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Our hospital recently took all on call from pacu and put all postops after 1800 in ICU for recovery. If icu is too busy the OR nurse (no ACLS) is left alone with pt in pacu. This happening anywhere else?
Yes - and it's not even new. Based on my experience with regulatory processes, there are a lot of pitfalls. There are some issues that have to be addressed if it's going to work.
1. ICU staff must be educated to the same standard as the PACU staff re: recovery competencies. This needs to be a formal process with documentation of everything. Afterward, the ICU staff have to have their PACU competency validated annually using the same processes as PACU staff.
2. Staffing cannot be compromised. So, if you are going to be recovering a patient, you have to meet the exact same PACU and ICU staffing standards at all times. Your 2:1 ICU patients cannot miraculously become 3:1 for a few hours while the ICU nurse is doing the recovery. Likewise, the PACU patient cannot be just dumped into the ICU mix & 'hope for the best'... they have to have the same amount of dedicated recover staff as they would receive in PACU. There needs to be documentation to prove this.
3. The environment must have all the same equipment that is available in PACU & it must be used in the same way... documented of course.
4. Transport of the PACU patient must be handled in the same way... just because they are in ICU does not mean that the 'temporary PACU' nurse can avoid physically accompanying the patient to their destination unit - even if it leaves the ICU shorthanded during that period of time (see #2).
Basically, it's a mess. It's much easier to accommodate if the patient's ultimate destination is going to be ICU anyway. But - if the patient has to be transported to another area after recovery.. that's where the real difficulties arise. I would recommend that a 'Plan B' be established for instances when it is just not feasible for ICU to recover. And these circumstances should be spelled out - ex: No empty beds, staff are fully assigned, no PACU-trained staff available, etc.
Good luck. Many of the hospitals I have dealt with tried to do this but reverted to the 'old model' after discovering that it did not result in any cost savings & did result in quality issues.
The OR nurses at my system aren't required to have ACLS either. I have it, but many don't and we don't have to recover pts. We operate 24/7 so if we had to recover a pt, we'd never have enough time to get our cases done.