Pulmonary Unit Admission and Discharge Criteria

University of Colorado Policy and Procedure
Pulmonary Unit Admission and Discharge Criteria
Approved by:
Coordination and Access to Care Subcommittee
Patient Services
Effective 4/99
Revised: 8/13
The Pulmonary Unit provides care for patients with acute respiratory
diseases, noninfectious decompensation of chronic lung diseases, respiratory infections, and
thoracic surgery requiring acute care interventions. The goal of the Pulmonary Unit is to provide
care for the respiratory diseases, infections and thoracic surgeries that may require, but not
limited to the following interventions:
1. Use of a CADD Legacy Infusion pump for Prostacyclin administration for Pulmonary
Arterial Hypertension
2. Intermittent B-pap and C-pap for respiratory diseases
3. Respiratory care such as therapivest, and aerosolized treatments
4. Use of chest tubes for thoracic surgery
5. Negative air flow rooms for infectious airborne diseases
6. Use of Ribavirin treatment for S/P lung transplant infection
7. Uses of insulin IV and subcutaneous protocol for tight glucose management.
Definition: Medically stable is defined as but is not limited to, no longer
requiring frequent observation or vital sign acquisition, artificial airway
support, and/or vasoactive therapy to maintain hemodynamic homeostasis.
Accountability: The charge nurse and admitting physician in collaboration with the House
Manager/Nurse Manager will evaluate the patient’s condition for admission and discharge from
the Pulmonary Unit. The CNS/Educator is responsible for the orientation and competency
training of the nursing staff to care for the Pulmonary Population as defined.
Policies and Procedures:
1. A. Admission CriteriaThe priority for admission is as follows:
a. Patients with Pulmonary Hypertension on Flolan or Remodulin
b. Thoracic Surgery, Pulmonary Hypertension:without Flolan or Remodulin,
Cystic Fibrosis, “Infected” Lung Transplant patients.
c. Rule out TB patients-only if available negative airflow room
d. Pulmonary Dx Medicine Patients: Pneumonia, COPD, Asthma
e. Medicine 4 team patients
f. Med-Surg Overflow patients
2. Patients transferring from the critical care areas, clinics and other facilities are also a
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Pulmonary Unit Admission and Discharge Criteria
3. Patients on continuous cardiac monitoring and/or continuous pulse oximetry
4. Off service patients will only be admitted if bed placement is available.
5. Exclusion Criteria
1. Patients requiring an intensive level of nursing care defined as frequent vital signs,
frequent dressing changes, or nursing observation/assessment/implementation
greater than 2 hours for a period of greater than 8 hours or if the level of care is
difficult to maintain safely at the discretion of the charge nurse and/or Nurse
Manager/ Director.
2. Patients who are medically unstable who require frequent titration of IV
medication to maintain hemodynamic homeostasis.
3. Patients less than 12 yrs of age or less than 40kg.
4. Patients on continuous CPAP or BIPAP.
5. Patients with active bleeding and hemodynamic instability.
6. Patients with an introducer port access or arterial line.
7. Patients requiring ICP monitoring.
8. Patients requiring IV chemotherapy.
6. Discharge Criteria
1. Patients are eligible for discharge when they are medically stable as
determined by the physicians and/or:
a. The Patient or their family/ significant other must be able to assume the
required care at home including knowledgeable medication
administration and required treatments (e.g. dressing changes, tube care,
etc) and/or the appropriate home care is ordered and scheduled.
b. The patient is referred to the appropriate facility for skilled nursing care,
assisted care, rehabilitation care, psychiatric care, etc. and is accepted by
the facility for transfer.
c. Arrangements have been made for medical follow up care with the
patients Primary Care Provider, referring physician and /or the
appropriate UCH clinic.
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