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Unit 24 Medicine Intermediate Care

Description of Unit

The 24 IMC/IMC of UF Health Shands Hospital is a 24-bed unit located on the 2nd of UF Health Shands Hospital North Tower. The unit consists of 4 POD environments which each house 6 beds. The unit has 4 negative pressure rooms, 8 other private rooms’ and12 semi private beds. Monitoring capabilities include 24 Hewlett Packard bedside monitors each capable of monitoring ECG, NIBP, invasive pressure monitoring, temp and oxygen saturation. Additional monitoring capability for invasive pressures monitoring and continuous cardiac output via a Flo Trac monitor. All monitoring parameters are transmitted via hardwire to the central station having capability to print ECG strips using a strip printer and other parameters using a laser printer. 24 IMC provides treatment for patients requiring complex stabilization and care.

Description of Patient Populations

The 24 IMC provides intermediate (step down) intensive care nursing for high-risk medical and surgical patients. Common medical diagnoses include: Coronary artery disease, Acute Coronary Syndrome, Congestive Heart Failure, Pneumonia, Respiratory Failure, Acute Stroke, other neurological conditions and disease, renal failure, endocrine dysfunction including diabetes, thrombolytic drug therapy, vasoactive drug therapy, multisystem failure and sepsis.

Common surgical diagnoses include: ICU step down care for Coronary bypass grafting, Heart valve(s) Replacement, thoracic aneurysm repair, vascular procedures such as femoral-popliteal bypass and carotid endarterectomy and thoracotomies.

These patients are admitted from the Emergency Department, referred from other hospitals, patients on med-surg units requiring a higher level of care or who have had a worsening in condition, and patients requiring complex cardiovascular or pulmonary management and intervention. A team of healthcare workers, admitting Attending Physicians, Residents and Interns as well as specialists as requested by the medical teams, nurses, social workers and ancillary personnel work together to provide this excellent care and service.

Nursing Care

Nursing care is based on the total patient care delivery model with co-worker assistance that is focused on the assessment, diagnosis, planning, treatment, and evaluation of patient’s frequent intervention in treatment. Nursing activities include hemodynamic monitoring, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management, specialized wound care, nutritional therapy, medication management, and comfort/sedation measures.

The nursing patient care focus model is centered on patient and family education/emotional support related to the patient’s condition and treatment, which is an essential element in the nursing care provided.

A Charge Nurse is present each shift (see staffing model below). Nursing care is focused on the assessment, diagnosis, planning, treatment, and evaluation of patient’s frequent intervention in treatment. Nursing activities include hemodynamic monitoring, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management, specialized wound care, nutritional therapy, medication management, and comfort/sedation measures. Clinical Manager and Clinical Leader prepare the staffing schedule and staffing is planned based on average occupancy of the unit, individual competency and experience. Strategies to ensure adequate staffing include encouraging overtime work, use of CSO staff, and use of agency staff. Meetings, staff education, PI activities, etc. are factored into the scheduled staffing.

Health Care Team

Care is provided to patients 24 hours a day/ 7 days a week. Scheduling of rotations is maintained through the Department of Medicine. Medical coverage is provided by the patients admitting team as well as opportunities for consultation groups.

Nursing Management for the unit includes a Harvey G. Norton, Jr MSN RN CCRN, Nurse Manager, Amy MacLean BSN RN CCRN Clinical Leader and Unit Assistant, Dawn Coffey. Department of Nursing Staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and departmental education plan.

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