurse is a nurse..................Betsy

[Guest guest]

I worked at a hospital that did 50 deliveries a month and they got everything

on the floor that had breast or a uterus. One night I was in charge and had

two orthopedic post MVAs . I thought I would cardiac arrest...I had not done

ortho since nursing school almost ten years prior and all I remembered was

embolus. In retrospect, I enjoyed the exposure to the med surg. as a

refresher, but I think too that sometimes it is unfair to those people to have

to hear a laboring woman yell through the night. I could here the lawyer

saying, " And when was the last time you took care of an MVA prior to this

night Mrs. Hecker,,,and what made you feel that you were capable of taking

care of a patient outside of your specialty area? " " Well, I called my

supervisor who said if I needed anything to call the ortho nurses. " I do not

think I would have had a leg to stand on if anything had happened. Well out

of my area of expertise.

Post surgery is another thing, because I think the general post surgery

complications are somewhat the same for most patients, I felt somewhat

comfortable with these. I think the biggest thing is for the nurses to have

some idea of the potential complications of the specific patient.

ie....things to look out for since we document to prove that they are doing

okay...it would be beneficial to address the things that are specific to those

surgeries that are not in the ob realm. Like with MGSo4 patients we know the

signs of toxicity so that we document BPs, respirations, DTRs. etc. If we

took someone from another floor, they would probably not realize the

significance of these these...are you getting what I am trying to say? Good

luck, I find it encouraging that there is management out there who cares what

others think..Lori

[Guest guest]

We have a small 14 bed unit and we used to get a few hysts if the surgical

unit was full..but now they have opened a short-stay unit for overnite holds,

and if the floors are busy they send the surgicals there until a bed opens.

We do have one private room that used to be an isolation room that has an

anetroom where if you shut both doors it is really quiet, and several of our

nurses have requested it when they have had surgery...usually simple things

like hyst or gb..we all prefer to be taken care of by our own..we can trust

each other.

Our biggest problem is that our HN is also HN of Peds, and they like to pull

us to peds every so often. Talk about unlike areas....nobody is comfortable up

there, they won't give us the orientation we have requested, and you can't

give meds unless you have passed the peds meds test..they also required their

nurses to be PALS certified, which we are not. If we are slow and float..they

also have the right to pull us back to OB during the shift if needed. I think

it's an infectious committee problem...as all those kids on peds are usually

contagious with rotovirus or some other respiratory thing, and we'd have to

shower and change before going back to our " clean " unit...with the newborns.

Most of the nurses who go to peds also come back ill within a week.. Thank

goodness they have hired more staff up there!! Lori

[Guest guest]

Willie, there must certainly be some guidelines reguarding this topic. What

about disease spread to these mom and babes?! I would address this matter

quicly, before it is an issue again.

On our L & D, (LDR), unit we have have laboring pts in recovery and our D & C

room, when we are full. Also pts that are just laboring can stay out in

triage to labor, as well.

I believe L & D, postpartum and the nursery are the only areas of the hospital

that should not be mixed, for many reasons.

When this occurs at your hospital, it sounds like it is time to start turning

pts away. Are there other local hospitals? Lynn

[Guest guest]

Well, on our L,D,R unit has about 6,000 deliveries a year and I would refuse

to go to another unit! (I would go to the Mother/Baby unit, High risk, and

normal nursery), which we have rooming in and only a few babes in nursery when

mom is sleeping, I would feel comfortable on a med/surg unit. That practice

seems very unsafe, especially if a nurse only knows L & D and has to transfer

out. I pray that never happens to me. Lynn

[Guest guest]

Our policy is that we are to get only clean surgicals on post partum. We are

supposed to leave two beds open for deliveries - one a C/S and one a vag

delivery - and staff accordingly. Depending on what's sitting in the ED and

who the supervisor is, that sometimes gets ammended and it doesn't make any of

the satff very happy. We aren't allowed to refuse patients if we have beds,

so I don't know why they even bother to ask! We have had stuff from a hip fx

in a 90 yr old to a lady with about 20 meds that we had to look up and

schedule according to their compatibility - of course, we weren't comfortable

with either of those - but too bad!

[Guest guest]

More concerning to me than the off service patients we get is the fact that we

are floated to other units where we are not familiar and may come in contact

with contagious patients! The other night I was working in the nursery and

was asked to go to peds to do an admission assessment. I figured that was

pretty safe, so I went - with a cover gown over my nursery uniform. When I

got there, they wanted me to do temps on the whole floor and get I & Os for the

shift - going into RSV rooms and God knows what else! When I said I couldn't

do that, they were very put out! I did the admission assessment in the room

with this probably RSV kid and then left - once back on the floor, I did my

charting and my printing, but refused to handle a baby, even tho I discarded

my cover gown and scrubbed. The PP nurse had to handle the babies for the

last hour of our shift! Not Fair to anybody and the supervisor wasn't

thinking when she told me to go!