Classification Levels for Northwestern Memorial Hospital ICUs
Level 1
Cardiovascular or pulmonary
disease requiring intermittent IV or
inhalation therapy.
Frequent timed interventions > or
= to q 2 hours.
Calm, cooperative
Level 2
CV disease requiring continuous
infusions and/or intra-arterial
pressure monitoring.
Pulmonary disease requiring
mechanical ventilator support or an
artificial airway.
Unstable spine or patients with
spine stabilization management.
Quadriplegia.
Combative and agitated
Frequent timed interventions q 1
hour.
Level 3
CV or pulmonary status that is
constantly changing or evolving
and requires frequent titration of
IV medications and/or positive
ventilation to maintain life
functions.
Frequent timed interventions > q 1
hour.
Dangerous agitation(climbing over
bedrails, pulling at lines)
ADL’s
Bedrest with turn q 2 hour.
Requires more than 2 staff to
assist.
Complete care q 2 hours. Oral care
protocol in place.
Complete care q 1-2 hours. Oral
protocol in place. Frequent linen
changes.
Vital Signs/Assessment
V/S q 2 hours.
Stable on cardiac monitor.
Neuro checks q 2 hours.
ICP q 1 hour and not elevated.
CMS q 1 hour.
Lumbar drains requiring
< or = to 15 minutes per hour to
drain.
Pain scores 4-6.
V/S q 1 hour.
Neuro checks q 1 hour.
ICP q 1 hour and may be elevated.
CMS q 1 hour.
Lumbar drains with q 1 hour
drainage (time to drain > 15
minutes per hour).
Arterial or invasive continuos
monitoring systems.
PA/Pulsco q 2-4 hours.
Pain scores 7-10.
V/S < q 1 hour.
Neuro checks < q 1 hour.
ICP elevated requiring multiple
interventions.
CMS < q 1 hour.
Nutrition
Total assist
Total assist.
GI prep.
Total assist.
GI prep.
Accuchecks < q 2 hours.
General
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Classification Levels for Northwestern Memorial Hospital ICUs
IV’s/Meds
Intermittent IV medications to
maintain HR and B/P parameters.
Continuous non-vasoactive IV
medication infusion (heparin,
PCA). Cardiotonic medications
with stable V/S. Chemical elective
cardioversion.
Inhaled medications by nebulizer
or albuterol inhaler.
IV pain management with scores
4-6.
Blood product infusions.
Chemotherapy.
CVHD meds IV.
Insulin drip with q 1 hour checks.
Labs q 2-4 hours not including
accuchecks.
Cardiac dysrhythmias or unstable
hemodynamic status requiring
intermittent or continuous
medications or electrical therapy.
(DCCV).
Chemotherapy with protocols.
Multiple vasopressors with
titration. Stable CVVH.
Multiple drips with frequent
adjustments. Rapid infuser for IV
fluids/blood. Multiple transfusions
or pressure bag infusions. Triple H
Therapy with 2 or > IV drips.
Hourly cc per cc replacements.
Neuromuscular blockaide.
Unstable CVVH.
Labs q 2 hour not including
accuchecks.
O2
FIO2 < or = to 50%.
BiPAP first 24 hours.
Suction q 2-4 hours.
PG2 Ventilator.
Vital capacity q 2 hour with stable
respiratory status.
FIO2 > 50%.
Artificial airway or recent
extubation ( < 2 hrs ).
Suction q 1-2 hours.
Ventilators: CPAP or SIMV AC.
Nursing Treatments
Treatments requiring 2 hours per
shift.
Chest tube to continuous suction.
Education
Intense teaching done at bedside
requiring reinforcement and
discharge planning.
Treatments requiring > 2 hours per
shift.
Rotorest bed.
B/P support IV.
Advanced education on treatments
and/or equipment.
Labs q 1-2 hours. Hemogram with
q 2 hour transfusions and multiple
blood products.
FIO2 > 60% and mechanically
ventilated patients with PEEP
levels > 10.
Frequent ventilator changes > 1
x/hour.
Frequent suctioning > 30 minutes
per hour.
Impending respiratory failure.
Treatments requiring > 1 RN.
Labs
Frequent education/counseling on
multiple issues regarding patient
care. Language/communication
barrier.
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Classification Levels for Northwestern Memorial Hospital ICUs
Psychosocial
Functional family with minimal
issues.
Patient and family coping well.
Patient family issues requiring q 24 hour interventions. Patient and
family having trouble coping.
Tests/ Transport Status
Requires competent and trained
nurse to administer IV or inhaled
drugs during study and transport.
Critical care or nurse and a Critical
Care Respiratory therapist ( if
applicable for airway and
ventilator support) needed for
transport and presence throughout
the procedure. A member of the
Critical Care physician team must
be immediately available
throughout the study for urgent or
emergent interventions.
Off Unit procedure time
Exception to nurse transporting:
(Written transfer order to general
care floor, awaiting bed – off
cardiac monitor, all invasive
monitoring line D/CD)
Exception to nurse staying during
procedure: All anesthesia
managed cases except patients
with EVD/Lumbar drains
Time off unit with nurse:
Dysfunctional patient/family.
Multiple issues requiring multiple
interventions from care team.
Crisis intervention.
Critical care nurse, critical care
Respiratory
Therapist, critical care physician
(attending, fellow or minimum 2nd
year resident with critical care
skills) and transport personnel to
facilitate emergency movement
and/or return to units.
Time off unit with team:
____________________________
Time off unit with nurse:
____________________________
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