transporting pts

Good morning,A little question I hope you can help me with:
1. Do you transport all patients with RN's?2. If not, do you have criteria to decide which patients need an RN for transport? Do you have a policy/protocol/guide you could share?3. How do you communicate report if an RN does not go and do you have a tool you could share?

Dayle Allen-Ackley RN

Visitation in PACU

Do you have standards or info on parental visitation in the PACU. We are developing a policy, but find there is little info available to review . Your help and guidance would beappreciated.

Thanks,
Cathy

Documentation

Do you have a standard of practice around the frequency and documentation of temperature in Phase II Recovery? Is it the same regardless of the type ofanesthetic (local, regional, neurolept, general)?

Jean
SJHC, London

Transfer of care

A question came up the other day regarding discharge from our Phase II Recovery. Our patients are generally escorted by wheelchair to their vehicles accompanied by our PSA and not the nurse. If a patient successfully meets the discharge criteria for Phase II Recovery, does accountability for that patient extend to the "door"?On occasion, patients have left Phase II Recovery and attended an outpaitient clinic, cast room, radiology for example after meeting discharge criteria for our unit. My thuoght is that we have a responsibility to ensure safety while under our "roof". What are your thoughts?

Thanks,Liz

Teaching Packages

Does anyone have a learning package on IV push or extubation that they are able to share?

Dayle

Frequency of VS with Epidural/PCA

We are reviewing our protocols around the frequency of VS with PCA, epidural, spinal analgesia (continuous or one shot neuraxial analgesia)

Thanks
Heather

Niagara

Tranporting patients

Who is transporting your patients to the nursing unit? We have an LPN (RNA; Practical nurse) who transports the patient by himself; an RN accompanies the LPN when the patient is in a bed or if the patient has a PCA / EPIDURAL INFUSION.
IT is being suggested that a porter could transport the patient. What qualifications are required for the person who transports your patients

Sharon

How to become a PACU nurse

I am interested in becoming a PACU nurse. What skills or courses are required?

Thanks
Steve

Narcotic counts

I would like to know how other PACU nurses document the waste of narcotic when you are on call and there is not a second RN to witness the waste. Do you leave it for the next regular shift to document the waste? This is aproblem for us since we don't have the patients chart to verify what was given. Or do you dispose of the narcotic without a second witness?

Thank you,
Anna

Conscious sedation

Would you be able to tell me what best practice currently is around conscious sedation in Ambulatory care clinics or Emergency departments? Who must be present for the procedures? I am loooking at updating a policy andprocedure. Thanks so much.

antiemetics

I work in a busy pacu in Owen Sound and would be interested in finding out about standards of care regarding the administration of antiemetics in the PACU. In particular, is there a delay in transporting a patient to floor or to Day Surgery for further recovery, after the administration of antiemetics, when all other parameters are OK?
Thanking you in advance,

Sheilah
Owen Sound

discharge criteria

Can you share your discharge criteria from PACU?
What are your criteria for when a only porter needs accompany a patient to a ward bed (day surgery or inpatient) and when a nurse must be present?

thanks in advance,
Evelyn

discharge home from PACU

Do the current standards provide support to deter the discharge home ofpatients directly from the PACU? We recently had a situation where the nightnurse was put in a position of discharging an elderly patient at midnight toher home post a general anesthetic for a fracture after falling.Thank you in advance for your feedback.

Sylvia

Medication Adminstration Records

Hi Everyone I have a quick question for you all. Do you use MARs in your PACU? We are heading this way for our ICU and longterm patients.(only) If you do use MARs, Do you also include the prn narcotics on the Mars or do they stay on the PACU record? Our staff is questioning removing these from the PACU flow sheet and putting them on the Mars. Thanks for your time. We are just wondering what other PACU are doing?
Lorna
PACU
Royal Columbian Hospital

neuro assessments

Does anyone have a teaching package for doing neuro assessments in PACU forpost-op spinal surgeries?

Staffing

I am team leader in the Operating Room and we are having difficulty in the answer to the following question. Is it recommended that there be 2 nurses present at all times in pacu (phase1 )when recovering a patient or can 1 person be available but not staffed in pacu?

thanks,
Elaine

documentation

I am revising the pacu flowsheet and would like to know what the exact requirements for documentation are. Are there any samples available? I recently purchased the new opana standards but it does not specify exactly what is required for documentation.
Thanks
Elaine

Nurse Anaesthetists

Can you please advise me if there are any nurse anaesthetists practicing in Ontario and if so, where are they getting their education to do this?
Thanks

Reta

Post C-section

I would like to know the criteria to follow before a C/S patient is accepted by a Maternity nurse who does not have any kind PACU training.

How long PACU nurse has to closely observe the patient?
When is a patient considered stable after C/S (post spinal or GA)?
What kind of assessment a Maternity nurse must do on a C/Section patient?
Please provide me with the above information, THANK YOU


Karmjit Kaur Sandhu
RN, BSN, CNE (temp)
MSA Hospital, Maternity
Ph (604) 853-2201 Ext 2642
Pager (604) 870-0041
Fax (604) 870-7590
karmjit.sandhu@fraserhealth.ca

OR- Time outs

What is your policy on marking of surgical site preop? Is a "time-out" consistently done prior to start of Sx with all staff present (surgeon, Anesthesiologist, OR Nurses, surgical assistant)?

IV sedation

I am looking for some information regarding discharge following I/V sedation, in particular, do you require that the patient (who has received I/V sedation) have a responsible adult stay with them for 24 hours, or just an escort home?

Daphne

monitoring- frequency

How frequently do you monitor vitals for pts receiving IV or Epidural analgesia?

spinals

Does your facility have a policy re: how to assess the sensory levels and motor blockade for patients receiving "plain old spinals" (no narcotics)? If so, would you be able to share?

Thanking you in advance for any assistance you may offer,
Sue

OSA

I would be interested to know if your PACU follows a sleep apnea protocol. Sleep apnea is becoming a hot topic amongst our anesthetists, yet some of our more "seasoned" staff feel that this is all "unecessary".
Thanks so much for your time and assistance.
Kathy, RN

Antibiotics Perioperatively

For total joint pts, when the pt has a penicillin allergy,what is your antibiotic of choice? Clindamycin or vancomycin or ?
Secondly, we have had a recent bunch of patients who have become hypothermic once they reach the nursing units.They had a reasonable core temp pre discharge from PACU.It does not seem to be anesthetist specific, thermometers in both areas are calibrated correctly, we are just wondering if anyone else has seen this and if so, what did you implement to "fix it".Appreciate all feedback, stay warm!

Leslie

continuous intercostal infusions

Does anyone have a policy on continuous intercostal infusions?

Thanks,
Daphne

Staffing in PACU Weekends

Can you please tell me what type of RN coverage you have on the weekend in the PACU and if you have additional staff on call on the weekend.
Thanks


Karen Wessel RN, BScN
Nurse Educator PACU/SACU/SDA
Southlake Regional Health Center
Newmarket, On

PADSS- endo

Hi everyone,for those who use a scoring system such as PADSS for endo pts, are you doing 2 vital sign checks on gastro pts if they return fully awake?

Leslie

PACU and Day surgery

IV meds in phase II areas

Does anyone give IV narcotics / antiemetics in their Day surgery to postop pts, and what monitoring do they receive? Our Day surgery staff do not currently give IV meds, as they feel the pt would require to have oxygen saturation and monitored for HR and B/P continuously while receiving these IV meds.


Thanks

Sharon Peabody BN RN
PACU
Saint John New Brunswick

Thanks

Sharon BN RN
PACU
Saint John New Brunswick

Protocols- colonosopy /bronch

I am wondering if anyone has any policies on Colonoscopy, Gastroscopy, Esophagoscopy or Enucleation.

Tracey

Recovery room layouts- designed for optimal visibility

Do any of you know of a PACU for OR patients, or other type of patients (i.e. Labour & delivery), where the layout is anything other than open concept with drapes between the stretcher bays?

Paula

Pt. Transfers from PACU

How many staff transport the patient? 2 staff
Who transfers the patient? 2 unit aides that work in PACU exclusively
Are there different policies for transfer to Same Day Surgery units (following GA) than for in patient units? Generally no, the pts must meet d/c criteria. An RN attends transfers for monitored pts and paeds.
How is transfer of care report given? By phone, unless ICU/step down/or paeds pt
If the nurse does not transfer the patient, are there specific criteria that must be met prior to transport by non-professional? Must meet d/c criteria, bromage score of 0, pain and nausea controlled.
Any comments/suggestions wil be appreciated.
Thanks,
Daphne
Daphne Whalen-Brake RN,BN
Clinical Educator SDC,PAC,PARR,
St.Clare's & General Sites,
Eastern Health,
St.John's,NL