PACU or ICU?

Results of a survey to the question:
"In your hospital, when there is a non-intubated post-operative patient to go to ICU, where is the patient recovered, in PACU or in ICU"?

1. From Sudbury Regional Hosptial - For our CardioVascularThoracic ICU, we recover all post-op patients that are intubated. However, patients that are not intubated post-op (I.e. lobectomy, pneumonectomy, urology and vascular post-ops) are recovered in PACU.
For our Medical-Surgical ICU they recover all of their own post-op patients whether they are intubated or not.

2. From Joseph Brant Memorial Hospital - The recovery of an ICU non-intubated patient for our facility is done in the ICU. These patients are transferred directly from the OR to the ICU. The decision was made due to the fact that these usually are our sickest patients.

3. From Hotel Dieu Grace Hospital- The non-vented ICU patients has always been a challenge, we have tried to send them directly to ICU but we have met much resistance, even when the patients are intubated we still have difficulty sending the patient to ICU. So currently we still recover the non-vented but we will continue to try to persuade the ICU to accept their patients, it would certainly help with the flow and it would not tie up one of our bay areas because sometimes the ICU staff does not come down to pick up the patient for 2-4 hours.

4. From Grey Bruce Health Services - all ICU patients are recovered directly in ICU whether intubated or non-intubated. ICU recovers all their own patients.

5. From Norfolk General Hospital- patient is recovered in PACU.

6. From KGH and HDH - Normally the patient is recovered in PACU.
* However, after hours, there have been times when:
the PACU RN goes to ICU with the patient and s/he 'recovers' the patient (i.e. airway management etc.) while the rest of the patient's care needs are managed by the ICU RN, or * the PACU RN goes to ICU with the patient and delivers all of the care to the patient.

7. From Huron Perth Healthcare Alliance- The pt goes directly to ICU unless the bed is not available yet.

8. From Cornwall Community Hospital - PACU (unless other reasons exist - hemodynamic monitoring, vasopressive drugs).

Use of Flumazenil (anexate)

Hello all,
what are your policies around administration of Flumazanil in PACU? Is there a minimum observation period after that is required, and how do you typically titrate/admin doses?
We rarely need to give such a benzo reversal.

Thanks!
Heather

Bipap and CPAP

I am looking for any policies or procedures around presurgical screening of patients who will use Bipap/CPAP perioperatively, consults, placement post surgery and management of equipment. Any would be helpful.
Thanks Maria
From GBHS

Care in Phase I & II Recovery- Q & A posted

Any concerns with patients being mobile enough to transfer to a reclining chair?
No, generally once the patients are awake, have their oxygen off, respond appropriately, we sit them on the edge of the stretcher and if they feel steady, transfer a couple of feet to the chair.

How do you monitor the patients? Portable Sat monitor with pulse; and a mobile BP unit for routine VS.

What is you post-op vital sign policy? Q15 min in Phase I (sometimes this is 10 minutes, depending on the patient ~ refer to your discharge criteria), then on transfer to Phase II, and on discharge from Phase II and if any adverse events.

How many chairs per room? We have 14 chairs for 11 OR's

Do they each have call bell access? No, the staff are in the wide open area where all chairs are located. 1:5 staffing for Phase II Recovery (see OPANA Standards), and a minimum of two staff assigned. As the number of patients decreases, one of the two moves to the PACU (Phase I) side of the room.

How close is the bathroom? Variable depending on the location of the chair: anywhere from 8 feet to 25 feet.
Are they assisted up to the BR each time or only the first time and then prn? The first time with a nurse, usually they only go once, but if a second visit is required, the family may accompany them depending on their status. This Phase could be as little as one half hour, again depending on the length of surgery/anesthetic, type of surgery, age of pt. etc.
Can family sit with them? Yes, we are focussed on Patient/Family Centred Care. The family may visit in PACU for 1 - 2 minutes

Discharge criteria following Spinal

Hi all,I'm interested in knowing what you have for discharge criteria for DaySurgery Spinal patients. Specifically in regards to voiding. I sure wouldappreciate your response to this question.Happy Holidays
Joan

Preop Versed for Paeds

Seasons Greetings everyone... question for you today:
1.What is everyone's policies out there about peds pts getting versed pre-op-are they accompanied to the OR by a nurse or just a porter?
Thanks!
Leslie Manary
Nurse Clinician, PACU and Day Surgery
North Bay General Hospital

Orientation Period

Good morning.

My name is Joe Cheechoo and I am the Clinical Team Leader of the Operating Room Suite here at Weeneebayko General Hospital in Moose Factory, Ontario.

My question today is:

What is the recommended time frame to train a general duty nurse to circulate, scrub and work in the PACU?

I would appreciate receiving some guidelines with which we can use to provide safe perioperative nursing care to the population that we serve.

Thank you kindly for your assistance.

Joe Cheechoo

Propofol in PACU

Hello Perianesthesia Nurses,
What are your practices around running Propofol infusions on patients in PACU? We are seeing this periodically for complex pts who need continued mechanical ventilation postop, but there are no available ICU beds.

Thanks,
Heather
Trillium Health Centre, Mississauga