For Physicians

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Inova Lung Services — Programs and Services — Inpatient Support Programs — Acute Pulmonary Unit (APU) — For Physicians

For Physicians

Admission Criteria for Acute Pulmonary Unit

Inclusion Criteria

  • Patients with compromised gas exchange/underlying disease with the potential for worsening respiratory insufficiency that requires frequent assessment
  • Patients requiring high flow nasal cannula oxygen support
  • Patients requiring ventilatory support such as with BiPAP or CPAP (see exclusion criteria)
  • BiPAP initiation for a Do Not Resuscitate (DNR) patient
  • Patients with expected fluctuations in levels of support needed, such that specialized expertise is necessary from the unit staff for timely response to changes in patient status such as weaning from high flow oxygen and intermittent BiPAP
  • Patients with therapeutic chest tubes for pneumothoraces, pleural effusions, or empyemas
  • Patients with neuromuscular disorders that impair ventilation, such as myasthenia gravis, requiring monitoring and supportive oxygenation/ventilation
  • Patients requiring frequent medications every 1-2 hours (scheduled and PRN)
  • Tracheostomy patients receiving suction every 1-2 hours, and appropriate teaching for home care post discharge
  • Patients with isolation pathogens, typical unit census includes 40-60% of patients on contact isolation
  • Patients, such as the Cystic Fibrosis population, on multiple IV antibiotics (3-5) for infusion
  • Inpatient hospice patients/palliative care patients, along with their families
  • NIOV
  • Cardiac telemetry
  • Continuous oxygen saturation monitoring
  • Continuous nebulizer therapy
  • Patients awaiting lung transplant
  • Monitoring: 24 bed capability for centralized monitoring of telemetry and continuous pulse oximetry

Exclusion Criteria

Respiratory

  • Need for invasive mechanical ventilation
  • New initiation of BIPAP for acute respiratory failure in patients who do not have an active AND/DNAR. Ipap of 20/10 with RR <27, a minute ventilation of <14 without respiratory distress
  • Need for suctioning or physiotherapy for secretion clearance greater than every 1 hour
  • Possibility of precipitous decline in respiratory function requiring immediate intubation and ventilation

Circulatory

  • Need for vasoactive drug to support blood pressure
  • Hypotension not responsive to fluid resuscitation

Neurologic

  • Central nervous system depression sufficient to compromise the patient’s airway or protective reflexes

Objective criteria

  • RR deviation of 20% from baseline
  • Systolic BP <80 from baseline with exception of AND
  • Ph <7.2 or >7.6
  • Serum Na <120 or >160
  • Serum K <2.5 or >7
  • Serum glucose >500

Transfer/Discharge Criteria

If any of the above exclusion criteria is met, the patient is transferred to higher level of care. Patients are discharged when their need for services provided by APU is no longer present or optimum wellness has been obtained. Patients are discharged to the community when inpatient care is no longer required.

Staffing

Our core staff consists of a charge RN, RN, and CT 7 days a week, 24 hours a day. A nurse director is also available Monday through Friday, and a unit secretary is available daily from 7 a.m. – 7 p.m. Staffing is adjusted based on census and other relevant factors.

Position Description License
Nurse Director Manages all unit staff. Ensures quality, cost-effective delivery of services for specific patient populations. RN
Charge RN Coordinates unit activity during assigned shift. Makes patient care assignment appropriately, coordinates with bed management and staffing. Provides support to staff. RN
RN Delivers competent nursing care to patient and family. Systematically assesses and identifies current patient care problems of a specific patient population. Seeks resources in planning and delivering care appropriately. RN
Clinical Technician Performs a variety of direct patient care activities. Assists nursing staff with procedures and /or tests, ADL’s, non-invasive body fluid specimens, laboratory draws, and IV insertion. N/A
Unit Secretary Performs a variety of clerical support and secretarial duties for a nursing unit. Ensures timely, efficient, and organized flow of operations for the assigned nursing station/area. N/A

Chain of Command

Unit Secretary to CT or RN or Charge RN Charge RN to Nurse Director or CLC/AD for urgent issues off shifts
CT to RN or Charge RN Nurse Director to Senior Director
Bedside RN to Charge RN Senior Director to CNO