Durham Regional Hospital

The role of the Cardiac Catheterization Laboratory is to diagnose the exact nature, extent and severity of a patient's heart disease to determine the correct therapeutic approach. Additionally, it functions, as a therapeutic laboratory performing those procedures deemed necessary by previous diagnostic procedures or by clinical investigation of a skilled physician. Service is available on an in and out patient basis.

The Cardiac Catheterization Laboratory is open to cardiologists who are credentialed and granted privileges by Durham Regional Hospital to perform invasive procedures. The Cardiac Cath Lab serves the patient populations of all medical, surgical, coronary floor units, as well as critical care and the emergency department.

STAFFING:

The staff consists of Registered Nurses, Cardiovascular Technicians, Registered Cardiovascular Technoligists.

The Cardiac Catheterization Laboratory team is available 24 hours a day, 7 days a week. The team is on emergency stand by call after hours and has a response time of thirty minutes.

Each procedure is staffed with three team members one of which is a registered nurse.

The delivery of care is interdisciplinary utilizing services from nursing, pharmacy, radiology, special services, environmental, maintenance, communications auxiliary, dietary and Chaplain services.

Variances in volume are accommodated by the use of part time employee, Float/Reserve pool staff personnel, overtime, PTO and time off without pay.

The 29,000 square foot facility has 8 operating rooms licensed by the state of NC; is certified by Medicare and accredited by the Accreditation Association of Ambulatory Health Care, Inc. (AAAHC). Approximately 6,853 cases were performed at DASC in 2007.

TRehab physician services may include the use of physician extenders. The attending rehab physician is required to round a minimum of five days per week. Rehab nursing services include RN's, LPN's and CNA's. A charge nurse is available 24 hours a day, seven days a week.

If continuum of care is not available at Durham Regional Hospital, e.g. pediatric intensive care, stabilization and arrangement for transfer to a health care facility that provides the service is arranged adhering to Federal regulations (EMTALA).

Unit Profile - Emergency Department

Facility: Durham Regional Hospital Unit Location: Durham Regional Hospital Geographic Area: Durham, NC Specialty: Emergency Medicine Director: Stephen Finch

# Beds/Visits: 33 Shift: 12-hour shifts, flexible scheduling options available, weekends as needed by department.

Patient Population:

Type of Service:

Emergency Services provides emergency medical care to all patients presenting with an emergent, urgent or a non-urgent condition(s).

Scope and Complexity of Patient Needs:

The Durham Regional Hospital Emergency Department (ED) serves a patient population that traverses the life span to include newborns, infants, toddler, pre-school, school age, adolescent, young adult, middle adult, and older adult age groups. Treatment and care is not refused to any patient.

All patients seeking care at Durham Regional Hospital shall receive a medical screening exam and stabilizing treatment that includes providing any necessary testing and on-call specialty services within the capability of the facility.

Emergent care is provided to all patients presenting to the ED.

If continuum of care is not available at Durham Regional Hospital, e.g. pediatric intensive care, stabilization and arrangement for transfer to a health care facility that provides the service is arranged adhering to Federal regulations (EMTALA).

Services in the ED are available 24 hours a day, seven days a week. At least one board certified emergency physician is available at all times. The most common discharge diagnosis evaluated in the ED include: Chest pain, abdominal pain, sprains and strains of the neck, asthma, fever, dizziness, renal colic, open wound of finger, headache, lower leg injury and acute respiratory infections.

Requirements:

The ED is staffed by at least one board certified emergency physician 24 hrs a day. As the patient visits increases, Physician and Physician Assistant (PA) staff increases. During peak hours of patient visits, two board certified emergency physicians and two physician assistants are on duty. The emergency physician is responsible for the medical evaluation of every patient presenting to the ED. The PA works under the direction of the emergency physician. Residents of all services are available to respond to the ED and assist in providing care to emergency patients.

Patients evaluated by a PA or resident, are screened by the ED physician and the Physician assures appropriate interventions are performed prior to patents discharge. Private Attending with privileges to practice at Durham Regional Hospital, may meet their private patients in the ED for treatment. If a patient becomes hemodynamically unstable the ED attending will assume responsibility for the patient until the Private attending or designee is in the department and assumes full responsibility of the patient.

Physician and physician assistant clinical privileges are kept on file in Medical Staff Services. Privileges may be viewed by using the on line service available to all staff members.

The Emergency Department Nurses are RN's committed to ensuring optimal emergency nursing care. He/she maintains a current state license as a Registered nurse, and, ACLS, PALS, and BLS certification. TNCC and CEN certification are recommended. Organizational membership in the Emergency Nurses' Association (ENA) is also encouraged. An ongoing program of continuing education and annual skills evaluation for all staff members is maintained to ensure quality of patient care.

The ED is staffed according to full-time equivalents derived from an average daily census and projected required manpower hours per patient. Staffing flexes with census and acuity. Staffing, both in numbers and competency will be sufficient at all times to ensure quality care is provided.

Nurses maintain current BCLS certification, ACLS certification, and their current state RN license. Nurses must also be credentialed in conscious sedation and maintain competency through annual training. Other staff must maintain BCLS certification. Membership in the Society of Gastroenterology Nurses and Associates is encouraged, as well as advancement up the clinical ladder. All staff are required to annually maintain his/her skills through mandatory continuing education. Skill level testing is required on an on-going basis.

There is staff available on all three shifts and seven days a week. The nursing orientation is individualized and based upon the needs of the employee. Skills are validated on the Skills Validation Checklist and verified by a nurse preceptor.

Float Pool staff consists of RNs, LPNs, NAs, and HUC's who are assigned to various units by management, based upon patient care needs. The Casual Pool consists of RNs, LPNs, NAs, and HUC's who are unscheduled and have the flexibility to choose the days and time they work.

Cardiac Diagnosis patients are primarily placed on the Cardiac Unit, 4-1. Unit 5-1 is a Nursing unit within the Division of Patient Care Services, staffed with professional and non-professional personnel to provide care for an average daily census based on established hours of care. The levels of staff include RN, LPN, NAI, NAI+4 and HUC.

Patients are admitted directly from the physicians' office, the Emergency Department, other acute care facilities, or as transfers from the PACU, OR, the Progressive Care Unit, or the medical/surgical units.

Each room is equipped with bedside monitoring that includes 5 Lead ECG, pulse oximetry, non-invasive B/P and respiratory monitors, and invasive pressure monitoring for pulmonary artery, arterial, central venous pressure, and intracranial pressure monitoring.

Intensive Care Facility: Durham Regional Hospital Unit Location: Durham Regional Hospital Geographic Area: Durham, NC, Specialty: Critical Care

Shift: Rotating 7am-7pm and 7pm – 7am, every other weekend and holidays as needed. Self scheduling available. Patient Population: Intensive Care Nursing is provided to all patients admitted to the ICU.

Scope and Complexity of Patient Needs:

The Critical Care Unit is a 22-bed newly renovated unit that provides care to patients with medical, surgical, neurological, and cardiovascular conditions. Patients are admitted directly from the physicians' office, the Emergency Department, other acute care facilities, or as transfers from the PACU, OR, the Progressive Care Unit, or the medical/surgical units and managed by the Intensivist Program.

Each room is equipped the latest technology including: Touch Screen Dialysis Smart bed Computer medication documentation Smart IV Pumps Individual RN module computer work station.

Age of Patients:

The Intensive Care Unit provides age appropriate care to the adolescent, young and middle adult, and the late older adult. All staff are competent to care for all ages.

Appropriateness, Clinical Necessity, and Timeliness of Support Services:

The provision of patient care is accomplished with the assistance of the Special Services Department for cardiac testing and respiratory care support, the Cardiac Catheterization Lab, the Radiology and Laboratory Department for ancillary testing and the Pharmacy for the provision of medications. The medical staff work closely with the patient care nurses to ensure continuity of care and optimal patient outcomes.

Extent to Which the Level of Care Provided Meets Patients Needs:

CCU provides care to variety of patient diagnosis, using invasive and non-invasive monitoring for cardiac and respiratory conditions. The CCU also has capabilities to perform transcutaneous and temporary transvenous pacing, and intraaortic balloon pump therapy, CRRT, CABG.

Orientation:

The unit orientation is individually tailored to the nurse's experience and learning needs. Orientation can last from 6 weeks for the experienced critical care nurse to 16 weeks for the graduate nurse. A preceptor is assigned to assist in the orientation process. We also require a critical care course that covers topics such as arrhythmia interpretation, hemodynamic monitoring, ventilator management, and renal failure. Additional education and training is provided to learn intra-aortic balloon pump monitoring.

Unit Based Teams

Teamwork is the cornerstone of our unit. We are committed to providing excellent patient care. We have a shared governance model that includes the Nurse Practice Council, Nurse Education Committee, Nurse Research and quality Council and the Customer Service and Safety Committee.

The labor and delivery unit is staffed by at least one obstetrical attending physician who is in the hospital at all times. A second year Obstetrical resident is present also. There are 7 private physician practices that utilize this unit for obstetrical management of their patients. The nursing staff consists of Registered Nurses, obstetrical technicians, and unit secretaries.

Staffed with professional and non-professional personnel to provide care for an average daily census based on established hours of care. The levels of staff include RN, LPN, NAI, NAI+4 and HUC.

Scope and Complexity of Patient Needs:

Providing patient care of orthopedic patients from young adult to geriatric adult 24 hours a day, 7 days a week. Patients are experiencing acute illness/injury to single or multiple body systems in varying stages of recovery from diagnostic and/or therapeutic interventions. Patients are assigned beds through Bed Control and arrive as an admit/transfer from outside the hospital, Same Day Surgery admission, Emergency admits from DRH ED, and transfers from in-house units.

Age of Patients:

Care is provided for adult patients, generally over the age of 18. Exceptions would be considered based on the needs of the patient and the unit's ability to meet those needs. All staff is required to fulfill age specific competency requirements to best meet the needs of the different age groups served.

Requirements:

Unit 7-1 is a Nursing unit within the Division of Patient Care Services. Management of the unit is the responsibility of the Nurse Manager with supervision, direction and support by the Administrative Director. Collaboration with Physicians and appropriate Department Managers takes place through formal and informal methods.

The attending physicians and/or their associates are responsible for directing medical care. The chiefs of the various services are available for the purpose of conflict resolution and/or providing medical direction should the attending physician be unavailable.

Teaching staff physicians are responsible for the orientation and oversight of Residents interns, and the medical students.

Physician and physician extenders clinical privileges are kept on file in Medical Staff Services and are on line for staff review.

The levels of staff include RN, NAIs and HUC. 1. All patients are assigned to an RN. 2. Private Duty Staff, Supplement Staff, and NAs, and Nursing Students will be co-assigned to an RN and a Nursing Instructor. 3. Patient care assignments are made based on the competency level of staff providing care, patient acuity and care needs.

Staffing needs are assessed each shift based on established hours of care and patient acuity and care needs. Adjustments are made in conjunction with Nurse Manager and/or Nursing Supervisor covering the hospital and the Unit Charge Nurse. Additional staff is provided via the use of approved overtime, additional hours by part-time staff, Casual Staff Pool, and/or Float Pool assignment and supplemental agency staff.

Staffing needs are evaluated at least annually at budget preparation and as patient care needs or acuity patterns change. All new staff will attend Hospital and Nursing orientation and will have an individualized orientation plan prepared by the unit Educator or designee. All staff will participate in continuing education based on mandatory requirements and identified educational needs.

TFacility: Durham Regional Hospital Unit Location: Durham Regional Hospital Unit 5-1 Geographic Area: Durham, NC Specialty: General Medicine/Dialysis # Beds/Visits: 36 Shift: 8 hour and/or 12 hour shifts, with every other weekend Patient Population: Type of Service: Unit 5-1 is a Medical Inpatient unit for acutely ill patients. The unit is comprised of 36 beds (three semiprivate and thirty-three private rooms) that may be set up for any type of isolation.

Scope and Complexity of Patient Needs: Unit 5-1 provides nursing care for patients with acute and chronic disease processes/injuries requiring supportive and or therapeutic interventions 24 hours a day, 7 days a week. Patients may be admitted through the emergency room, direct admit from outside the hospital or transfer from another unit within the hospital. The six top principle diagnosis of the patient population are: Simple Pneumonia, COPD, Respiratory Infection and Inflammation, Septicemia, Diabetes > age 35, and Cellulitis.

Age of Patients: Patients that are admitted to unit 71 are over the age of 14 through geriatric adult.

Requirements: The responsibility of directing medical care is that of the attending physician/Hospitalist. The chiefs of the various services are available for the purpose of conflict resolution and/or providing medical direction should the attending physician be unavailable.

Teaching staff physicians are responsible for the orientation and oversight of medical residents, interns and medical students.

Physicians and physician assistant/nurse practitioner clinical privileges are kept on file in the Medical Staff Services office and are on line for staff review. Private attending physicians who treat their own patients while in the hospital must have privileges to practice at Durham Regional Hospital.

Management of unit 51 is the responsibility of the Nurse Manager of Operations with the supervision and direction of the Clinical Operations Director. The Clinical Operations Director reports to the Chief Nursing Officer. Collaboration with physicians, multidisciplinary teams and other department managers takes place on a formal and informal basis.

Unit 51 staffing levels are based on census and established hours of care. Professional and nonprofessional staff provides care to the patients.

The levels of staffing include RN, LPN, NAI, NAII, and HUC. Staffing needs are assessed each shift based on the census, needs of the patient and competency level of the staff. Adjustments are made to staffing numbers /levels by collaboration with the COD, Operations Administrator, and unit charge nurse.

Orientation- All 51 staff participate in hospital orientation programs and unit orientation. The preceptor or designee according to the staff member's need prepares individualized orientation for the unit. All staff will have a review at the end of the six to eight week orientation period based on 51 standards, nursing responsibilities for the patient population and identified learning needs of the new staff member.

Minimum educational requirements are summarized in Performance Standards for each job category. Mandatory education will include but not limited to: CPR ; Yearly Skills Competency Safety Training; Age Specific Competency Affirmative Action HIPAA Compliance Educational records will be maintained and it will be the responsibility of each staff member to maintain any independently obtained education for the records.

Participation in learning activities is an important part of the employee appraisal process as well as 51 Performance Improvement Plans. Staff is expected to participate in ongoing performance improvement activities for the purpose of assuring compliance to unit standards, identifying learning needs and identifying/resolving staff/unit patient care problems.

The Obstetrical/ Gynecological unit is staffed by at least one OB/GYN physician, who is in the hospital at all times. A second or third year obstetrical resident is in the hospital 24 hours a day, 7 days a week.

There are 7 private physician practices that utilize this unit for OB/GYN management of their patients.

The nursing staff consists of registered nurses, nursing care assistants, and health unit coordinators.

Procedures performed in the Surgical Services department include general, gynecolology, ENT, obstetrical, opthalmology, neuro, orthopedic, vascular, thoracic, open heart (adult only), urology, plastics, gastrointestinal endoscopy, pulmonary endoscopy, pain management and patients who also require postanesthetic recovery.

Received 2007 NCNA Hallmarks of Healthy Workplaces Award.

Patient Population: The Cardiac/Telemetry Unit serves a patient population that traverses the life span to include the young adult, middle adult, and older age groups. Admissions include but are not limited to patients with cardiac problems/potential cardiac problems, dysrhythmias, congestive heart failure, respiratory failure, drug overdose, post cardiothoracic surgery and pre and post cardiac catheterizations. The hospital and unit 5-2 benefit from the community atmosphere of our facility while providing quality and compassionate care.

The Cardiac/Telemetry Unit registered nurse assesses the patient's overall physical, emotional, spiritual, and psychological needs upon admission. The family/significant other needs are included in the patient plan of care. There are patient care rounds to review and assess the needs and concerns of the patient, family or significant other. Interventions may include studies provided by the laboratory, radiology, special services, and other ancillary departments. All care provided for the patient is according to the standards and guidelines of DRH.

Requirements: Scheduling:

The staff on 5-2 enjoy the autonomy of self-scheduling to meet unit needs. There is considerable flexibility in scheduling as we recognize the value of balancing home and work schedules.

Type and Availability of Staff:

The leadership and direction for 5-2 is provided by a multi-disciplinary team that includes medical and nursing leaders. The nursing leadership is responsible for the nursing staff, the departmental budget, the physical plant and assure that all nursing staff function within the scope of practice according to the North Carolina Board of Nursing.

The Adult Health Medicine Director and the Nurse Manager, Operations has 24 hour accountability for the overall operation of the unit. The Nurse Manager or a registered nurse function as the charge nurse for a given shift, supervises unit activity, clinical practice and patient care. The Nurse Manager, Operations is directly responsible to the Director of Adult Health Medicine.

The average daily census and acuity of patients dictates the nursing staffing requirements. The team is comprised of RNs, LPNs, PCA/HCTs, Monitor Technicians, and Unit Clerks. The staff utilizes a modified self-scheduling process for staffing the unit according to the patient needs. There is twenty-four hour coverage a day.

The Radiology Department is composed of twelve (12) divisions: Diagnostic Radiology, Ultrasound, Peripheral Vascular Imaging, Nuclear Medicine, CT, MRI, Vascular/Interventional, Lincoln Community Health Center Radiology, Center for Women Radiology, Radiation Oncology, Radiology Nursing, and Support Services provide services to both inpatients and outpatients. Ten divisions provide services to inpatients and outpatients, while two divisions are outpatient satellites.

All members of the response team have ACLS, PALS, BCLS, and PICC line credentials. The response team is required to complete a yearly competency based validation of skills as deemed necessary by the response team unit manager. Facility: Durham Regional Hospital Unit Location: 2nd Level Specialty: Emergency Medicine Nurse Manager/Director: Roy Hudson, Manager, Stephen Finch, Director Shift: flexible scheduling options available, 8 or 12 hour shifts. Patient Population: Adult

The response team is responsible for the initiation and management of intravascular devices within the hospital and functions as a nursing resource to all areas that provide patient care. In addition to this, the response team functions as a member of the code blue team acting as the IV/medication nurse. Intravenous management includes all IV insertions and restarts, assessing for IV complications, central line care and discontinuation, and the placement of Peripherally Inserted Central Lines (PICC). The response team,also, performs moderate sedation for TEE's ,as well as, provide nursing care for all Dobutamine stress tests and cardiac bubble studies performed in the Special Services area.

The response team provides the nursing staff with resources to intervene with general nursing and critical issues. These issues include initiating and maintaining protocols of ACLS during code blue events. The goal during these events is to provide nursing care and support to patients who demonstrate an increase in acuity until they can be transferred to a higher level of care, i.e. ICU.

The response team provides nursing care and support to all inpatient and outpatient areas of Durham Regional Hospital. These service areas include the medical, surgical, outpatient; post anesthesia, critical care, and emergency care areas. Patient needs are met through general nursing practice, assessment, procedures, IV management, and emergent/ intensive patient care. All members of the response team have ACLS, BCLS, and PICC line credentials. The response team is required to complete a yearly competency based validation of skills as deemed necessary by the response team unit manager.

Requirements: The overall goal of the response team is to provide quality patient care to the sick and injured, including IV management, PICC's, support for patients with increasing acuity, and education to patients and staff.

The response team is an all RN staff with credentials in ACLS, BCLS, , and PICC insertion. The response team is available via the paging system 24 hours a day, seven days a week.

Nursing staff coverage is based upon the acuity of the patient, census, standards of care, and the determined hours of care per patient day. One nurse is assigned the role of Neonatal Code Blue Team and is responsible for attending at risk deliveries. Support staff includes a Health Unit Coordinator.