Scope of Practice for BCH Inpatient Units

Quick Patient Placement Grid:

  Vital Signs, monitoring, nursing interventions Respiratory Support Medications, infusions Special Criteria
Pediatric Floor Q4 hour vital signs, neuro checks, labs, monitoring. Continuous VEEG.
Continuous EKG for HR monitoring only.
Continuous O2 sat monitoring.
Room air, nasal cannula, blow by oxygen. Respiratory toilet or other management Q 4 hours or less frequently.
Trach to collar or valve.
Continous albuterol at 20 mg/hr or less.
Routine infusions requiring adjustments less freqently than Q4 hours.
Heparin infusions per BCH policy/order set.
SQ Insulin

Chest tubes.
Adolescent med patients: MSP

COWS/CIWA: C5 MSP, C5 TCUP, ACRT

Bili lights: C5 MSP

TCUP Q2-3 hour vital signs, neuro checks, labs, monitoring.
Continuous EKG for HR and rhythm monitoring.
Continuous O2 sat monitoring.
HFNC:
2 – 8 L for infants less than 1 year
2 – 10 L for children 1 - 4 years
2 – 20 L for children greater than 4 years
CPAP or BiPap on home settings (increased O2 requirement okay)
Routine infusions requiring adjustments less freqently than Q3 hours. Spinal fusion post-op
Renal transplant post-op
CTCU Q2-3 hour vital signs, neuro checks, labs, monitoring.
Continuous EKG for rhythm monitoring.
Continuous O2 sat monitoring.
Arterial lines.
HFNC: case by case
CPAP or BiPap on home settings, overnight only
Routine infusions requiring adjustments less freqently than Q3 hours.
Milrinone infusions.
Floor-appropriate patient managed on cardiology service.

Cardiac cath post procedure.
PICU/CICU Hourly (or more frequent) vital signs, labs, neuro checks, labs.
Continuous EKG for rhythm monitoring.
Arterial lines.
Central line used for pressure monitoring.
HFNC that exceeds TCUP criteria.
Transport patient on HFNC at OSH.
Trached patient on CPAP/BiPAP/Vent.
Intubated/ventilated patient.
Pt requiring pulmonary toilet Q1-2 hours or more frequently.
Insulin infusions
Sedation infusions
Any infusion requiring monitoring, labs, adjustments more frequently than Q2 hours.
Specific inhaled medications (ex iloprost)
Vasoactive medications, pressors.
ICP monitoring.
ICN Hourly (or more frequent) vital signs, labs, neuro checks, labs.
Continuous EKG for rhythm monitoring.
Arterial lines.
Central line used for pressure monitoring.
    Any patient under 36 weeks gestation.
Floor-appropriate infant requiring external heat source.
Phototherapy.
Neonatal cardiac cath post-procedure.

 

 

Scope of Service for all BCH Units can be found here.

A more detailed guideline can be found here.

Admitting OB-Gyn patients to pediatric floors: guidelines here.