Escolar Documentos
Profissional Documentos
Cultura Documentos
Duke Hospital
Teaching
Technology
Teamwork
Rebecca Johnson, RN, Lupino Washington, BSN
Duke University Health System, Durham, NC
CCU Description
16 bed cardiac intensive care unit
Major Diagnoses include
Cardiogenic shock
Acute myocardial infarctions
Cardiomyopathy
Unstable angina
Life threatening arrhythmias
CCU Staffing
Charge Nurses - act as resources to
nurses and physicians
Charge Nurses do not take patients
The staff is 90% Registered Nurses
There are 60 RNs in the CCU
Nurse patient ratio is 1:1 to 1:2
CCU Staffing
Nurse Clinician
Liaison between the patient,
family and healthcare team
Assists in end-of-life issues
Patient Resource Manager
Manages discharge planning
and insurance issues
CCU Staffing
Attending physicians
Round morning and evening
Available 24 hours a day
Pharmacists
Available on the unit for rounds and
consultation from 7:00AM to 11:00PM
Patient Room
Cardiac Care Unit
Patient Room
Progressive Care Unit
Daily Rounds
Nursing Contribution
to Rounds
Update
Routine Care
Responsibilities and
Nurse Driven Protocols
Titration of vasopressors to patient
hemodynamics
Phase I Cardiac Rehab
Nurse Driven protocols
Heparin titrate according to nomogram
Potassium supplement according patient lab value
Magnesium - supplement according patient lab value
Tube feedings
Bolus
Dose
(units)
Stop
Infusion
(minutes)
Rate
Repeat
Change
aPTT
(ml/hour)
< 40
3,000 units 0
+ 1 ml/hr
6 hours
40 - 49
+ 1 ml/hr
6 hours
50 - 75
no change
next AM
76 - 85
- 1 ml/hr
next AM
86 - 100
30 minutes
- 1 ml/hr
6 hours
101 - 150
60 minutes
- 2 ml/hr
6 hours
> 150
60 minutes
- 3 ml/hr
6 hours
Responding to Emergencies
Nursing Education
AD Associate degree 2 years
Diploma in Nursing 3 years
BSN Bachelor of Science in Nursing 4 years
MSN Master or Science in nursing 2 -3 years
NP Nurse Practitioner
CRNA Certified Nurse Anesthetist
CNS - Clinical Nurse Specialist
MHA Masters in Hospital Administration
Men in Nursing
Nursing Education
Ph.D. Doctorate in Nursing
Researchers
Administrators of practice
Educators
Dr. Bradi Granger
Heart Center Nurse Researcher
Nursing Structure
Medical Cardiology
Clinical Operations
Director
Nurse
Manager
Operations
7100*
Nurse
Manager
Education
71 / 73
Nurse
Manager
Operations
7300*
Nurse
Manager
Operations
7200**
Nurse
Manager
Education
7200
Staff Nurses
Staff Nurses
Staff Nurses
Nursing
Assistants
Nursing
Assistants
Nursing
Assistants
Orientation
Unit Orientation
Coordinator
RN
Facilitates
Orientation
Classes:
IABP
Hemodynamics
Shock
Pacers, etc.
Preceptor,
Experienced RN
Coaches new nurse
In developing critical
thinking skills
Mentoring
Experienced RN
Continues to coach
and support after
formal orientation
Teamwork
Nurses have the additional responsibility
to participate in hospital wide
multidisciplinary committees
Mortality and Morbidity
Cardiovascular Medicine Performance
Improvement
Cardiovascular Serviceline Council
Medical Directors meeting
Heart Center Discharge meeting
Teamwork
Education, experience,
autonomy and responsibility
prepare nurses to be
competent and respected
members of the healthcare
team.
Attending
Physicians
Pharmacists
on
i
t
pa
u
c
Oc ists
l & rap
a
sic The
y
Ph
Chaplain
Patient
llow
e
F
ogy
l
o
i
d
Car
nts
e
sid
e
R
&
ns
r
e
Int
Res
pir
Nursing
Die
tic
ian
ator
y
The
rapi
st s
Family Visitation
Visiting hours are daily from morning until
bedtime and are open, but not unlimited
Visitors are requested to use an intercom
system to call back before entering the unit
Staff members have the right to ask family to
wait before coming
Yes, He is in
room 7214.
r.
M
e
Can g h av
in
s
?
u
Cla isitors
v
Teaching, Technology,
Teamwork
Teaching, technology and team work
have allowed Duke to successfully
achieve extraordinary care for our
patients and their families.
and
Through education, responsibility and
autonomy, nurses have a strong impact
on patient care and outcomes.
Duke Hospital
achieved Magnet
Status for
excellence in
Nursing Services
in 2006
Teamwork!