Most people are familiar with the ICU in hospitals, however they may not be aware of all of the services offered at an ICU. They may also not be aware of what patients and their families can expect when a loved one has to be admitted to the ICU.
Here to speak with us today about what to expect in the ICU and PCU is Sharon Ormsby. She is the Director of the ICU, PCU and Cath Lab at Palmdale Regional Medical Center.
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What to Expect in the ICU & PCU
Featured Speaker:
Sharon Ormsby
Sharon Ormsby is the Director of the ICU, PCU and Cath Lab at Palmdale Regional Medical Center. Transcription:
What to Expect in the ICU & PCU
Melanie Cole (Host): Most people are familiar with the ICU in hospitals. However, they may not be aware of all the services offered at an ICU and what patients and their families can expect when a loved one has to be admitted to the ICU. Here to speak with us today about what an ICU actually is, my guest Sharon Ormsby. She's a registered nurse and the director of the ICU, PCU and Cath Lab at Palmdale Regional Medical Center. Welcome to the show. Most people are familiar. They don't want to hear about an ICU because they're thinking that's terrible but lay some groundwork for us. What actually is it and what types of patients do you typically have in there?
Sharon Ormsby, RN (Guest): Thank you for the welcome. I typically tell people I'm a very friendly person and I love to have people come and visit me, but please don't come visit me at work because it is intensive care unit and that means there's a little extra something going on with a patient and I'd rather visit you out for dinner somewhere maybe, but not necessarily at my work. ICU is more of an intensive care given to the patient. In other words, they have something extra going on. You could have pneumonia, for instance, in a regular medical-surgical unit, you could even be on a telemetry unit with pneumonia, or you could be as high as PCU and ICU where you could even be on a ventilator. ICU has patients that are requiring ventilator support with what people typically call a breathing machine. We do life support, so patients that have maybe experienced a heart attack or cardiac arrest and we’re able to resuscitate them, they would all come to ICU. Sometimes patients that have just had a heart attack and gone to the Cath lab and maybe had some stints or something placed, many of those come back for monitoring. We end up with just the people that need a little bit closer supervision, whether it be an end of life or life and death situation or maybe just the medications that they require that require close supervision.
Melanie: Patients aren’t quite sure and their families are not quite sure what they're allowed to do in the ICU as far as flowers or visiting hours. Give us a little bit of patient’s families’ expectations for the ICU.
Sharon: We do have a lot more rules. We’re a specialty unit so we do things a little bit differently. One of the things is that our visitation is longer hours than most areas of the hospital; we do try to restrict it during our report time, which is roughly between seven and eight o'clock, both a.m. and p.m. so that we can give an accurate and full report. However, if you are in the unit during that time, we will include you in the report, answer some of your questions and ask questions of you so we can better take care of your loved one. As far as flowers and food and things of that nature, we don’t have live flowers or food brought into our unit.
It’s similar to when you're doing international travel and how they’ll always check your fresh produce or any live plants because we don’t want to have transmission of disease. These patients many times are compromised with their immune system, so they can't really handle anything extra attacking their bodies at this time. Food for the visitors, we also encourage that they not eat at the bedside because again this is an area that does have a lot of communicable diseases and you're not really going to want to, if you think about it, it’s not really sanitary and it’s not a great sanitary environment; it’s not the operating room. You're probably not going to want to sit down and have your dinner in here and we don’t allow it anyway. In our waiting area, you can have some snacks and bottled or canned drinks, but we really don’t recommend bringing big meals from outside. We do have the cafeteria that has pretty liberal hours, and even if you bring in something from the outside, we recommend you sit in the cafeteria dining room and spread out down there because it’s more conducive to that environment anyway.
As far as visiting, there's one more caveat I forget to mention, and those are children. We do typically have people wanting to bring their children in to visit their loved ones and we understand that. However, we don’t have any children coming in under the age of 16, and especially if it’s the flu season, we don’t bring in children under 12 just simply for the reason of the kids are in school and they take up other germs and they’ll bring them into this environment where the patients are very ill. We don’t want them picking up germs and taking them back home as well.
Melanie: How long might a person actually stay in the ICU typically? I understand it's certainly dependent on whatever the reason is that they're there, but what's typical?
Sharon: Typically, about a four-day stay would be on the average, but as you indicated, that can range. We have patients that spend overnight. Maybe they had a cardiac catheterization and had some sort of procedure done. They spend the night and they may even go home the next day or move to another area of the hospital we have other people that have had very devastating strokes, brain bleeds, things of this nature, and they may be on life support for two or three weeks before a resolution is attained. At that point, you could be here anywhere from a day or two to a few weeks.
Melanie: How many nurses and physicians are available or assigned to the ICU patient?
Sharon: That’s a good question. With the physicians, it varies just like you had indicated on the length of stay. From something very simple to something very complicated, you could end up with just one primary physician. If you came in with maybe diabetic ketoacidosis and you were just requiring an insulin drip, maybe your primary physician can handle those orders and get you through that disease course and just one physician. Likewise, on the other end of the spectrum, you could end up having a loved one here with several different complicating factors and you need a doctor to not only be your primary but one to manage the ventilator support, cardiac doctor, maybe a neuro doctor for the brain injury that may have taken place. You could end up with easily four doctors on a case.
As far as nursing, that’s very regulated. A few years back, our governor, Schwarzenegger put in the nursing ratios and it is in law now. In ICU, the most patients one nurse will have is two patients. We do sometimes have a one on one nursing care and those are for our most critical patients.
Melanie: That’s very encouraging for listeners to here if they have a loved one in the ICU that you're also dedicated to each one of the patients. You also have a PCU. What is that? Tell people what that is.
Sharon: The PCU is called the progressive care unit. It is this step-down intermediary between the ICU and the regular telemetry floor. It also has a mandated ratio of one to three patients – one nurse with no more than three patients. It’s another level of intensive care where we can keep a little bit closer eye on you than having you out on the regular nursing floors in the hospitals. The telemetry floor has one nurse for four patients, for example. Instead of just going straight from ICU where it's one to two to doubling the nurse's load, the PCU is that catch-all area where we can just provide little extra eyes on, hand on care before they move onto the next level.
Melanie: Even if someone had a stroke or a pacemaker put in after they're in the clear or in stable condition, then they can be moved to the PCU?
Sharon: Yes. Typically, the PCU can handle patients that were in the ICU but they have now stabilized, they’ve come off the ventilator, they don’t require near the specialty care that is necessary in the ICU. They don’t have to have hourly interventions, maybe we’re down to every two or three hours, so it’s a little bit more relaxed on that care, but still higher level than what you would find in other areas of the hospital.
Melanie: We know it certainly depends on what the patient’s status is, but when are they transferred out of the ICU and into the next phase of their care?
Sharon: What we typically do is on ventilators, they stay in the ICU, so as long as they're requiring a breathing machine to support their breathing functions, they will stay in the ICU. Once we can get them off of that, but we’re still wanting to keep a really close eye to make sure we don’t have to go back on that therapy, the PCU would be a great option there. The other reasons that we would go there is maybe they’ve been on IV continuous medications to monitor blood pressure and heart rate, things of this nature, maybe even the diabetic ketoacidosis patients that’s been on a constant insulin drip but now we’re transitioning off of that and they're becoming more stable. Once the medications come off, they can go to the PCU and still get the tighter observation, but not have the medications that require the intensive care unit. It’s a nice intermediary before they go to the floor where the nursing ratios are increased again.
Melanie: While this is information for another show, would the ICU be a place where advanced directives are discussed with the family, living will and that sort of thing because you have such seriously critically ill patients?
Sharon: Yes. We actually ask it upon admission to the hospital, so no matter where you're going, if you're talking to an admitting person in registration, they are going to ask you if you have an advanced directive. It’s okay if you don’t. They can also ask you at that time if you would like to have someone come and speak to you about it. Once you’ve come to the ICU, it doesn't matter what the answers to those questions were. If you have an advanced directive, of course, we're going to ask for a copy and then we'll utilize it when the time is right. We're never going to activate it until that's the situation the patient is in. However, this is a lot of times the first time families have thought about the end of life decision making. This is a perfect environment for that. We do have the support here with palliative care and with social services and case managers that are very well versed in answering the questions and can help the end of life decision making.
Melanie: To wrap it up, it’s such great information, do you have anything else you'd like to say about these units that you feel perspective patients or family members should know?
Sharon: I will have to say that I have been a critical care nurse for 25 years and it has been my absolute love. I fell into it as a brand new nurse and I've stayed with it my whole career. It is so exciting for me to be able to take these patients and know them, every single system and every single thing going on with them. As we mentioned earlier, I would only have one or two patients, so I know everything about those one or two patients. To be able to be a part of the healthcare team and make decisions and move them through the system and get them better is such a joy. I have found that to be the case here at Palmdale. The level of care these nurses provide was amazing to me. When I came here and walked down the halls and watched how they interact with the families and the physicians, the level of professionalism was astounding. I couldn't wait to join the team. When you come and visit us here, you're going to get top-notch care, I promise you, and the compassion that this staff has is amazing. I've seen them laugh with the families and cry with the families and enjoy the successes as patients move onto downgrade in better areas of the hospital or if it's time for the loved one to move onto the next stage in life, the nurses are there to hold their hand and help them through that as well. I'm very proud of this team and I think that's what you will find when you come to visit us.
Melanie: Thank you so much and thank you for all the great work that you do. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit palmdaleregional.com. That’s palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
What to Expect in the ICU & PCU
Melanie Cole (Host): Most people are familiar with the ICU in hospitals. However, they may not be aware of all the services offered at an ICU and what patients and their families can expect when a loved one has to be admitted to the ICU. Here to speak with us today about what an ICU actually is, my guest Sharon Ormsby. She's a registered nurse and the director of the ICU, PCU and Cath Lab at Palmdale Regional Medical Center. Welcome to the show. Most people are familiar. They don't want to hear about an ICU because they're thinking that's terrible but lay some groundwork for us. What actually is it and what types of patients do you typically have in there?
Sharon Ormsby, RN (Guest): Thank you for the welcome. I typically tell people I'm a very friendly person and I love to have people come and visit me, but please don't come visit me at work because it is intensive care unit and that means there's a little extra something going on with a patient and I'd rather visit you out for dinner somewhere maybe, but not necessarily at my work. ICU is more of an intensive care given to the patient. In other words, they have something extra going on. You could have pneumonia, for instance, in a regular medical-surgical unit, you could even be on a telemetry unit with pneumonia, or you could be as high as PCU and ICU where you could even be on a ventilator. ICU has patients that are requiring ventilator support with what people typically call a breathing machine. We do life support, so patients that have maybe experienced a heart attack or cardiac arrest and we’re able to resuscitate them, they would all come to ICU. Sometimes patients that have just had a heart attack and gone to the Cath lab and maybe had some stints or something placed, many of those come back for monitoring. We end up with just the people that need a little bit closer supervision, whether it be an end of life or life and death situation or maybe just the medications that they require that require close supervision.
Melanie: Patients aren’t quite sure and their families are not quite sure what they're allowed to do in the ICU as far as flowers or visiting hours. Give us a little bit of patient’s families’ expectations for the ICU.
Sharon: We do have a lot more rules. We’re a specialty unit so we do things a little bit differently. One of the things is that our visitation is longer hours than most areas of the hospital; we do try to restrict it during our report time, which is roughly between seven and eight o'clock, both a.m. and p.m. so that we can give an accurate and full report. However, if you are in the unit during that time, we will include you in the report, answer some of your questions and ask questions of you so we can better take care of your loved one. As far as flowers and food and things of that nature, we don’t have live flowers or food brought into our unit.
It’s similar to when you're doing international travel and how they’ll always check your fresh produce or any live plants because we don’t want to have transmission of disease. These patients many times are compromised with their immune system, so they can't really handle anything extra attacking their bodies at this time. Food for the visitors, we also encourage that they not eat at the bedside because again this is an area that does have a lot of communicable diseases and you're not really going to want to, if you think about it, it’s not really sanitary and it’s not a great sanitary environment; it’s not the operating room. You're probably not going to want to sit down and have your dinner in here and we don’t allow it anyway. In our waiting area, you can have some snacks and bottled or canned drinks, but we really don’t recommend bringing big meals from outside. We do have the cafeteria that has pretty liberal hours, and even if you bring in something from the outside, we recommend you sit in the cafeteria dining room and spread out down there because it’s more conducive to that environment anyway.
As far as visiting, there's one more caveat I forget to mention, and those are children. We do typically have people wanting to bring their children in to visit their loved ones and we understand that. However, we don’t have any children coming in under the age of 16, and especially if it’s the flu season, we don’t bring in children under 12 just simply for the reason of the kids are in school and they take up other germs and they’ll bring them into this environment where the patients are very ill. We don’t want them picking up germs and taking them back home as well.
Melanie: How long might a person actually stay in the ICU typically? I understand it's certainly dependent on whatever the reason is that they're there, but what's typical?
Sharon: Typically, about a four-day stay would be on the average, but as you indicated, that can range. We have patients that spend overnight. Maybe they had a cardiac catheterization and had some sort of procedure done. They spend the night and they may even go home the next day or move to another area of the hospital we have other people that have had very devastating strokes, brain bleeds, things of this nature, and they may be on life support for two or three weeks before a resolution is attained. At that point, you could be here anywhere from a day or two to a few weeks.
Melanie: How many nurses and physicians are available or assigned to the ICU patient?
Sharon: That’s a good question. With the physicians, it varies just like you had indicated on the length of stay. From something very simple to something very complicated, you could end up with just one primary physician. If you came in with maybe diabetic ketoacidosis and you were just requiring an insulin drip, maybe your primary physician can handle those orders and get you through that disease course and just one physician. Likewise, on the other end of the spectrum, you could end up having a loved one here with several different complicating factors and you need a doctor to not only be your primary but one to manage the ventilator support, cardiac doctor, maybe a neuro doctor for the brain injury that may have taken place. You could end up with easily four doctors on a case.
As far as nursing, that’s very regulated. A few years back, our governor, Schwarzenegger put in the nursing ratios and it is in law now. In ICU, the most patients one nurse will have is two patients. We do sometimes have a one on one nursing care and those are for our most critical patients.
Melanie: That’s very encouraging for listeners to here if they have a loved one in the ICU that you're also dedicated to each one of the patients. You also have a PCU. What is that? Tell people what that is.
Sharon: The PCU is called the progressive care unit. It is this step-down intermediary between the ICU and the regular telemetry floor. It also has a mandated ratio of one to three patients – one nurse with no more than three patients. It’s another level of intensive care where we can keep a little bit closer eye on you than having you out on the regular nursing floors in the hospitals. The telemetry floor has one nurse for four patients, for example. Instead of just going straight from ICU where it's one to two to doubling the nurse's load, the PCU is that catch-all area where we can just provide little extra eyes on, hand on care before they move onto the next level.
Melanie: Even if someone had a stroke or a pacemaker put in after they're in the clear or in stable condition, then they can be moved to the PCU?
Sharon: Yes. Typically, the PCU can handle patients that were in the ICU but they have now stabilized, they’ve come off the ventilator, they don’t require near the specialty care that is necessary in the ICU. They don’t have to have hourly interventions, maybe we’re down to every two or three hours, so it’s a little bit more relaxed on that care, but still higher level than what you would find in other areas of the hospital.
Melanie: We know it certainly depends on what the patient’s status is, but when are they transferred out of the ICU and into the next phase of their care?
Sharon: What we typically do is on ventilators, they stay in the ICU, so as long as they're requiring a breathing machine to support their breathing functions, they will stay in the ICU. Once we can get them off of that, but we’re still wanting to keep a really close eye to make sure we don’t have to go back on that therapy, the PCU would be a great option there. The other reasons that we would go there is maybe they’ve been on IV continuous medications to monitor blood pressure and heart rate, things of this nature, maybe even the diabetic ketoacidosis patients that’s been on a constant insulin drip but now we’re transitioning off of that and they're becoming more stable. Once the medications come off, they can go to the PCU and still get the tighter observation, but not have the medications that require the intensive care unit. It’s a nice intermediary before they go to the floor where the nursing ratios are increased again.
Melanie: While this is information for another show, would the ICU be a place where advanced directives are discussed with the family, living will and that sort of thing because you have such seriously critically ill patients?
Sharon: Yes. We actually ask it upon admission to the hospital, so no matter where you're going, if you're talking to an admitting person in registration, they are going to ask you if you have an advanced directive. It’s okay if you don’t. They can also ask you at that time if you would like to have someone come and speak to you about it. Once you’ve come to the ICU, it doesn't matter what the answers to those questions were. If you have an advanced directive, of course, we're going to ask for a copy and then we'll utilize it when the time is right. We're never going to activate it until that's the situation the patient is in. However, this is a lot of times the first time families have thought about the end of life decision making. This is a perfect environment for that. We do have the support here with palliative care and with social services and case managers that are very well versed in answering the questions and can help the end of life decision making.
Melanie: To wrap it up, it’s such great information, do you have anything else you'd like to say about these units that you feel perspective patients or family members should know?
Sharon: I will have to say that I have been a critical care nurse for 25 years and it has been my absolute love. I fell into it as a brand new nurse and I've stayed with it my whole career. It is so exciting for me to be able to take these patients and know them, every single system and every single thing going on with them. As we mentioned earlier, I would only have one or two patients, so I know everything about those one or two patients. To be able to be a part of the healthcare team and make decisions and move them through the system and get them better is such a joy. I have found that to be the case here at Palmdale. The level of care these nurses provide was amazing to me. When I came here and walked down the halls and watched how they interact with the families and the physicians, the level of professionalism was astounding. I couldn't wait to join the team. When you come and visit us here, you're going to get top-notch care, I promise you, and the compassion that this staff has is amazing. I've seen them laugh with the families and cry with the families and enjoy the successes as patients move onto downgrade in better areas of the hospital or if it's time for the loved one to move onto the next stage in life, the nurses are there to hold their hand and help them through that as well. I'm very proud of this team and I think that's what you will find when you come to visit us.
Melanie: Thank you so much and thank you for all the great work that you do. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit palmdaleregional.com. That’s palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.