Discharging vaginal/lap assist hysterectomy pt's home from PACU

[gizmopacurn]

we are currently starting to discharge hysterectomy patients home same day surgery from pacu. It is a mixed feeling about this in our unit. Some feel it is not safe and others feel it is no different than sending lap choles home. I am curious as to what other facilities are doing and if this has been the norm for them for a while or recently changed.

We are having a hard time discharging these pt's as they are so nauseous and painful and weak. The more pain meds we give the more they become sedate. It is a catch 22 to get them ready for dc to home. Also 70% of them can not pee before they go and that also delays them. We give a lot of fluid to help this but then they are still not able to go and end up having to straight cath them and start over, ugh!!! The RN's all cringe when they are assigned vag/hys to go home. Give me an ICU pt any day, that I know how to deal with.

I would really like any feedback on this or how to become more proficient/efficient on this.

[Rose_Queen, BSN, MSN, RN]

We never discharge straight from PACU. All patients go to our short stay observation unit, where those who are ready to be discharged are sent home and those who are felt not ready for discharge can spend the night without having spent most of the day in PACU, where visitors aren't allowed. Also frees up PACU slots for fresh post-op patients.

[gizmopacurn]

Thanks for the reply. Our unit had talks of turning part of it into short stay/observation but not sure what happened to that idea. Our unit also allows families back when the patient wakes up. It can be difficult sometimes when you are trying to discharge someone home in one bay with 2 family members allowed and then in the other bay you get a fresh post-op, who could either be inpatient or outpatient and the family is listening to the report from CRNA and what their surgery is and all the complications etc., sometimes it can get very awkward. So to have the pt and family there for 5-8hrs and then trying to take care of other pt's at the same time and transfers is difficult.

DO you know what the short stay/obsv nurses do to get these pt's home sooner or any hidden secrets that you can share?

[fitzfan82]

Yeah, we have a Phase 2 recovery area, so when the pt is stable (like when an inpatient would be dc to the floor) they go there to make sure they can pee, hold down food, pain is controlled, etc. It does take most of them a long time to pee. After a certain time phase 2 closes up and those pts are held in the PACU. Some lap hysterectomy end up back here...definitely would have been better to give them a room.