Is the pt recovered enough to come to Med/Surg?

[brenda-boo]

Does anyone out there have a problem with patients who seem to not quite be stable enough to come out of PACU/RR ? My experience has been recently we have pts who have a warmer on them in Recovery Room and they may get reversal agents but when we get them back, the temps are 94-96ish and they need the chin lift-jaw thrust movement because they are waaaaay too sedated. Does anyone have info on the criteria used to determine when to transfer a pt back to floor care - you know where the RN has 9 other pts and can't really babysit a bad one?

Would appreciate it and how come my surgeries seem to come back in twos just when I have half my floor staff gone to lunch? Help!

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[JillR]

God Brenda these patients sound WAY too unstable to be released for recovery. I know that our facility has a rating scale but I'm not sure what it all entails. I know that the patients MUST be alert enough to maintain their own airway. These are dangerous and unsafe situations and I would really take this to someone who cn make changes. Start with you immediate supervisor and go up. This is setting you and the facility up for a big law suit. Good luck.

[ratchit]

I usually work ICU but do some PACU here and there- there is usually a score- BP must be within 20percent (+ or -) of baseline, same with heart rate ad resp rate. Mentation must be close to baseline (PACU isn't a cure for Alzheimers! ), a little groggy is OK. They have to be awake enough to manage their own airway. If the patient had a spinal, must be able to move and have some sensation down to the toes. Have to wait 30 min after any IV narcotic (except PCA doses, epidural drips) and an hour after any IVF bolus for BP. Temp of at least 96. Pain must be controlled. Any important labs drawn in PACU (hct, potassium, etc) must have results and treatment in progress if needed. And after all that, an anesthesiologist has to sign them out of PACU in many places. If the BP is stable and the labs are OK takes about 2 hours for a general, depending on the procedure. Sounds like your unit is being used as phase 2 recovery... Good luck.