Ok.... So nearly ALL our patients scheduled today came out in a three hour time span, like stacks of three at a time, killing us. At one point we are out of PACU bays, putting people on the edges with transport monitors. THEN we send total joints over to inhouse holding. THEN three more come out with an ICU at the end, all angry we have no where to put them and crazy impatient as we scramble to put them places.
One of our nurses is a long time PACU nurse with experience in other hospitals and said several places she worked the OR had to call and see if they could come out, and had to actually HOLD patients in the OR until their bay was available. Our OR chugs along completely unconscious of our capacity or resources, and we are all getting a bit worried about missing something, or not giving people enough attention.
Whats up in your PACUs?
Apr 20, '11
Our ORs have to call the PACU before leaving. The phone call not only alerts PACU that we are coming, but they also assign us a bay, so that we aren't coming out and it's a free-for-all where we go. If they can't take us, we will hold in the OR, or if it's that there are empty bays but no PACU nurse to staff, occasionally we will come out with the patient, but the CRNA must stay until a PACU nurse is available- this only happens on rare occasions where the PACU nurse may be on a transport to the ICU or calling report on a patient that the CNA is going to take upstairs.
Apr 21, '11
wow that sounds nice. For us its pot luck, when the doors open we have no idea which patient it is, or how big a case it was until they slide into a place. Knowing the size and severity would really help us to be better prepared and let the OR know right where to go. It seems like a better way to go. Thanks!!
Apr 23, '11
Rosey, as soon as your PACU is full, get the UM to inform the ORs that they have to wait until notified that there's a bay available. If you have transport monitors and O2, you can accommodate one or two more, but it's essential that you have sufficient staff to cover the load. When it's as busy as you describe, ICU patients should be woken up in theater and taken straight through by the anaesthetist to ICU. The UM should make that clear to the drs.
Apr 23, '11
LOL, THAT would be fantastic! Its been a huge issue lately, and I think the situation is going to be discussed in practice council. We do utilize the extra transport monitors with O2 on the sides to take extra folks. I have often wondered why in these instances ICU couldnt take their patients straight from the room, it makes sense and is an excellent point
Apr 29, '11
Yes, we put people on hold. If I don't have a slot to put a patient in then the CRNA has to wake the patient up themselves. I'm not having patients lined up in the halls with portable O2 and Monitors. Here lately, I've been having 4-5 rooms on hold for upwards of 45 minutes. It's been to the point where they are leaving the OR and taking folks straight back to Same Day Surgery and the floors.
Apr 30, '11
exactly what meandraggonbrett said. it is not safe for the o.r. crew just to bust through the pacu doors without some sort of phone report and to have pts being "waken up" recovered in the hallway. the o.r. crew will recover in the or until a pacu bed opens up or the pt is recovered enough to be transfered to the floor.
Apr 30, '11
Our OR's are required to call prior to coming to PACU. Plus we follow ASPAN standards. If there is not a bay available we will call them back as soon as one becomes clear. If there is not an RN available the CRNA can bring the pt out, but she remains the primary caregiver, monitoriing,medicating, and documenting care until someone is free, however long that may be. This has become more prominent with the rush to for the OR to reach turn over times to save money, while for our unit we are down 4 RN's.
Last edit by pacu72 on Apr 30, '11
: Reason: misspelling
May 3, '11
Rosey, please join ASPAN and purchase their standards. What you are describing sounds unsafe. Your management needs to know that there are published standards that they will be measured against if there is a sentinel event. It doesn't matter whether people in the department know about the standards. Believe me, the lawyers know about them and will be dancing a jig if the standards are not followed.
In short, an ICU patient is one on one. A nurse may have two phase one patients but only one with an airway.
ETA: I don't think you need to join ASPAN to buy the standards but it is a great organization and they have excellent educational seminars.
We have put ORs on hold when there is not a spot to place a patient. It does interrupt the flow of patients but it's the only safe way to handle it.
Jul 13, '11
I've worked in 2 different PACU's and both have to call out ahead of time to make sure there is a spot and nurse available to take the patient. At 1 hospital, it was a strict 30 min heads up and then 5-10 min before arrival. A mini report was always given when the OR calls PACU for the heads up. The other place was a 5-10 min heads up. No mini report, just the doctors case and we would look through the OR list to see what patient it was and what surgery they had. Unless it was an ICU case, we would then find out if they had lines or special equipment we needed to prepare for. If there was no spots/RN's available, the OR would hold. The docs would be extremely mad when this happens but that's just the way it goes. Everyone tries to discharge/transfer as soon as they can and we even have the nurse managers come out to help to expedite the flow. I would hate to work in a PACU setting where the OR can bring out however many patients they wanted whenever they wanted. The max ratio is 2 patients to 1 nurses no matter what. Ratio is there for a reason. Anything beyond that calls for unsafe practices and will either harm the patient or one's nursing license. Just my 2
Hopefully you can create some changes in your department for better and safer working conditions.
Jul 20, '11
i work in a level one trauma center( PACU rn for 18 out of my 27year career).. we have 30 OR's and we frequently put the OR on hold--happens pretty much 4 outof 5 days a week ( they dont like it!) if it is a long wait ( longer than about 20 minutes, you can bet the docs want to know WHY they are waiting and often have no problem calling the manager and saying " ummm fix the problem!"--- often, upper management comes to solve problem --always the problem is that the floors or ASU can't take the volume at which we are sending them... so STAFFING-- be it on the floors or ASU or wherever is the problem.....
and i can say that better managers work right beside you ... and we always explain to surgeons and anesthesiologists it is STAFFING.. need more nurses in other places of the hospital to handle the volume--teh docs always get it...
the administration NEVER GETS IT...
Jul 25, '11
My understanding is that where I work, yes the OR must hold until a spot opens up in PACU. Of course, when that happens, they all come out of the woodwork to help PACU get them moved out.
Aug 23, '11
I agree with all the posts. Our OR must call and we tell them where to call. There have been times when they forgot to call and there have been no bays and we turn them right around back to the OR. ASPAN is awesome. THey have a clinical practice forum that you can ask questions and not have to join. I have worked at 2 PACU's 1 a very busy Level 1 trauma center and they still call report 10-15 minutes before the patient is coming out. I don't agree with a portable monitor and O2 at a desk for a fresh post op. You are setting yourself up for a possible bad event. I would move a patient that is nearing the end of their recovery to the desk and put the fresh post op in a bay.