PS1006 SARASOTA MEMORIAL HOSPITALDEPARTMENT POLICY TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNIT(PACU)POLICY #: 139.1603 (PACU) 126.802 aternal1/887/6/2011DEPARTMENTAL INTERDEPARTMENTAL 1 of 7 Job Title of Responsible Owner: Director of Perioperative establish admission and discharge criteria for the post anesthesia patients as set forth by the Department of Anesthesia POLICY STATEMENT: 1.
Patients requiring intensive nursing care during the 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 atient will be reassessed prior to the transfer.2.
All patients having vaginal deliveries in the delivery room, labor and delivery unit EXCEPTIONS:
The following postoperative patients will not be admitted.Patients admitted to the Open Heart ICU for recoveryappropriate unit. 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.PROCEDURE:
Criteria: atients who have undergone the following types of anesthesia will be admitted for intensive nursing care:General AnesthesiaSpinal/Regional AnesthesiaLocal/Standby Anesthesia at the discretion of the anesthesiologist and/or surgeon TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU) POLICY #: PAGE: 139.1603 2 of 7
4.Moderate Sedation per SMH policy 00.PAT.38 Perioperative patients requiring intensive nursing who have had their surgical procedure cancelled can be admittedat the discretion of the anesthesiologist orsurgeonProcedures requiring an anesthesia provider, such as, but not limited to :Joint manipulations, electroconvulsive therapy, line insertionsProcedures that may require sedationProcedures done by the anesthesiologist such as epidural blood patch.Nursing personnel will follow established policies, procedures and standards of care pertaining to the immediate postoperative care of the patient.Discharge CriteriaThe patient will have a discharge order from the anesthesiologist or surgeon.The following criteria will be met (see attached PACU Discharge Assessment Standards):Level of Consciousness:behavior appropriate to situationarouses readilyPsychosocial:
The patient expresses concerns and fears are addressed.Respiratory:The patient maintains airway.
Respirations are eupneic.Unless supplemental oxygen is ordered postop, oxygen is discontinued 15 minutes prior to discharge.If there is an order for extubation, the patient is extubated and observed for 3060 minutes prior to dischargeIf the P02 is less than 92%, oxygen will be restarted at 24L/min via cannula per anesthesia orderIf the patient is to remain intubated and/or ventilated after transfer from PACU, an order will be entered in SCMCardiac:
The patientsrhythm and rate are within the preop range.
If any changes are noted, anesthesia will be notified.
TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU) POLICY #: PAGE: 139.1603 3 of 7
5.Temperature: The patients temperature will be between 96Vitalsigns stability:
Systolic blood pressure is within 50 points of patientsnormal patientsmovement and strength is at a level equal to preSpinal patients will be able to move lower extremities or remain in PACU forwhich ever occurs first.Pain:The patient is experiencing optimal comfort level achieved within safe physiological parametersThe patient is encouraged to selfreport pain, using the visual/verbal analogue scale 0The patient will be observed 15 minutes past the initial dose of opioidsIf ordered by the surgeon, the patient controlled analgesia pump is initiated.
the IV site is patent, withoutredness and swellingPatients 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 moderatesedation follow criteria inSMHPolicy # 00.PAT.38 ModerateSedationusing the modified Aldrete Scoring System.(Document on the Moderate Sedation Record/ or SISAll postop 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:Inform patient of transfer.Provide emotional support in an attempt to reassure thepatient and allay fearsDocument 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 #: PAGE: 139.1603 4 of 7
1.Discharge criteria met Vial SignsTransfer dataSignature and statusPaper forms will be used in the event of computerdowntime.Otherwise, the information will cross over electronically after PACU RN signs off chart in SIS, or OB/PACUS RN signs off chart in QSCheck and complete postoperative orders (pertaining to recovery phase)The anesthesiologist will write an order for transfer of the surgical patient from the PACUA report will be given to the nurse assigned to patient where appropriate including the following informationatients admission numberdate of birth, physician, and anesthesiologistType of anesthetic and procedureMedication and intravenous fluids given/creditVital Signs and level of conscious as well as LOC prior to surgeryStatus of dressings, drain tubes and lochia if an obstetrical patientIntake and Output to include time patient voidedAllergiesImmediate postoperative surgical or medical complications, if any, during the recovery periodReview of unusual ordersGeneral conditionAll patients will be transported from the PACU by a registered nurse, LPN, clinical technician, hospital/PACU transporterAllOB patients will be transported from OB/PACUby a registered nurse or LPN.RESPONSIBILITY:
It is the responsibility of the dept.
directors to assure that medical and nursing staff are familiar with and adhere to this dept.policy REFERENCES:
Standards of Post Anesthesia Nursing Practice, American Society of PeriAnesthesia Nurses Standards, Standards of PostAnesthesia Care, American Society of Anesthesiologists,2009.Retrieved March 21, 2011 TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU) POLICY #: PAGE: 139.1603 5 of 7
Joint Commission Edition v188.8.131.52 2011
Joint Commission ResourcesState of Florida Agency for Health Care Administration (AHCA), 3.2085, Hospital Licensure H4.00 AUTHOR(S):
Loraine Butler, Director of Perioperative Services Pam Beitlich, Director of Maternal, Child ServicesChristina Henry, Clinical Manager,PACUBrent Hirschy, BSN, Clinical ractice pecialist, PACUJoanna Sabol, Clinical Manager, PACU, Cape SurgeryDebbie Dietz, Advanced Practice Nurse Womens ServicesDr.
Terrylyn Bankes, Medical Director of Anesthesia ATTACHMENT(S): a.
ASA physical status classification b.PACU discharge assessment standards
TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU) POLICY #: PAGE: 139.1603 6 of 7
/M00; 00; 00;/M00; 00; 00;APPROVALS:Signatures indicate approval of the new or reviewed/revised policy Date
Committee/Sections (if applicable):
Anesthesia Department 3/18/11 Clinical Practice : Lorraine Butler, Director Perioperative Beitlich, Director of Maternal, Child .
Terrylyn Bankes, Medical Director of Anesthesia
Vice President/Administrative Director (if applicableSignature:Name and Title: Jan Mauck, Vice President, Chief Nursing Officer
TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU) POLICY #: PAGE: 139.1603 7 of 7.