Read Admission/Discharge Criteria Post Anesthesia Care Unit (PACU) (126.802) text version

PS1006

SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY

TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU) POLICY #: 139.1603 (PACU) 126.802 (Maternal) EFFECTIVE DATE: 1/88 REVISED DATE: 7/6/2011 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING NURSING CARE POLICY TYPE: PAGE: 1 of 7 Director of Perioperative Services

Job Title of Responsible Owner: PURPOSE:

POLICY STATEMENT:

To establish admission and discharge criteria for the post anesthesia patients as set forth by the Department of Anesthesia 1. Patients requiring intensive nursing care during the immediate post anesthetic phase will be admitted to the post anesthesia care units according to the criteria established in this department policy. Patients who have received anesthesia will be assessed on admission and monitored by the PACU RN. Based on this data, the RN will transfer the patient from the PACU when the established discharge criteria are met. The patient will be reassessed prior to the transfer. 2. All patients having vaginal deliveries in the delivery room, uncomplicated cesarean sections, or tubal sterilizations will be observed in the Obstetrical/PACU Satellite (OB/PACUS) or labor and delivery unit The following postoperative patients will not be admitted. a. Patients admitted to the Open Heart ICU for recovery b. Patients with intra-aortic balloon pumps will be cared for in collaboration with the director or designee of the appropriate unit. Obstetrical/Post Anesthesia Care Unit Satellite (OB/PACUS); A nursing unit located within the Obstetrical/Surgical Satellite (SOR) or Labor & Delivery Unit, which provides recovery and observation of patient. Admission Criteria: a. Patients who have undergone the following types of anesthesia will be admitted for intensive nursing care: 1. General Anesthesia 2. Spinal/Regional Anesthesia 3. Local/Stand-by Anesthesia at the discretion of the anesthesiologist and/or surgeon

EXCEPTIONS:

DEFINITIONS:

PROCEDURE:

TITLE:

ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU)

POLICY #: 139.1603 PAGE: 2 of 7

4. Moderate Sedation per SMH policy 00.PAT.38 b. Peri-operative patients requiring intensive nursing who have had their surgical procedure cancelled can be admitted at the discretion of the anesthesiologist or surgeon c. Procedures requiring an anesthesia provider, such as, but not limited to : 1. Joint manipulations, electro-convulsive therapy, line insertions 2. Procedures that may require sedation 3. Procedures done by the anesthesiologist such as epidural blood patch. d. Nursing personnel will follow established policies, procedures and standards of care pertaining to the immediate postoperative care of the patient. Discharge Criteria: A. The patient will have a discharge order from the anesthesiologist or surgeon. B. The following criteria will be met (see attached PACU Discharge Assessment Standards): 1. Level of Consciousness: a. behavior appropriate to situation b. arouses readily 2. Psychosocial: The patient expresses concerns and fears are addressed. 3. Respiratory: a. The patient maintains airway. Respirations are eupneic. b. Unless supplemental oxygen is ordered post-op, oxygen is discontinued 15 minutes prior to discharge. c. If there is an order for extubation, the patient is extubated and observed for 30-60 minutes prior to discharge. d. If the P02 is less than 92%, oxygen will be restarted at 2-4L/min via cannula per anesthesia order. e. If the patient is to remain intubated and/or ventilated after transfer from PACU, an order will be entered in SCM. 4. Cardiac: The patient's rhythm and rate are within the pre-op range. If any changes are noted, anesthesia will be notified.

TITLE:

ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU)

POLICY #: 139.1603 PAGE: 3 of 7

C.

D.

E.

F.

G.

5. Temperature: The patient's temperature will be between 96°F and 100°F. 6. Vital signs stability: Systolic blood pressure is within 20-50 points of patient's normal pressure. 7. Musculoskeletal: The patient's movement and strength is at a level equal to pre-op. Spinal patients will be able to move lower extremities or remain in PACU for one hour, which ever occurs first. 8. Pain: a. The patient is experiencing optimal comfort level achieved within safe physiological parameters. b. The patient is encouraged to self-report pain, using the visual/verbal analogue scale 0-10. c. The patient will be observed 15 minutes past the initial dose of opioids. d. If ordered by the surgeon, the patient controlled analgesia pump is initiated. 9. IV Site: the IV site is patent, without redness and swelling. Patients receiving spinal anesthesia will meet the previous criteria with the possible exception of #7. In addition, orders are written specific to the level of sensation/motor activity and/or time required. Patients receiving moderate sedation follow criteria in SMH Policy # 00.PAT.38 Moderate Sedation using the modified Aldrete Scoring System. (Document on the Moderate Sedation Record/ or SIS All post-op orders will be reviewed. STAT orders will be completed and documented. Anesthesia orders will be initiated and signed off electronically. The name of the anesthesiologist responsible for the patient on arrival to PACU will be documented on the PACU record. The PACU RN will document on the PACU record that discharge criteria are met prior to transfer. If the patient does not meet criteria, an explanation will be documented in the PACU record and anesthesia is consulted for discharge order.

Preparation for Transport and Transfer: A. Inform patient of transfer. B. Provide emotional support in an attempt to reassure the patient and allay fears. C. Document the following information in the electronic record (SIS for PACU, and QS for OB/PACUS).

TITLE:

ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU)

POLICY #: 139.1603 PAGE: 4 of 7

1. Discharge criteria met 2. Vial Signs 3. Transfer data 4. Signature and status D. Paper forms will be used in the event of computer downtime. Otherwise, the information will cross over electronically after PACU RN signs off chart in SIS, or OB/PACUS RN signs off chart in QS. E. Check and complete postoperative orders (pertaining to recovery phase). F. The anesthesiologist will write an order for transfer of the surgical patient from the PACU. G. A report will be given to the nurse assigned to patient where appropriate including the following information 1. Patient's admission number, date of birth, physician, and anesthesiologist 2. Type of anesthetic and procedure 3. Medication and intravenous fluids given/credit 4. Vital Signs and level of conscious as well as LOC prior to surgery 5. Status of dressings, drain tubes and lochia if an obstetrical patient 6. Intake and Output to include time patient voided 7. Allergies 8. Immediate postoperative surgical or medical complications, if any, during the recovery period 9. Review of unusual orders 10. General condition H. All patients will be transported from the PACU by a registered nurse, LPN, clinical technician, hospital/PACU transporter. I. All OB patients will be transported from OB/PACUS by a registered nurse or LPN.

RESPONSIBILITY:

REFERENCES:

It is the responsibility of the dept. directors to assure that medical and nursing staff are familiar with and adhere to this dept. policy Standards of Post Anesthesia Nursing Practice, American Society of PeriAnesthesia Nurses Standards, 2010-2012. Standards of Post-Anesthesia Care, American Society of Anesthesiologists, 2009. Retrieved March 21, 2011 from http://www.asahq.org/For-Healthcare-Professionals/StandardsGuidelines-and-Statements.aspx

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ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU)

POLICY #: 139.1603 PAGE: 5 of 7

Joint Commission E-dition v3.0.0.0 2011 © Joint Commission Resources State of Florida Agency for Health Care Administration (AHCA), 59A-3.2085, Hospital Licensure H4.00 AUTHOR(S): Loraine Butler, Director of Perioperative Services Pam Beitlich, Director of Maternal, Child Services Christina Henry, Clinical Manager, PACU Brent Hirschy, BSN, Clinical Practice Specialist, PACU Joanna Sabol, Clinical Manager, PACU, Cape Surgery Debbie Dietz, Advanced Practice Nurse Women's Services Dr. Terrylyn Bankes, Medical Director of Anesthesia a. ASA physical status classification b. PACU discharge assessment standards

ATTACHMENT(S):

TITLE:

ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU)

POLICY #: 139.1603 PAGE: 6 of 7

APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Date

Committee/Sections (if applicable): Anesthesia Department Clinical Practice Council Signature: Title: Lorraine Butler, Director Perioperative Services Signature: Title: Pam Beitlich, Director of Maternal, Child Services Signature: Title: Dr. Terrylyn Bankes, Medical Director of Anesthesia Signature: Title: Vice President/Administrative Director (if applicable): Signature: Name and Title: Jan Mauck, Vice President, Chief Nursing Officer

3/18/11 4/7/11

6/23/11

7/5/11

6/6/11

7/6/11

TITLE:

ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU)

POLICY #: 139.1603 PAGE: 7 of 7

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Admission/Discharge Criteria Post Anesthesia Care Unit (PACU) (126.802)

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