Outstanding Critical Care with a Heart: Helping Patients and Families Through Life-Threatening Situations with Care and Compassion
The Intensive Care Department consists of two medical surgical ICUs, totaling 28 beds (ICU South = 12 beds; ICU North = 16 beds). The same critical care nursing staff covers both units. Both units are covered by an intensivist 24 hours a day. Critical care PAs are on the units 24/7. OB, Family Practice, and Internal Medicine residents rotate through the ICU North monthly. 24-hour care is delivered to the patient population (males and females ranging in age from 18 to 100+, with diverse cultural, social backgrounds and needs) an interdisciplinary care delivery team. Nurses are responsible for integration and coordination of this care. The intensive care nursing staff and critical care PAs support the code team and Rapid Response Team.
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- We will be recognized by the community for outstanding patient and family care delivered by a dedicated, clinically competent healthcare team.
- We will become a magnet ICU while being one of the country's outstanding critical care units.
- We are committed to team spirit, an environment of continuous learning and professional growth.
- We will be recognized as critical care nurse experts and viewed by our colleagues as resources to educate others in critical care.
- We will incorporate state of the art technologies and care treatment modalities into our practice.
- We will maximize patient outcomes by integrating care coordination with all health care team members.
- We will inspire confidence from patients and families and provide outstanding patient centered care by respecting the changing needs of the patients and families, valuing their contributions, and integrating families into the plan of care.
- We will maintain our mutually respected partnership between all spectrums of health care providers through continuous improvement in communication.
From Mike Willie, RN
Being a new graduate working in an ICU setting, I was terrified about many aspects of the job. I was unsure how much assistance I would get from other, more seasoned nurses. My fears were certainly unfounded. The staff welcomed me like a new brother into a big family. I feel comfortable approaching any staff member to ask for advice or to get answers for any questions I may have. I know that this team will do their best to make sure I succeed. I witness nurses from the ICU help all members of the health care team every day. When a new patient comes in, multiple staff members scurry to the room to assist each other and provide optimal patient care. The ICU nursing team members are also very good about coming in on days off, making sure difficult to staff shifts are covered and are willing to switch shifts to help out coworkers. The ICU nurses at MedStar Franklin Square truly are a team. I am very proud to be a part of that team.
Dr. Fleishman suspected a brain stem CVA of small vessels secondary to a hyper coagulation state due to her postpartum condition. In addition the dry CT, he also asked Blair Andrew - interventional radiologist - to do CT angiography which confirmed the brain stem CVA. It was clear that she met all of the criteria for tPA administration. Dr. Fleishman explained every thing to the patient whose speech was so affected that she could not make her wishes known, and to her obviously distraught family. They understood the explanation of the risks and it took them a bit of time to make up their mind. Meanwhile her NIH Stroke Scale numbers were increasing as her stroke was further evolving. Finally the family consented - the trust that the patient's mother had in Dr. Fleishman from her prior experience with him helped them to trust him this time - and the tPA was quickly started just within the 3-hour window for administration. It was almost miraculous to see the results of the medication! She very quickly started to show improvement and gradual reversal of her most noticeable disabilities and stroke symptoms. She was transferred to the ICU where she was met by Steve Selinger - intensivist and ICU director - and Amy Taylor who was to be her primary nurse. The ICU team took over monitoring her blood pressure, glucose, and other critical values during the next 24-hour period that was vital to her recovery after tPA. The following day, the patient shared with Amy that she had been breastfeeding and was worried that she wouldn't be able to continue this when she got home. Amy contacted Barbara Crist - lactation consultant - for advice. Barbara came to ICU to talk with the patient and the nurses about breast pumping and whether the breast milk was safe to save at this point considering the medications the patient had been given. The patient was given medical clearance to pump her breast milk and was advised to discard it while in the hospital. Barbara brought her a breast pump to use during her hospitalization. Her husband and his mother - who was helping him to care for the new baby at home - came to the ICU often, and brought the baby with them so that she could continue to bond with her child. After only a few days, she was transferred from ICU to 2SouthA, where she was cared for by direct care nurses Stacy Shimer and Lisa Dobry and continued to improve. While on 2South A, she started physical therapy with Julie Nowasky, and began working with Lisa Martterer, speech therapist. She was discharged from the hospital in about 5 days with little residual impairment, and she was given clearance to resume breastfeeding.
Amy Taylor, who cared for this patient in the ICU, shared this story. "After I had been caring for this young lady for several days, she shared her feelings with me about this experience. She said she was terrified and felt imprisoned in her own body. She told me about her ED experience. As Dr. Fleishman told her the possible consequences of the tPA, she was not able to express that she wanted the treatment, but on the inside she was screaming, 'PLEASE JUST GIVE ME THE DRUG!!!!!' After a full recovery she was discharged home with her husband and new baby. She was grateful for the rapid identification and intervention by the ED team and the ongoing care and personalized attention that she received in the Intensive Care Unit. MedStar Franklin Square not only saved her life, but restored her to her former level of functioning." This patient returns to see Dr Fleishman regularly and is back to normal. She is a healthy, young wife and mother of 2 toddlers who is fully functional today due to flawless collaboration among the healthcare team members including her husband who quickly called 911, the EMS crew who correctly identified her stroke, the MedStar Franklin Square ED nurses and physicians who assessed and treated her quickly and provided timely education to help the family understand the need for tPA, the radiologists, the neurologist, and the lab staff who were all in the right place when she needed them, and then the inpatient team of physicians and nurses from both ICU and 2SA, along with physical and speech therapists who collaborated in the continuation of her care until she was ready for discharge. Social services played a role in helping the husband and family to cope with the stress of caring for a newborn while juggling visit to the hospital and worrying about how well the patient would be able to function post-discharge. And the hospital chaplain was always available to provide extra support and prayer. This patient was so pleased with the care she received at MedStar Franklin Square that she actually came with her baby to meet with the Joint Commission surveyors when they visited MedStar Franklin Square several months later to review our application to be a Stroke Center of Excellence. By telling her personal story, she put a face on the difference that interdisciplinary collaboration made.
Caring Outside the Square
By Marcy Robbins, RN CCRN
My husband I went to feed the homeless around Christmas time. I was so very pleasantly surprised to also see Susan Lafko and Rani Mercado (both ICU nurses) there. You don't hear them saying, "I am going to feed the Homeless," or make a big deal about it. They quietly show up there and give their time without any recognition needed. I thought this was great.