PICU Transition to Adult Intermediate Care During the Pandemic

Authors: Sheila Levins, DNP, RN, NE-BC, CPN, and Amanda Simo, MSN, RN, CCRN, CNL

In mid-November 2020, the Pediatric Intensive Care Unit (PICU) was tasked with assisting in the care of adult ICU patients during the COVID-19 surge. The impact of the pandemic on the pediatric population was less severe than for adults and there was no surge in PICU patients. With our low census and high bed capacity, we converted 11 of the 18 beds for adult patients. The nursing leadership team assessed the probability of expanding the skill sets of the PICU nurses. It was determined that caring for adults with respiratory issues related to COVID-19 in an intermediate ICU capacity was the best match for PICU nurses’ skills and hospital expansion needs.

The 11 beds were in the southern end or U-shaped wing of the unit, where the entry area was converted to accommodate adult patients and patient supplies, Epic, airway carts, Pyxis and Philips monitoring. This physically separated provider staff and served as a specific location for registered nurses to locate providers when needed. Medical coverage was provided by the Medical Intensive Care Unit while nursing was provided by PICU volunteers with additional specific training. This unit was supported by the Critical Care Outreach Team with daily rounds and quick responses when any patient’s status escalated to ICU.

The interim nurse educator, Amanda Simo, MSN, RN, CCRN, CNL, created a self-study module to prepare the staff to have the necessary competencies: “Caring for the Adult ICU Patients in the Pediatric ICU during a COVID Surge, Respiratory Questions and Rationale.” Other educational self-study information provided to the staff included handouts and additional materials on advanced cardiac life support, COVID-19 MICU criteria, the policies on surge documentation, adult insulin and glucose stabilizer, patients under investigation and COVID-19 patient transfers. Amanda Simo was acknowledged for her contributions with the Magnet Course for Excellence Individual Award.

The new unit remained active between November 2020 and January 2021. We are extremely proud of this team, especially in light of there being no adverse outcomes such as falls, catheter-associated urinary tract infections, central line-associated bloodstream infections or codes in the unit during its operation.