Endoscopy units recovering phase 1 patients

[MommyRN15]

Looking for input from nurses on other endoscopy units. We have a mostly self-contained unit with our own pre-op and phase II recovery. Our general anesthesia patients go to the main PACU. However, they (PACU) want us to start recovering our own generals. Do other endoscopy units do this? I have never heard of this anywhere. We are concerned that this will not be safe for patients as well as not work for our high volume of outpatients. Any input from other endo nurses? Thanks!

[brownbook]

We recover patients who have received propofol from an anesthesiologist but are fine, awake and alert.

It it depends on what sedation was used, whether the patient is somewhat awake and alert when brought to recovery.

The term general anesthesia is too vague.

[MommyRN15]

You are right. What I mean is phase 1 recovery. So patients intubated and received succs, gas, and propofol.

[brownbook]

I don't think phase II is appropriate for intubated patients with succ and gas for anesthesia. DUH!

[MommyRN15]

Yes very stupid, but the issue is they want us to become phase 1. We don’t have the time or space for it, even if our nurses get trained properly. We have 6 PACU bays am do an average of 30 outpatients. When we work PACU we barely have time to move out our phase 2 patients before we run out of bays. They are asking for all kinds of trouble.

[MommyRN15]

Yes very stupid, but the issue is they want us to become phase 1. We don’t have the time or space for it, even if our nurses get trained properly. We have 6 PACU bays am do an average of 30 outpatients. When we work PACU we barely have time to move out our phase 2 patients before we run out of bays. They are asking for all kinds of trouble.

[brownbook]

It seems wrong.

I know this isn't anything to directly deal with your issues. I've worked/floated to GI nursing for 17 years. I've never seen or heard of succ, gas, intubated patients for endoscopy procedures.

[MommyRN15]

We do more than just egd/colons. We get some very sick patients so not every one is an easy sedation. Mostly patients will be intubated for first time ERCPs, EBUS cases and some other Bronchs depending on anesthesia and pulmonary preferences. Stretta cases,food bolus and foreign body. Active upper bleed. Nausea and vomiting to protect airway they will get tubed.

[brownbook]

Upper GI bleeds, we do in ICU, where they get admitted.

Never had an ERCP patient that needed intubation.

Irregardless neither you or I decide what anesthesia the patient will receive.

If the patient is so sick they need that level of anesthesia, they need 1-1 or 2-1, level I PACU recovery.

I would think the anesthesiologist would insist on level I PACU? Maybe you could take your concerns to them.

[kp2016]

I have worked in hospitals that had endo suites that did their own recoveries separate to the main PACU. But they actually had a Phase 1 area with appropriately trained staff. Their Phase 2 areas were not equipped to handle Phase 1 recovery.

I would start by giving the person proposing this a reality check. To ensure patients receive the appropriate care you are going to need the same equipment as the main PACU. Monitors with ECG capabilities, wall suction, O2, a stocked emergency cart with a defib, drugs, airway equipment. Also the staff with need ACLS training and training in Phase 1 recovery. I would suggest cross training in the main PACU. Be sure to check the policy/ procedure manual from the main PACU relating to the minimum Phase 1 stay after general anaesthesia with muscle relaxant, hint it's normally 45 minutes.

I would think failing to supply this equipment and maintain standards may cause some issues at their next Joint Commision visit. ASPAN has some very clear standards on these issues.

In terms of patient flow lack of space is bound to grind your quick turn overs to a halt. If you can do it without looking like a troublemaker sharing that info with the surgeons will likely get a swift response.

I'd also start taking to the anesthesia department, surely they can't be happy with this change. Use words like concerned re unsafe standards of care and patients receiving a lower standard of care than the main PACU patients.

[MommyRN15]

Thank you KP for such an awesome reply. I will definitely take your advice ?