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 Description: 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 priority. x005n11 Page 1 of 2 Pulmonary Unit Admission and Discharge Criteria 3. Patients on continuous cardiac monitoring and/or continuous pulse oximetry monitoring. 4. Off service patients will only be admitted if bed placement is available. 1. 2. 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. 7. x005n11 x005n11 Page 2 of 2