Pediatrics

Pediatrics is a 35-bed inpatient unit that consists of nine intermediate beds (three private and three semi-private) and 26 acute beds  (six private and 20 semi-private). These numbers include four negative air flow isolation rooms. The IMC rooms are designed to accommodate continuous monitoring of heart rates, respiratory rates, non-invasive blood pressure and oxygen saturation. This information can be monitored from within the patient rooms as well as remotely from all IMC alcoves and centrally at the nursing station. The 26 acute care beds are set up to allow for oxygen saturation monitoring on 16 patients as well as remote telemetry monitoring of up to 8 patients.  Average bed occupancy 75%.

Description of Patient Populations

Pediatric services have a strong statewide referral base for both medical and surgical management. Services provided on the pediatric floor consist of both acute care and intermediate care patients. The majority of the patients cared for are general pediatric surgery patients including pediatric burns, cardio-thoracic surgery patients and neurosurgery patients. Other surgical patients receiving care on this floor include pediatric orthopedic and ENT patients. Subspecialty groups normally considered medical in nature are also followed here when pediatric surgical intervention is either anticipated or planned. Examples of these services are pediatric cardiology patients and pediatric neurology patients. Average length of stay is 3.6 days.

Nursing Care

Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of preoperative, postoperative, surgical/non-surgical patients from admission to discharge. Emphasis on airway management, patient/family education and support, pre and post-operative care and initiation of the rehabilitation process.  The Pediatrics unit/role specific job descriptions identify the patient populations/common diagnoses served, equipment utilized, skills required to perform treatments/procedures, clinical parameters monitored, safety precautions initiated and emergency events encountered. Nursing activities consist of: age appropriate care including developmental appropriate care; pain management including epidural and patient controlled analgesia; wound management including Vacuum Assisted Closure Systems; JPs; respiratory management including pulse oximetry; oxygen therapy and chest tubes; cardiac management including remote telemetry and continuous monitoring for those in the IMC; nutritional management including TPN; NG-tube/G-tube/J-tube feedings; assessment and management of abdominal/GI drainage systems including G-tubes, J-tubes, ostomies, NGs; neurological assessment and evaluation – including continuous and remote video monitoring; medication management; safety precautions and patient/family education and support.

Health Care Team

A pediatric surgeon who is a professor in the Department of Surgery serves as the medical director for Pediatric IMC/Floor.  The medical care services practicing on the Pediatric floor consist of attending physicians, fellows, residents, interns, physician assistants, advanced registered nurse practitioners and medical students.  Scheduling of rotations is maintained through the Department of Surgery and/appropriate service.  Licensed social service staff serves as liaisons between the medical staff and multidisciplinary team, providing continuity of care for surgery patients from admission through clinic follow-up.  Available support services for the Pediatric patients include: respiratory therapy, physical therapy, occupational therapy, pharmacy services, nutrition services, enterostomal therapy as well as patient and family services.

The nursing management structure consists of a nurse manager and clinical coordinator with support from a central administrative coordinator.   Department of Nursing staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the departmental education plan. Registered nurses, licensed practical nurses and patient care assistants provide nursing care.  Unit clerks provide clerical support for the direct patient caregivers. The registered nurse is responsible for guiding care of the patient based upon an individualized plan.  Nursing care delivered by licensed practical nurses and patient care assistants is coordinated under the direction of the registered nurse.

Staffing Plan

Nursing care Pediatrics/IMC is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance.  The licensed practical nurse (LPN) and patient care assistant (PCA) are assigned under the direct supervision of the registered nurse (RN).  Unit clerical coverage is available 24 hours a day.  Skill mix is 80% RN, 3% LPN, and 17% PCA. The predominant staffing ratio of nurses to patients is 1:3 in the IMC and 1:4 on the pediatric acute beds. The charge nurse (CN) generally does not take a patient assignment unless absolutely necessary and when doing so takes a decreased patient assignment. On all shifts, the charge nurse is available to all staff for consultation and assistance in providing patient care. Patient care assignments are made each shift by the charge nurse, as described in the Hospital Plan for Nursing Care. Patient bed assignments are made by the charge nurse and are based upon patient safety concerns, patient/family requests, monitoring capabilities and skills required.Patients requiring 1:1 observation as a result of personal safety concerns are assigned sitters.  Sitter requests are coordinated through the central staffing office.