View source for Harbor:Right level of care

''These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment''
* '''An admitting attending can always write an order to override below criteria'''
** '''Use corrected Na''' - the admitting team can write a '''communication order: "Ok for ward with Na 128 per Dr. X" ''' (Dr. Stein 5/2024)

*Right Level of Care Flowchart:

*[https://lacounty.sharepoint.com/sites/DHS/Harbor_PP/Harbor-UCLA%20Medical%20Center%20Policies%20and%20Procedures/307-Admissions,%20Discharge%20Criteria%20for%20the%20Adult%20Wards,%20Telemetry,%20Progressive%20Care%20Units.pdf Policy 307]
*[https://lacounty.sharepoint.com/sites/DHS/Harbor_PP/Harbor-UCLA%20Medical%20Center%20Policies%20and%20Procedures/325M-Guidelines%20for%20Intravenous%20Medication%20Administration.pdf Policy 325M]

* [[Harbor:Observation placement|Observation/Short-Stay Medicine]]

==Ward<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==
* Unmonitored
* Stable Patients
** HR 40-115 (120 max for A-fib), RR 8-28, SBP 90-210, SpO2>88%
** Na 130-160 (corrected Na)
* Nursing ratio 1:5
** Nursing interventions q4 hrs (vitals, labs, POC testing)
* OK on ward
** 4L O2 via NC
*** Chronic CPAP or Nasal BiPAP (with pulm attending approval)
** Meds: Ativan IV q6, Bumex, CaCl, digoxin IV, Dilantin IV, Dilaudid IV, heparin IV, Lasix, potassium IVPB
** ETOH withdrawal on PO meds only
** NG tube, chest tube, peritoneal dialysis (ambulatory patient)
** Palliative/comfort care admissions, including vented comfort care patients

==Telemetry<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==
* 3W, 4W, 5E, 6W
* '''Continuous cardiac and pulse ox monitoring'''
* Stable patients 
** HR 40-130 (140 for A-fib), RR 8-28, SBP 90-210, SpO2>88%
** Na 130-160 (corrected Na)
* Nursing ratio 1:4
** Nursing interventions '''q4 hrs''' (vitals, labs, POC testing)
* Ok on Tele:
** 6L O2 via NC
*** CPAP, BIPAP, chronic vent OK
** Non-titrated IV meds:   Adenosine IV, amiodarone IV/gtt, fosphenytoin IV, hydralizine IV, insulin IVP only for hyperkalemia; labetalol IV, Lovenox IV, metoprolol IV, Precedex, Vasotec IV. Drips include non-titratable amiodarone, bumex, lasix, integrilllin, insulin. 
*** DKA patients requiring active drip titration will require a higher level of nursing intervention
** ETOH withdrawal on PO meds only
** Femoral central line/Quinton per Policy 324

==PCU/SDU<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==
* 3W SDU, 4W/5E PCU
* Continuous cardiac and pulse ox monitoring
* Acceptable Vitals & Labs:
** HR 40-140 (160 for A-fib), RR 8-34, SBP 90-220, Sp02>75%
** Na 120-165 (corrected Na)
* Nursing ratio 1:3
** Nursing interventions '''q2 hrs''' (vitals, suctioning, labs, POC testing)
* Ok on PCU/SDU:
** O2 via NRB or HFNC
*** Respiratory treatments q2 hrs
** Meds: ''Non-titrated'' IV vasoactive drips approved for PCU: Cardizem, Esmolol, NTG gtt, dopamine, dobutamine 
** ETOH withdrawal requiring IV medications per CIWA protocol
** Peritoneal dialysis patients with cycler
** Subdural drains, procedural sedation
*** '''NOT allowed''':  temporary pacer, ''active chest pain'', significant dysrhythmia or acute ''ischemic EKG changes'', significant pulmonary edema

==ICU<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==
* 3W/5W/6W ICU, 3WCTU, 4WCCU
* Nursing ratio 1:2 or 1:1 depending on instability
** Nursing interventions '''q1 hr''' (vitals, labs, POC testing) 
* Actively managed ventilators
** Frequent ABG monitoring
* Actively titrated Drips: Cardene, nitroprusside, pentobarbital, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors
** Na <120 (corrected Na)

==See Also==
*[[Harbor:Main]]

==References==
<references/>
Policy 307 Revised 7/2020

[[Category:Admin]]