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Criteria for ICU Singles Charge for Patients Receiving 1:1 Care in an ICU Setting (9.03)

Criteria for ICU Singles Charge for Patients Receiving 1:1 Care in an ICU Setting (9.03) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.03

POLICY & PROCEDURE





Effective Date:
January 1, 2016

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.03

Original
Revision

Page 1
Of 4

Title: Criteria for ICU Singles Charge for
Patients Receiving 1:1 Care in an ICU
Setting




I. PURPOSE
Patients will be charged a higher daily care rate when they are admitted to selected inpatient units and
meet certain criteria as specified in the Policy section below.

II. POLICY
A. This Daily Care ICU Singled Care charge) applies only to the ICU units: TLC, Burn,
Neurosciences ICU, Cardiac ICU, Cardiothoracic (CT) Surgery Acuity Adaptable Unit and
Pediatric ICU.
B. Criteria for Daily Care ICU Singled Care charge
1. To receive this higher ICU charge, the patient would need to have received 1 on 1 care
from an RN for greater than 4 consecutive hours within a 24 hour period. Each 24 hour
period runs from 12:01 am through 11:59 pm. At 12:00 midnight, the appropriate patient
charge is captured for billing. This charge will be applied only when the 1 on 1 care of a
patient is warranted based upon the criteria for "singling" patients listed below.
C. Criteria for "Singling" Patients in an ICU setting
1. For a patient to be considered 1:1, at least one of the following criteria must be met. The
Care Team Leader (CTL) and nurse caring for the patient determine if the patient meets the
criteria for 1:1 nursing care ("singling").
Neonatal, Pediatric and Adult ICU 1:1 Staffing Criteria
Five characteristics help identify and guide the 1:1 staffing decision: Stability, Complexity, Vulnerability,
Resiliency and Predictability (AACN).

Characteristics Guiding Examples
Stability: Does the patient require
immediate intervention to maintain
stability 2 times or more in 1 hour,
with anticipation of a minimum of 4
hours

ξ Vital sign and clinical Instability:
 Requiring frequent assessments and/or
interventions
(physical/hemodynamic/pulmonary/neurologic)
 Some examples may include: multiple pressors,
CRRT, ECMO, VAD, IABP, post tPA, respiratory distress
requiring non-conventional ventilation
ξ Active Cooling and rewarming


POLICY & PROCEDURE





Effective Date:
January 1, 2016

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.03

Original
Revision

Page 2
Of 4

Title: Criteria for ICU Singles Charge for
Patients Receiving 1:1 Care in an ICU
Setting




ξ Acute bleeding
ξ Active resuscitation
ξ Extubated post-operative patients that have bypassed
PACU (Phase one recovery)
Complexity: Does the patient have
2 or more systems (body, family,
therapies) that require the nurse to
be at the bedside or off unit for a
minimum of 4 hours
ξ Moderate sedation and recovery
ξ Potential organ donors
ξ Multiple consecutive procedures (intubation, line
placement, road trips etc.)
ξ Advanced wound care
Vulnerability: Does the patient or
family require frequent
interventions for emotional support
that require the nurse to be at the
bedside 2 times or more in 1 hour
with anticipation of a minimum of 4
hours

ξ Complex teaching
ξ Ethical concerns
ξ OTD cases and end of life meetings
ξ Emotional trauma that requires coordination with other
support services
Resiliency: Is the patient in the
acute phase of illness and needs 2 or
more interventions in one hour or
constant registered nurse
monitoring to control confusion,
sensory overload and psychosis?
ξ Acute mental status changes requiring frequent nurse
assessment and/or interventions (alcohol withdrawal,
hyperactive delirium)
ξ Active titration of sedative or neuromuscular blockade
infusions requiring constant nurse monitoring
Predictability: What is the
trajectory of the illness? Can we see
potential for change?
ξ Reflect on the patient’s characteristics above. Can
medical knowledge of the diagnosis, trajectory of illness, or
recent changes in status help forecast care needs?

Reference:
Hartigan, R. C. (2000). Establishing criteria for 1: 1 staffing ratios. Critical Care Nurse, 20(2), 112.

*Exclusive to Pediatric 1:1 Staffing
Criteria



POLICY & PROCEDURE





Effective Date:
January 1, 2016

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.03

Original
Revision

Page 3
Of 4

Title: Criteria for ICU Singles Charge for
Patients Receiving 1:1 Care in an ICU
Setting




 Intubated pediatric patients
 Pediatric patients with an unstable airway (uncuffed endotracheal tube, recent
surgical ENT airway procedure or agitated)

See Policy 7.16: Admission & Discharge Criteria for Neonatal Intensive Care Unit
(NICU)
https://uconnect.wisc.edu/policies/clinical/uwhc-clinical/uwhc-wide/patient-support/716.policy




III. PROCESS
A. Application of the ICU Singled Care Charge:
1. The Care Team Leader (CTL) and nurse caring for the patient determine if the patient
meets the criteria for 1 to 1 nursing care ("singling"). If the criteria for an ICU Singled
Care charge are met, then this charge must be applied by updating the patient's
accommodation code from ICU to Singled Care. The Singled Care accommodation code
must remain in effect through midnight, when the patient charges are posted for the
previous 24 hour period. If the ICU Singled Care charge criteria have been met, the CTL is
responsible for communicating this to the Health Unit Coordinator (HUC).
2. It is the responsibility of each Nurse Manager to specify which staff member is accountable
for charge entry when a HUC is not working. Generally, the task of assuring correct
charges are reflected in the system will be assigned to either the Care Team Leader or the
Nurse caring for the patient when a HUC is not available. The assigned staff member is
responsible for entering the Singled Care accommodation code into Healthlink.
3. The defining criteria for an ICU Singles charge will be available 24/7 on uConnect for use
by staff.
B. Discontinuation of the ICU Singles Charge:
1. The ICU Singled Care charge will remain in effect until the criteria are no longer met. This
daily care charge must be evaluated for appropriateness prior to midnight on each day of
the patient stay. The nurse assigned to the patient will communicate with the Health Unit

POLICY & PROCEDURE





Effective Date:
January 1, 2016

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.03

Original
Revision

Page 4
Of 4

Title: Criteria for ICU Singles Charge for
Patients Receiving 1:1 Care in an ICU
Setting




coordinator (or appropriate delegated staff member) when the ICU Singled Care charge
should be discontinued. To discontinue this charge, the accommodation code is updated to
ICU.
2. It is the responsibility of each Nurse Manager to specify which staff member is accountable
for charge entry when a HUC is not working. Generally, the task of assuring correct
charges are reflected in the system will be assigned to either the Care Team Leader or the
Nurse caring for the patient when a HUC is not available. The assigned staff member is
responsible for entering the Singled Care accommodation code into Healthlink
C. Daily Patient Charge Review:
1. On a daily basis, the Manager or Manager's delegate (e.g. Care Team Leader/Senior Team
Member (STM) or Health Unit Coordinator) is responsible for reviewing all active charges
before midnight and for assuring that all patient charges are correct for the midnight charge
capture. Data pertinent to the daily care patient charges can be found in either the home
page patient list or the unit census snapshot report in Healthlink. Each morning the HUC
will review the log of singled patients and assure the accommodation code has been
changed to ICU for any patient "unsingled" the previous day.
2. On a daily basis, the Manager or Manager's delegate (e.g. Care Team Leader/STM or
Health Unit Coordinator) must review the Daily Activity Journal report (DAJ) which lists
all charges posted for a patient the previous midnight. A comparison of the DAJ with the
unit census snapshot run for the previous 24 hours will be conducted. Any patient charge
errors discovered as a result of this review will be corrected immediately. If the patient is
not yet discharged, corrections can be made in Healthlink by the unit staff. If the patient
has been discharged by the time the error is discovered, the unit staff will notify the
Admissions Department. Admissions will then correct the charge error when feasible to do
so.
IV. REVIEWED BY
A. Financial Officer for Nursing & Patient Care Services, January 2016
B. Clinical Directors, Med/Surg (TLC) and PICU, January 2016
C. Nursing Administrative Policy & Procedure Committee, January 2016

V. AUTHORED BY
Financial Officer for Nursing & Patient Care Services

POLICY & PROCEDURE





Effective Date:
January 1, 2016

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.03

Original
Revision

Page 5
Of 4

Title: Criteria for ICU Singles Charge for
Patients Receiving 1:1 Care in an ICU
Setting





SIGNED BY:

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services,
Chief Nursing Officer