Caring for an Adult in a Pediatric Cardiac Intensive Care Unit

Last year I went to the Adult Congenital Heart Association Conference in Chicago with my zipper sister, Tracey. We both have tricuspid atresia, have had the Fontan procedure, and live in the same area. If that wasn’t enough of a bond, we also work together at a nationally-ranked pediatric hospital in the Cardiac Intensive Care Unit (CICU).

On our way to the conference, we discussed how many more adult patients we were seeing at our facility. It seemed like we were seeing more adult patients each year—at least anecdotally—but we didn’t have any hard, cold facts. We examined the difficulties that we thought we personally had with taking care of an adult patient in a pediatric center. Our conversation organically grew and we could tell that this was a project that we both were passionate about.

After we got back to work—with a real fire lit from the conference—we continued to talk about the care of an adult at our pediatric hospital and the unique challenges and opportunities that arise from that situation. After several lengthy conversations Tracey and I decided to create a task force to gather information, mostly from nursing staff about their knowledge base and comfort with taking care of the adult CICU patient.

Our adult care task force developed a survey to gauge the bedside nurses’ thoughts and feelings on different aspects of caring for the adult CICU patient. We talked about proper adult dosing for drugs, adult pain management, advance cardiac life support, and the comfort level of our nurses taking care of an adult patient. We also looked up some statistics and found that we are seeing an increase in adult patients, as well as their length of stay as the years progress.

With this data in hand, the task force has decided to take on a huge challenge to educate the nursing staff, the pharmacy staff, and biomedical engineering to change the IV pumps to allow adult dosing to be utilized easier, in addition to revamping the adult post-op critical care order set. An order set is a group of orders that the doctor can easily place when a patient is admitted.

Our task force quickly realized that this was going to be an extraordinary goal to complete. We have broken down each step, assigned different tasks to people and have worked very hard for the last 6 months.

My task is to create a frequently used drug card for a reference. We have a pediatric drug reference card that gives the nurses a quick double check of medication doses and we want to do the same thing for the adult patient. We’ve also created a poster to take to different nursing conferences to teach them about how we take care of adult patients in our CICU.

The further involved I get into this project the harder it is to look at it objectively. It is hard to think “What would I want my nurse to know?” So now ACHA friends, I look to you! If you were in a pediatric hospital in the Cardiac Intensive Care Unit, what would you want your nurse/care team to know?