Harbor:Right level of care - Revision history

Bchap23 at 13:51, 1 June 2024

2024-06-01T13:51:26Z

← Older revision		Revision as of 13:51, 1 June 2024
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	''These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment''		''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'''		* '''An admitting attending can always write an order to override below criteria'''
	** '''Use corrected Na''' - the admitting team can write a communication order ~~e.g.,~~ "Ok for ward with Na 128 per Dr. X" (Dr. Stein 5/2024)		** '''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:		*Right Level of Care Flowchart:

Bchap23 at 13:49, 1 June 2024

2024-06-01T13:49:57Z

← Older revision		Revision as of 13:49, 1 June 2024
Line 1:		Line 1:
	''These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment''		''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'''		* '''An admitting attending can always write an order to override below criteria'''
	* '''Use corrected Na''' (Dr. Stein 3/2024)		** '''Use corrected Na''' - the admitting team can write a communication order e.g., "Ok for ward with Na 128 per Dr. X" (Dr. Stein 5/2024)

	*Right Level of Care Flowchart:		*Right Level of Care Flowchart:

Bchap23 at 00:30, 7 March 2024

2024-03-07T00:30:49Z

← Older revision		Revision as of 00:30, 7 March 2024
Line 1:		Line 1:
	''These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment''		''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'''		* '''An admitting attending can always write an order to override below criteria'''
			* '''Use corrected Na''' (Dr. Stein 3/2024)

	*Right Level of Care Flowchart:		*Right Level of Care Flowchart:
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	*[https://lacounty.sharepoint.com/sites/DHS/Harbor_PP/Harbor-UCLA%20Medical%20Center%20Policies%20and%20Procedures/325M-Guidelines%20for%20Intravenous%20Medication%20Administration.pdf Policy 325M]		*[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]]==		* [[Harbor:Observation placement\|Observation/Short-Stay Medicine]]

	==Ward<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==		==Ward<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==
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	* Stable Patients		* Stable Patients
	** HR 40-115 (120 max for A-fib), RR 8-28, SBP 90-210, SpO2>88%		** HR 40-115 (120 max for A-fib), RR 8-28, SBP 90-210, SpO2>88%
	** Na 130-160		** Na 130-160 (corrected Na)
	* Nursing ratio 1:5		* Nursing ratio 1:5
	** Nursing interventions q4 hrs (vitals, labs, POC testing)		** Nursing interventions q4 hrs (vitals, labs, POC testing)
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	* Stable patients		* Stable patients
	** HR 40-130 (140 for A-fib), RR 8-28, SBP 90-210, SpO2>88%		** HR 40-130 (140 for A-fib), RR 8-28, SBP 90-210, SpO2>88%
	** Na 130-160		** Na 130-160 (corrected Na)
	* Nursing ratio 1:4		* Nursing ratio 1:4
	** Nursing interventions '''q4 hrs''' (vitals, labs, POC testing)		** Nursing interventions '''q4 hrs''' (vitals, labs, POC testing)
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	* Acceptable Vitals & Labs:		* Acceptable Vitals & Labs:
	** HR 40-140 (160 for A-fib), RR 8-34, SBP 90-220, Sp02>75%		** HR 40-140 (160 for A-fib), RR 8-34, SBP 90-220, Sp02>75%
	** Na 120-165		** Na 120-165 (corrected Na)
	* Nursing ratio 1:3		* Nursing ratio 1:3
	** Nursing interventions '''q2 hrs''' (vitals, suctioning, labs, POC testing)		** Nursing interventions '''q2 hrs''' (vitals, suctioning, labs, POC testing)
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	** Frequent ABG monitoring		** Frequent ABG monitoring
	* Actively titrated Drips: Cardene, nitroprusside, pentobarbital, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors		* Actively titrated Drips: Cardene, nitroprusside, pentobarbital, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors
			** Na <120 (corrected Na)

	==See Also==		==See Also==

Bchap23 at 00:28, 7 March 2024

2024-03-07T00:28:02Z

← Older revision		Revision as of 00:28, 7 March 2024
Line 1:		Line 1:
	''These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment''		''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'''

	*Right Level of Care Flowchart:		*Right Level of Care Flowchart:

Bchap23 at 00:25, 7 March 2024

2024-03-07T00:25:57Z

← Older revision		Revision as of 00:25, 7 March 2024
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	==[[Harbor:Observation placement\|Observation/Short-Stay Medicine]]==		==[[Harbor:Observation placement\|Observation/Short-Stay Medicine]]==
	* Goal of our observation/Short Stay is admission avoidance
	* Consider a brief additional stay in the ED if it will prevent an admission
	* All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs
	* (Previous: When boarding >5 obs patients in ED, admit DHS empaneled OBS-level patients)

	==Ward<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==		==Ward<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==

Bchap23 at 16:57, 6 October 2020

2020-10-06T16:57:04Z

← Older revision		Revision as of 16:57, 6 October 2020
Line 2:		Line 2:

	*Right Level of Care Flowchart:		*Right Level of Care Flowchart:

	*~~Policy 307:~~ 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		*[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]
	*~~Policy 325M:~~ https://lacounty.sharepoint.com/sites/DHS/Harbor_PP/Harbor-UCLA%20Medical%20Center%20Policies%20and%20Procedures/325M-Guidelines%20for%20Intravenous%20Medication%20Administration.pdf		*[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]]==		==[[Harbor:Observation placement\|Observation/Short-Stay Medicine]]==

Bchap23 at 16:54, 6 October 2020

2020-10-06T16:54:27Z

← Older revision		Revision as of 16:54, 6 October 2020
Line 1:		Line 1:
	''These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment''~~[[:File:1 -~~ Right Level of Care Flowchart ~~final 2018 tabloid view~~.pdf]]		''These are meant to be representative of minimum levels of care that can provide said services and should NOT replace clinical judgment''

			*Right Level of Care Flowchart:

			*Policy 307: 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 325M: https://lacounty.sharepoint.com/sites/DHS/Harbor_PP/Harbor-UCLA%20Medical%20Center%20Policies%20and%20Procedures/325M-Guidelines%20for%20Intravenous%20Medication%20Administration.pdf

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

Bchap23: /* PCU/SDUChappell 9/2020, Hospital Policies 307 & 325M */

2020-09-28T23:13:19Z

PCU/SDUChappell 9/2020, Hospital Policies 307 & 325M

← Older revision		Revision as of 23:13, 28 September 2020
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	* Continuous cardiac and pulse ox monitoring		* Continuous cardiac and pulse ox monitoring
	* Acceptable Vitals & Labs:		* Acceptable Vitals & Labs:
	** HR 40-140 (160 for A-fib), RR 8-34, SBP 90-220, ~~Sp)2~~>75%		** HR 40-140 (160 for A-fib), RR 8-34, SBP 90-220, Sp02>75%
	** Na 120-165		** Na 120-165
	* Nursing ratio 1:3		* Nursing ratio 1:3

Bchap23: /* Observation/Short-Stay Medicine */

2020-09-28T10:14:03Z

Observation/Short-Stay Medicine

← Older revision		Revision as of 10:14, 28 September 2020
Line 3:		Line 3:
	==[[Harbor:Observation placement\|Observation/Short-Stay Medicine]]==		==[[Harbor:Observation placement\|Observation/Short-Stay Medicine]]==
	* Goal of our observation/Short Stay is admission avoidance		* Goal of our observation/Short Stay is admission avoidance
	* If a brief additional stay in the ED will prevent admission~~, consider this option~~		* Consider a brief additional stay in the ED if it will prevent an admission
	* All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs		* All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs
	* (Previous: When boarding >5 obs patients in ED, admit DHS empaneled OBS-level patients)		* (Previous: When boarding >5 obs patients in ED, admit DHS empaneled OBS-level patients)

Bchap23: /* ICUChappell 12/18, Hospital Policies 307 & 325M */

2020-09-28T10:09:24Z

ICUChappell 12/18, Hospital Policies 307 & 325M

← Older revision		Revision as of 10:09, 28 September 2020
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	*** '''NOT allowed''': temporary pacer, ''active chest pain'', significant dysrhythmia or acute ''ischemic EKG changes'', significant pulmonary edema		*** '''NOT allowed''': temporary pacer, ''active chest pain'', significant dysrhythmia or acute ''ischemic EKG changes'', significant pulmonary edema

	==ICU<ref>Chappell 12/18, Hospital Policies 307 & 325M</ref>==		==ICU<ref>Chappell 9/2020, Hospital Policies 307 & 325M</ref>==
	* 3W/5W/6W ICU, 3WCTU, 4WCCU		* 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		* Actively managed ventilators
	* ~~Nursing interventions '''q1 hr''' (vitals, labs, POC testing)~~		** Frequent ABG monitoring
	* ~~Nursing ratio 1:2 or 1:1 depending on instability~~		* Actively titrated Drips: Cardene, nitroprusside, pentobarbital, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors
	* Actively titrated Drips: Cardene, ~~Nipride~~, pentobarbital IV, phenobarbital IV, propofol, tPA, TXA, Versed, vasoactive dose pressors

	==See Also==		==See Also==