DISCHARGE from PACU? Who does this?

[BABRNBSN]

My hospital is attempting to start a new practice of discharging the patient from PACU after hours. The patients used to go to the floor if SDS was already gone, now our CNO wants us to do it. We are a PACU of 4 and do 400-500 cases per month. We are already worked to death, besides this practice does not seem safe. Especially for pediatric patients who have had general anesthesia. WHAT IS EVERYONE ELSES STANDARD OF PRACTICE? (I'm new @ this as charge nurse.)

[penguin2]

We have had to dc patients home after SDC closes on several occasions and I agree that it is not a good practice. Especially when it's 1030PM and I'm the only RN on the unit and I have to get this hip reduction dressed and in a wheelchair while there is another case going in the OR that will be finished at any time. Often with limited resources, as you could imagine.

Just curious-what is your policy re: discharge after medications? My experience is that patients cannot leave for 30 min after receiving any meds.

[sharann, BSN, RN]

As far as I was aware, discharging from a designated Phase I PACU to home is a type 1 Joint Commission infraction. It is also unsafe and not right. The patient needs to be stepped down to a phase 2 level of care or a nursing unit where they can ambulate, have D/C education, void, eat and drink something small. You may work in a combined unit PACU where there this is possible, but you need more than one RN in there.

[debthern]

Just curious-what is your policy re: discharge after medications? My experience is that patients cannot leave for 30 min after receiving any meds.

We keep ours 30 minutes if they are going home and 20 if they are going to the floor

[Ortho_RN]

We have to discharge out of phase 1 quite often.. If Same Day Sx says they are busy and can't take the patient then we have to do it... Then they leave at 5:30 so any outpatient cases after that we must send home..

[ativanni]

i would like to know if there are hospitals that RN's do not transport. PEds patients.

[ativanni]

I think over the years, at least as I see it, PACu has become a "catch all".

We discharge to home on any given day and especially on weekends.

Why would discharging to home be any different then another department doing it?

You keep them until they meet your discharge criteria for PACU II and send them on their way. This is not any different then another unit doing it, use that criteria. As you get more comfortable it ends up saving time not to mention space. It can be a pain, anything new is, but this is going on everywhere!

[Pedi-Gree, BSN, RN]

How about discharging home from the ICU? That happens sometimes at the hospital where I work now, and fairly often where I used to work.

[Babs0512]

I work in a rural PACU, I too, would be the only person on duty at 2230.

We do not discharge from PACU. We move the patient to another floor to fully recover and then be discharged, however, in the event that the hospital is full, the PACU nurse is expected to move the patient to the adjoining Ambulatory Surgery unit (which is closed after hours and weekends) and the PACU nurse is expected to fininsh the recovery until d/c.

I have a HUGH problem with that. Due to the fact that as a PACU nurse, if I am on call, I can be called in any time, day or night. The ASU staff also takes call on weekend, 2nd call. They come in to "help" the PACU nurse in the event of a critical patient. I think that the PACU nurse should be able to call in the ASU nurse to take care of a patient on the ASU unit after hours so the PACU nurse can go home and get some sleep before the next case crops up. The nurse manger disagrees, quote "why inconvenience two nurses, if you're already here?"

We have a lousey nurse manager.

Blessings

[PACU'er]

We discharge patients at all hours. If it's late then the phase 1 nurse is the one who discharges. We interchange as phase 1 and phase 2 nurses.