DAILY ROUTINE AND NOTES TO REMEMBER

730am - 830am - STOC ACA + All Units 

8:30 - 8:15 - Charge Rounds Only

9:15am - 9:30am Charge Coffee Breaks

9:30 - 10:00am - Downgrades Put In

NOTE:  Please refrain from pending ED patients to rooms for approval between 7:00 and 9:30 AM, as this will interrupt their coffee breaks. ( ED Approval is 15 Mins Only )

For ED patients only. If you put a patient in a clean bed, transport will be informed and will transfer the patient before approval. 

Keep in mind, Providence takes 15 minutes to approve the bed, while Swedish takes 30 minutes.  So, ensure you pend to the room when the bed is fully clean, not when it is still dirty. 

Patients with CABG and CRANI surgeries, those with deep incisions (Post Ops), and complex cases should only be in private rooms. Similar to the Swedish campus, incarcerated patients, those with PSA, HD patients, dying patients, isolation patients, and others depend on individual needs and care levels. 

Nursing Units does not permit pre-planning admissions, so do not pend incoming patients for the same room while the current patient is still there, as we do at Swedish. They prefer to wait until the room is completely empty before assigning a new patient. Therefore, you might want to jot down your plans on a piece of paper and hold onto it until you see the discharge and the room is vacant. 

IMPORTANT: Prov do not use the EPIC census and do not update it hourly or when changes occur, so you need to call each unit to confirm their staffing before pending patients to rooms. You will be included in all charge nurses' group chats. If it's urgent, go to Teams and join a video call to ask your question directly to the nursing supervisors who are on standby. 

7A General Medical is NOT accepting patients from the ED only, so do not pend/Admit any patients for this unit. This is a very low level of care, and the nurses are not trained. They only accept INTERNAL TRANSFERS that are suitable, so always seek assistance when placing patients in the 7A General Medical Unit. See the layout on the next page for the right cases for this unit. 

Some surgical ICU patients may be transferred to the Medical ICU, such as ARDS (Acute Respiratory   Distress Syndrome), Resp Failure,   BIPAP, HIFLOW. Post Cardiac Arrest, Post cardiac arrest with TTM (Targeted   Temperature Management) Fresh Trach, Certain Meds, Intubated. 

critical labs such as   Na below 116, or greater than 165, vasopressors etc etc. 

Refer To critical lab   on the website page. IABP(Intra Aortic Balloon Pump), Neuro-spine and Neuro   surgeries,

Impella-(pVads) Heart   pumps, General Cardiac & Vascular Surgeries

CABG (Coronary Artery   Bypass Graft Surgery), Adult trauma, surgeries, General complex surgeries, and the   rest is similar to the Swedish surgical critical level of care categories. 

To ensure proper placement, always contact   the floor charge RN for verification. 

CODE Blue’s, Post   cardiac arrest, ARDS, Respiratory failure, ARDS, BIPAP, HIFLOW, DKA, ETOH and   Drug Withdrawal, Sepsis, CRRT, TNK(tPA), Neuro IR

EKOS, Postpartum   continuous Magnesium, External Pacers.

Certain Meds,   Intubated, critical labs such as Na below 116, or greater than 165,   

vasopressors etc etc.

To ensure proper placement, always contact the floor charge RN for verification.  

Insulin Infusion, NON   ICU Tele Traumas, Thoracic Care, Surgeries, Chest Tubes, Vascular Surgeris,   Post CVL patients with closure devices, DKA

Cardiac Drips, See   Medication Safety-High Risk Medications Policy.

Home vent/Trach   Patients, Stable non-invasive Mechanical Ventilation, Esophagectomy,   Bronchoscopies, NIH

BIPAP, HIGHFLOW (Downgrades)

To ensure proper placement, always contact the floor charge RN for verification.

Consider this floor, where all cases go to   First Hill Campus 7SW and 10SW Tele 

can also access this floor.

ETOH, Sepsis, General Medical Tele   Patients, Rule out MI, but no surgical interventions needed.

Tele patients workup. If the cardiac telemetry unit is at capacity, straightforward procedures 

can be directed to this floor.   

To ensure proper placement, always contact the floor charge RN for verification.  

This is surgical Tele. Consider this floor, where all cases are directed to Cherry Hill 2East and 4East. floor can also   access this floor.R/O MI, TAVR(Transcatheter Aortic Valve Replacement), Pre   and Post OP CVL(Central Venous Line)

Post PTCA(Percutaneous Transluminal   Coronary Angioplasty, Closure Devices, Arrythmias, Pacemaker

CHF- Uncompromised respiratory status,   Elective cardioversion, AICD(Automatic Implantable Cardioverter-Defibrillator and PCD (Primary Ciliary Dyskinesia)

To ensure proper placement, always contact the floor charge RN for verification.  

Consider this floor, where all cases are directed to Cherry Hill 3East floor can also access this floor.

STROKE (NIH), Seizures, Post Traumatic Head   Injury, Staple Post Op, Craniotomies/neurosurgeries

GFT (Glial Fibrillary Tangles) patients with Tele Orders.

This floor can accommodate medical tele patients if Tele is at capacity, but it cannot handle complex cardiac cases.

To ensure proper placement, always contact the floor charge RN for verification.  

Trauma surgeries, chest tubes, Overflow from Med surg cases but not long-term cases.

Consider this floor, where all cases go to   First Hill Campus 10East, 11East and 11SW can also access this floor. Gastric   sleeves, colorectal, abdominal, urological surgeries.

Complex wounds and wound vac. Intrathecal   Dilaudid patients

To ensure proper placement, always contact the floor charge RN for verification.  

Consider this floor where all cases are directed to Cherry Hill 5East and First Hill 3SOI can also access this floor,   please note, this is NOT the Tele floor. Trauma ortho surgeries and other traumas that are appropriate. Please, GFT non-Tele, Chest Tubes also can go to this floor. Post-op orthopedic surgeries, post-op spinal cord injury and surgery.

To ensure proper placement, always contact the floor charge RN for verification.

Consider this floor where all cases are   directed to CDU or short stay can also access this floor. 

Chest pain, TIA(Transient Ischemic Attach),   and syncope with no interventions needed. Cellulitis, COPD,

Asthma, dehydration, anemia, pain control,   watchman overflow. All observation cases expcted to be 

Discharge from the hospital within 24hrs.   No complex cases on this floor.

To ensure proper placement, always contact the floor charge RN for verification.  

  Kidney stones, Urinary tract infections, Dialysis, Renal failure and complications; some renal tele can also access this floor.

 Appropriate for Urology and Renal cases, 

but no bariatric over 350 lbs allowed.

Consider this floor where all cases go to First Hill Campus 11East. Simple surgeries 

can also access this floor. 

To ensure proper placement, always contact the floor charge RN for verification.  

Oncology, chemo, and radiology 

Patients go to this floor.

Consider this floor, where all cases are directed to First Hill Campus 12East can also access this floor. 

Blood transfusions, Pain management, old chest tubes, Neutropenic patients, and Palliative and comfort care. Overflow from medical and surgical floor. DNR high flow.

To ensure proper placement, always contact the floor charge RN for verification.  

  YOU MUST NOT ADMIT ED PATIENTS TO THIS FLOOR. Only take internal transfer only Very low level of care, and nurses are not trained to take patients except few and appropriate to this floor. This is a long term care unit, such as patients waiting for insurance to go home, waiting for placements and for those of long term cases waiting for placement as well.

To ensure proper placement, always contact the floor charge RN for verification 

  Cases like Issaquah MSU can be directed to this unit. No Tele patients allowed on this floor, and no bariatric patients more than 350lbs. Cases such as pneumonia, CHF no intervention, Cellulitis, confusions, Long term IV antibiotics, substance abuse cases, behavioral component and mental health cases.

To ensure proper placement, always contact the floor charge RN for verification.

   Cases like First Hill Campus 4SOI, 5SOI, 9SW can be directed to this unit.

To ensure proper placement, always contact the floor charge RN for verification 

  Can take ICU and IMCU Medical downgrades, medical, EOH, cellulitis, abscess, and bariatric lift. Complex medical non-tele patients. Surgical overflow, 

Sepsis not tele.

To ensure proper placement, always contact the floor charge RN for verification. 

  Full medical floor. Similar to First Hill Campus 5SOI, 9SW, and 4SOI. Can take observation patients if 4C is full. This is not a tele floor. Asthma, respiratory infections, dehydration, malnutrition, GI disorders, diabetes, etc.

To ensure proper placement, always contact the floor charge RN for verification.