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OVERVIEW
Waikato Hospital has a high dependency unit (HDU) which was established in
1973. It has recently undergone refurbishment to accommodate neurosurgery
and will have and increase in bed numbers from 10 - 12 beds. It admits
over 1700 patients yearly, with an average duration of 30.25 hours. It is
located next to the ICU and there is a close functional relationship
between the two units.
Although it is under the administrative control of the ICU, ICU and HDU differ in that
patients in the ICU are managed by the ICU medical staff while those in
the HDU are managed by the admitting medical or surgical team. The
Intensive Care consultants do 3 rounds a day in HDU with the nurse
co-ordinator to help the clinical staff with any problems, identify
potential and/or developing crises, and to support the HDU nursing staff
with clinical and logistic difficulties. The ICU staff attend any major
emergencies.
Each of the 12 HDU beds has the same electrical and gas fittings as the
ICU. Monitoring is available for each bed and includes ECG, two direct
pressure outlets, non-invasive blood pressure, temperature, and pulse
oximetry. This is being upgraded from the current portable propac monitors
to a Marquette system that is compatible with the ICU. Infusions, patient
controlled analgesia, and epidural infusion pumps are available as needed.
Bipap mask ventilators and other equipment is shared with ICU.
Patients in HDU fall under six broad categories:
1. complicated postoperative cases, e.g. elective aortic aneurysms, major
maxillofacial surgery and carotid endarterectomy
2. miscellaneous surgical patients, e.g. shocked patient from perforated
bowel needing resuscitation, pancreatitis
3. trauma patients not needing ICU, e.g. several large fractures
4. medical patients, e.g. overdoses needing monitoring, diabetic
ketoacidosis, stable gastrointestinal bleed, type II respiratory failure requiring BIPAP/CPAP
5. post ICU patients needing an intermediate area before going to the
routine ward
6. overflow from ICU
Admissions to HDU are approved by the HDU Clinical Nurse Leader or
co-ordinator depending on bed space availability. They will, in
conjunction with the parent medical teams and the ICU staff, negotiate the
discharge of patients to the ward. The intensive care medical staff visit
HDU 3 times daily on ward rounds and have an overview of the patients in
HDU. They are available for consultation on all patients in the HDU and
frequently need to facilitate the discharge of patients from HDU or
restrict admissions if the unit is busy.
STAFFING
The unit is staffed by 27.8 full time equivalent registered nurses who
have either ICU or specialist HDU training. HDU nurses have developed
particular skills which include advanced monitoring, pain management
(including epidural care), management of vasoactive drugs and tracheostomy
care.
Sue Akehurst and Lynette Jones share the Clinical Nurse Leader (CNL) role
of HDU, which incorporates clinical, administrative and education
portfolios.
Nurses are rostered on either 8 hour or 12 hour duties, depending on their
preference. There are experienced, long standing permanent night staff who
work similar shifts.
50% of the nursing staff have completed nursing career pathway portfolios
Registered nurses undertake specific portfolios within the unit. These
include 2 I/C, preceptors and mentors to students, quality assurance,
nursing career path facilitator, acute pain service representatives, I.V.
certificators, wound care, NZNO representative, health and safety / risk
management, and social club activities.
EDUCATION
The HDU has a comprehensive orientation programme, supportive
preceptorship and mentoring, along with regular inservice and allocated
study days. It also runs a Critical Care Course – High Dependency Unit
module – in conjunction with Intensive Care Unit.
All staff are encouraged to participate in fortnightly inservice and/or
focus board display. All staff have current HWL and Unit specific
certification, as well as CPR and Fire training.
The HDU also has ongoing quality control and audit programs.
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