New Guidelines for PCU Level of Care Begin Nov. 21

Cedars-Sinai is implementing new patient placement guidelines for Progressive Care Unit (PCU) level of care beginning Monday, Nov. 21.

The new guidelines streamline much of the current five pages of PCU placement procedures into five main criteria and also impact the list of medications requiring PCU status. The changes are expected to promote a more efficient process of assigning the appropriate level of patient care including ICU avoidance when possible.

Teams from the medical staff, nursing, pharmacy and patient placement, with support from clinical transformation, collaborated to create the new guidelines. The executive sponsors of the initiative are Scott Weingarten, MD, senior vice president and chief clinical transformation officer, and Linda Burnes Bolton, DrPH, RN, FAAN, health system chief nursing executive, vice president for Nursing and chief nursing officer.

"The guidelines will assist the team in providing appropriate care in the right setting," said Burnes Bolton. "When fully operationalized the guidelines will facilitate appropriate patient placement, decrease inappropriate use of PCU status for patients and improve access to PCU beds to avoid ICU admission."

The new five main criteria for PCU placement are:

• Ongoing nursing interventions and assessments every two hours (not to exceed eight occurrences)
• Moderate to high risk of cardiac dysrhythmia
• Moderate to high risk of respiratory decompensation
• Invasive hemodynamic devices (e.g., PA catheter)
• Use of medications which require PCU level of care

Nurses assigned to PCU patients have advanced training to care for these higher-acuity patients.

Earlier this month, staff training began to support implementation of the new criteria. Clinical decision support in CS-Link™ is expected to begin March 2017.

For more information or questions, please contact Todd Griner, MSN, RN, NEA-BC, at todd.griner@cshs.org or 310-962-7859.