Keep Pace With Step-Down Care

Abstract

High-Performance Care Teams The PCU care delivery team comprises a mixed level of caregivers. PCU nurse managers vary in background and expertise from critical to general care. Staff nurses may often be graduates with minimal experience. Licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) can efficiently administer medications. Under nurse supervision, LPNs also can provide direct care, give treatments, and make observations, but not clinically assess patients. Unlicensed assistive personnel (UAPs) provide support services including direct care, technical procedures (phlebotomy, ECG, monitor set-up, and surveillance), and equipment and environmental maintenance. These team members also work under RN supervision. Because of high acuity and changing patient conditions, it’s imperative to develop a highperformance team with a clear communication structure and appropriate delegation. RNs with minimal clinical experience may be challenged to learn assessment skills in addition to supervisory skills for LPNs/LVNs and UAPs. Unit leaders, such as nurse managers or advanced Fifty-year-old Marvin Smith, an African American male with no significant history of heart disease, presented to the ED with 6/10 chest pain and diaphoresis. His heart monitor showed normal sinus rhythm, and ECG showed ST segment depression in the anterior leads. His troponin was positive, indicating an acute non-ST-segment elevation myocardial infarction (MI). Five to 15 years ago, the ED nurse manager would have assigned Smith to a CCU bed. Today, as advanced technology supports higher-acuity stable patients in lessintensive environments, managers have other options. Since Smith is hemodynamically stable, he’s more likely to receive ongoing monitoring and therapy on the cardiac stepdown unit. Progressive care units (PCUs)— also called step-down, telemetry, intermediate care, and transitional care units—continue to grow in number as the patient acuity gap between critical care and medical/surgical care narrows. Optimally, patients should be transferred to where they can get the best care, without limiting their placement by traditional unit boundaries. Thus, patients’ care needs define acute and critical care, not the hospital’s geography. Patients admitted to PCUs span a range of diagnoses and care demands. Typically, they need highfrequency monitoring interventions and are at risk for rapid status ProgressiveCare