ICU Assignment Process During Pandemic

There will be a team approach to managing a group of 12-14 pts within each unit.
Each team will consist of staff MD, Fellow and ICU RNs and non-ICU RNs. A team lead
RN will be identified by management and will, if at all possible, have less bedside
responsibilities.
Rounds will start 715am for each team. The previous shift team will give report to the
oncoming team. A report sheet with check boxes will be used to speed the process and
ensure all issues are addressed. This ensures all team members are aware of the patient as
they will be responsible for the care during break relief.
Team will identify who is able to be transferred and will underline the patient’s name on
the white board.
Each team is responsible for the care of the patients in their cohort.
Once the teams have completed rounds, a central debrief will occur to identify any
patients who are too critical to not have increased ICU staffing ratios.
The names and services of the patients for transfer will be given to the flow team to
assign ward/stepdown beds
Report will be given to ward RN by phone from the ICU RN and the patient will be
transferred by a non-ICU RN/PCA & transportation as deemed appropriate
Rounds will occur in the evening (TBD) & patients will again be identified ready for
transfer and staffing ratios prior to night staff arriving
Staffing ratios will have to be assessed on an on going basis to recognize the safety of
critical patients and assignments might change without notice if necessary

Staffing model of each team:

Consists of MD, Fellow, ICU RN, non-ICU RN and PCAs

Ideally, 1:1 patient nursing ratio will be reserved for:
Vented, unstable, multiple Inotropes and additional devices needed to maintain life
Although, we agree with this model in principle, staffing constraints may not allow for
this model.

Based on normal staff numbers available per shift & 30 % sick rate, 16 ICU RNs should
be available to care for 32 ICU beds opening in CVICU space on 2GW, 18 ICU RNS
should be available to care for 36 ICU beds opening in MSICU space on 10 PMB and 8
RNs should be available to care for 14 ICU beds in CICU plus respond to Code Blues
and STEMIs.
We will begin with a 1:2 ratio and move to 1:3 ratio as patient volumes increase and the
need to open additional ICU spaces outside of our current ICU locations.

Support will be provided by non-ICU RNs in a team nursing model

With a 1:2 ICU RN/pt ratio, non-ICU RNs would be staffed at a 1:4 ratio
With a 1:3 ICU RN/pt ratio, non-ICU RNs would be staffed at a 1:2 ratio

March 26 2020
Roles of nurses in a 1:2 ICU RN model
ICU RN: 1. Hemodynamic monitoring
2. Shift assessment & documentation of care in the ICU surge flow sheet
3. Medication administration
4. Line removal & assist with insertions if needed
5. Managing instability and weaning of medications
6. Obtaining, processing and follow up of blood work and tests
7. Relieve another ICU RN for breaks
8. Notify MD of any issues

Non- ICU RN:

1. Basic care including turning, bathing, mobilizing, skin care and assessment and
mouthcare
2. Gathering of supplies for ICU RN
3. Transferring pts to stepdown/ward as required
4. Relieve non-ICU RN for breaks
5. Suctioning & administering oxygen and monitoring oxygen saturation
6. Report any abnormal findings to ICU RN
a) changes in heart rate/abnormal beats, blood pressure, oxygen saturation,
urine output, neurological status ( ie confusion, aggressiveness or
somnolence) and temperature
b) Vomiting
c) Pain
d) IVs drips running low
e) Alarms going off
f) Patient gagging on oral endotracheal tube
g) Any signs of bleeding from dressings, sites or GI tract
h) Loss of lines or non-functioning lines
i) Change in limb warmth, colour or loss of pulses
7. Assist with obtaining fluid balances at shift change
8. Document on ICU flow sheet all fluids given as well as IV solutions hung
9. Documentation of care provided on ICU surge flow sheet

Roles of nurses in a 1:3 ICU RN model

ICU RN: 1. hemodynamic monitoring
2. shift assessment & charting
3. medication administration of restricted ICU drugs
4. line removal & assist with insertions if needed
5. managing instability and weaning of medications
6. Obtaining, processing and follow up of blood work and tests
7. Relieve another ICU RN for breaks
Non- ICU RN:
1.Basic care including turning, bathing, mobilizing, skin care and assessment and
mouthcare
2.Gathering of supplies for ICU RN
3.Transferring pts to stepdown/ward as required

March 26 2020
 4.Relieve non-ICU RN for breaks
5.Suctioning & administering oxygen and monitoring oxygen saturation
6.Report any abnormal findings to ICU RN
a) changes in heart rate/abnormal beats, blood pressure, oxygen saturation,
urine output, neurological status ( ie confusion, aggressiveness or
somnolence) and temperature
b) Vomiting
c) Pain
d) IVs drips running low
e) Alarms going off
f) Patient gagging on oral endotracheal tube
g) Any signs of bleeding from dressings, sites or GI tract
h) Loss of lines or non-functioning lines
i) Change in limb warmth, colour or loss of pulses

7. Assist with procedures

8. Obtain blood work from art line or peripheral stab
9. Administer all non restricted meds
10. Assist with obtaining fluid balances at shift change
11. Document on ICU flow sheet all fluids given as well as IV solutions hung
12. Documentation of care provided on ICU surge flow sheet

Patient assignment

Efforts will be made to assign ICU RNs to patients within their scope ie. MSICU RN to
lung transplant and CVICU RN to emergency cardiac surgery patient etc but this may not
always be possible due to staff/patient mix. A resource manual of quick tips on specific
patient populations will be provided to assist the ICU and non-ICU RN with care and
MDs will be available to assist with information and plan of care.

RNs will report to the unit and gather in the education room to receive assignment. An
assignment sheet will identify each team, its members for the shift and the rooms
assigned. Each team member will fill out a name tag with their name and service
(possibly colour coded by service). They will then gather as a team to receive report from
the previous shift staff.

Each team under the guidance of the Team lead RN will assign each RN to specific
patients and tasks as outlined in the models of care for 1:2 or 1:3 nursing ratios using ICU
and non-ICU nursing staff. If staffing issues are identified, they are to be brought to the
attention of management so an effort can be made to address concerns.

March 26 2020
Principles of Breaks

1. Everyone is entitled to a break

Breaks will be limited to ONA/CUPE contract
Break rotations will begin:
Break at 830am for 20 minutes
Lunch at 1130 for 45 minutes
Break at 1400 for 20 minutes
Break at 1700 for 20 minutes.
2.
3. The Team lead RN will use a break assignment sheet to assign break times for
their shift and this will be done for both day & night shifts.
4. ICU RNs will cover another ICU RNs assignment
5. A non-ICU RN will cover a non-ICU assignment
6. Ideally, the ICU & non-ICU RN with the same patient assignment will be
assigned different break times but this may not always be possible due to overlap
of assignments and schedules of care.

March 26 2020