3/20/2023 0 Comments Levophed dripIdeally conduct rounds in a physical location that allows RN to attend while remaining near the patient Inform RN prior to rounding on each patient.Perform team rounds in a work room/space that allows sufficient distancing between providers.Huddle with nursing management, care managers, social work.Briefly walk by all intubated patient rooms with RT, review current settings and morning ABG/VBG, discuss anticipated plan for when RT next enters room (ie vent changes, extubation, etc) Complete “ventilator rounds.” This is traditionally led by a MICU fellow though the structure may change depending on personnel available.Use the COVID-19 report accessible through Chart Review to review relevant information including: vitals, medications, labs, ventilator settings, results, radiology, etc. Review all vitals, labs, rates of continuous infusions, overnight events, etc in Epic.Ensure all team members are signed into appropriate pagers.Do not enter COVID-19 patients’ rooms prior to rounds unless there is an urgent indication.Re-evaluate patient in timely manner to ensure clinical status has not changed. Then inform primary team of ICU recommendations and complete consult note documentation. Note: If a patient does not warrant ICU transfer, contact the ICU attending of record to discuss. Proceed with ICU admission steps 2-8 above for ED admissions.If patient is being admitted to an alternative ICU team, make sure to contact them and discuss.Call bed control (x45795, pager 1111) to get bed assigned.Notify ICU charge nurse of transfer and to discuss bed availability/location.If patient warrants transfer to the ICU (e.g, increasing oxygen requirements, hemodynamic instability):.Note: Donning enhanced precautions PPE in this situation may increase anxiety of the patient’s care team, but should be done to ensure safety.If the patient is not on precautions but there is concern for COVID-19, don enhanced precaution PPE prior to entering room (consider chart review with ICU attending prior to entry to discuss risk of COVID-19 if clinical situation permits).If possible, discuss case in-person with resource nurse, patient’s nurse and primary team before entering room to help anticipate what equipment might be needed when entering. COVID-19 patients may rapidly deteriorate and thus a low threshold of transfer to the ICU should be maintained.Evaluate patient for consideration of transfer to ICU.Complete documentation and written signout for the night team.Contact HCP/NOK/other family to alert/update.Do not be judicious (If you think you will want a lab in the next 24 hrs, get the lab upfront and consolidated with other admission labs) Consolidate lab order timing to minimize room entries by nursing.Refer to MICU COVID-19 Best Practices: initial ICU evaluation to see the recommended tests for COVID-19 patients and PUI.Refer to MICU COVID-19 Best Practices: home medication section.Cardiology ( Pager 2273): Consult Cardiology if there is concern for late onset acute heart failure.Pulmonary ( Pager 0500): Consult Pulmonary if persistent PaO2/FiO2 30 cm H2O.ID/COVID-19 ( Pager 5236): Consult ID for newly confirmed COVID-19 or if there is evidence of accelerated decompensation including worsening hypoxemic respiratory failure and/or inflammatory indices.Consult subspeciality teams as appropriate: The below listed consult teams do not need to be consulted on every PUI or COVID-19 patient who is admitted to the ICU but are listed for convenience.Complete HCP if patient does not have one Verify health care proxy (HCP)/next of kin (NOK) and code status with patient.For decompensating patients: prepare for ACLS in COVID-19 patient (see MICU COVID-19 Best Practices) and contact anesthesia COVID-19 team ( Pager 3688) early if patient not intubated.For acute patients: consider physician evaluation be performed by physician capable of completing all tasks (e.g., procedures, POCUS).For non-acute patients: consider nurse evaluation first followed by physician to address outstanding issues.Consolidate medication administration times to minimize nurse exposure.Avoid ICU electrolyte repletion order set if possible (requires frequent room entry by nursing).First choice DVT prophylaxis: enoxparin (Lovenox).MDI inhalers ( NOT nebulizers) should be used to treat COVID-19 patients and persons under investigation (PUI) with albuterol or ipratropium.First choice vasopressor: Norepinephrine (Levophed).See SEDATION/ANALGESIA/PARALYSIS section of the MICU COVID-19 Best Practices Fentanyl infusions, propofol, precedex, midazolam, and MDI inhalers are on shortage discuss alternatives with pharmacy.Place holding orders using EPIC “COVID ICU admission” order set.
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