Special Inpatient Situations

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BH to North Star: sually at the recommendation of the behavioral health clinician and requires a doc-to-doc conversation

Code: The *Doc (star-doc) wears the code beeper and in addition to responding to all hospital “code blues,” is the code leader on NW until the ER attending arrives. There are 2 crash carts with Zole defibrillators on NW and the closest AED is immediately outside of NW in the Surgery waiting area. Early “shock” and transport to the ER should be considered. Preventive code blue measures such as not accepting unstable patients to NW and designating code or “natural death” status are encourage.

Death on NW: This requires a physician to “pronounce” the patient, write a “death note” as part of the discharge summary and contact the state medical examiner. The charge nurse has the complete list of things that need to be completed before sending the body to our morgue. see Death Protocol for more details.

Remote resuscitation or videoconference: As mentioned earlier, there are 3 VTC phones in the hospital (2 on NW) to assist with a remote resuscitation. No medevac should be activated without a pulse present.

Patient to OR or Endoscopy: Usually this occurs when a GI bleed patient is actively bleeding or an elderly patient requires an inpatient prep and of course a procedureist is available

Breastfeeding patients: If the patient is breastfeeding, her infant can also usually be accommodated if there is a 3rd person present specifically to care for the infant. This is current 2015 policy per both our chief-of-staff and corporate nurse CEO.

When a patient asks to leave early: This may involve the art of mutual respect as well as the art of medicine and sometimes an interpreter. The key issues involve whether discharge now can be a viable plan and if not, the patient is asked to sign a “left Against Medical Advice (AMA)” form.

This of course does not apply to a “titled” BH, incarcerated or TB-isolated patient. The latter patient may require the rare order from our state TB control officer (see TB section above) to keep him inpatient.

Please feel free to consult a fellow clinician for advice.

Disruptive patients/family: see above 1st paragraph

No boarding: per Peds Group

Isolation: In addition to Universal Precautions on Northwing, patients requiring isolation fall into 3 categories

  1. Contact
  2. Droplet
  3. Airborne

All patients with the above isolation status have signs posted outside their room with instructions on how to responsibly enter. Also outside each isolated patient’s room should be a shelf or cart with the necessary protective equipment. Every nurse and physician should be fitted for the appropriate N-95 respirator.

In addition, washing (or antiseptic gel/lotion) before and after contact with any patient is our infection disease standard and is enforced. Northwing nurses/physicians have had a good history of compliance


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