Pediatric Intensive Care Unit
The Pediatric Intensive Care Unit (PICU) is a 12-bed inpatient unit with provisions for complex invasive hemodynamic monitoring and treatment of pediatric patients during the critical phase illness following open heart surgery, thoracic surgery, neurosurgery, orthopaedic surgery, otolaryngology surgery, plastic surgery, urologic surgery and transplantation of the heart, lungs, bone marrow and liver.
The PICU is also the critical care unit where pediatric patients are managed following major trauma. The unit is comprised of 12 private rooms including two individual rooms specifically built to house patients who require extracorporeal membrane oxygenation. Monitoring capability is available at each bedside. There are a total of four negative airflow isolation rooms. Each isolation room is fully monitored with a remote alarm system to the center island station of the pod.
The average bed occupancy averaged 90.83% prior to the reduction in PICU beds from 24 to 12 beds. Since the reduction, PICU occupancy has averaged close to 100%.
The unit remains operational 24 hours a day, seven days a week.
Patient Population
Patients are admitted to the PICU for recovery during the critical phase following:
- Open heart surgery to correct or palliate congenital anomalies
- Craniotomy for tumor
- Surgical treatment for multi-trauma victims including general and orthopedic surgeries
- Cardiac transplantation
- Lung transplantation
- Liver transplantation
- ENT procedures
- Plastic surgery to treat burn victims
- Spinal fusion
- Exploratory laparotomy for gastrointestinal obstruction.
- Neurosurgical procedures
- Management of medical patients for whom surgery is contemplated and imminent
- Management of medical patients who need continuous renal replacement therapy (CRRT)
- Management of patients with congestive heart failure who may require pharmacological support, or implantation of a ventricular assist device (VAD)
The children admitted to the PICU range in age from the first day of life to 18 years old. The average length of stay is 4.28 days.
Common medical procedures and therapies performed in the unit include arterial and central venous line placement, chest tube placement and removal, intubation and extubation, temporary cardiac pacing, mechanical ventilation (including high frequency jet ventilation), bronchoscopy, continuous veno-venous hemofiltration and hemodialysis.
Nursing Care
Nursing staff is committed to family-centered and innovative patient care through the assessment, diagnosis, treatment and evaluation of pain, fluid and electrolyte abnormalities, hemodynamic instability, alteration in neurologic status, respiratory compromise, impairment in skin integrity, developmental delay and family anxiety related to the intensive care experience.
Registered nurses (RNs) in the PICU meet the basic requirements for registered nurse staff and function in accordance with the unit-based job description as described in the hospital plan for nursing care. Additional unit requirements for registered nurses to prepare them to care for critically ill children are met through an extensive orientation program. Following orientation, specific additional educational objectives are met by the end of the probationary period and annually. Nurses are expected to demonstrate a positive attitude toward family-centered care and also the ability, willingness and interest in working with the age-appropriate and developmental needs of patients.
Unit clerks meet the basic requirements for their positions and function in accordance with their unit-based job description as described in the hospital plan for nursing care. Additionally, unit clerks must support the team focus on family-centered care.
Health Care Team
The medical director for the PICU is the University of Florida division chief of Pediatric Critical Care Medicine. A multidisciplinary approach is utilized to provide intensive and comprehensive care. The pediatric critical care medicine team provides primary or concurrent care for all PICU patients 24 hours a day, seven days a week.
Interdisciplinary, comprehensive care is provided by the medical and nursing staffs, social services, case management, Child Life, rehabilitative services, food and nutrition services, cardiopulmonary services, pharmacy, pastoral care, and other health care providers as indicated by the patient’s health status and identified needs. A hospital-based school teacher from the Alachua County School Board is available during the school year to work with children requiring repeated or extended hospitalization. Weekly multidisciplinary rounds provide a forum for sharing assessments and planning care needs for each patient. Care conferences are held as a result of these discussions for a more indepth look at short- and long-term goals.
The nursing management structure consists of a nurse manager and clinical coordinator with support from a central administrative coordinator and a unit assistant. The management team provides training experiences to attain and maintain competence as defined by the Unit’s specific job descriptions and the departmental education plan.
Staffing Plan
Nursing care for the PICU is based on the Total Patient Care Delivery model as described in the hospital plan for nursing care. Each shift has a designated charge nurse (CN) and unit clerk seven days per week. On all shifts, the charge nurse is free from bedside assignment and available to all staff for consultation and assistance in providing patient care. Patient bed assignments are made by the charge nurse and are based upon patient safety, isolation concerns and acuity levels. The bedside registered nurse has authority and accountability for decision making for the patient(s) assigned on his/her shift.
The skill mix for the unit is 100% registered nurse. The usual staffing ratio is 1:1.5. The staffing plan is based on a budgeted 16.58 HPPD, 6.50 HPWI, an acuity of 2.55 and is adjusted to obtain the nurse to patient ratios as identified above. The current budgeted staffing is reflective of the combined PICU and PIMC, and the staffing grid should be viewed as more of an historical document since the unit now is comprised solely of PICU patients. Thus, the grid based on the budgeted HPPD, acuity and HPWI is identified below. Adjustments to this grid are reflected in the targeted staffing projections in OneStaff and are based on the census and acuity of classified patients (WinPFS Classification System). The targeted staffing will more closely approximate appropriate staffing. Patient care assignments are made each shift by the charge nurse as described in the hospital plan for nursing care.