Published Jun 10, 2004
You are reading page 3 of Family Visitation in the PACU
Hey PACUJennifer, I agree with your post. The decision for family visits are up to the nurse. The doctor sometimes tells the family that they will be able to visit in a specified time, and when that doesn't happen, they get upset. I tell them that the doctor shouldn't have made that promise.
mama_d, BSN, RN
Not a PACU nurse here, but I've had two surgeries and my nine year old has had two surgeries, so this is just personal experience...
When I had outpt surg done, limited family was allowed once I was moved to a recovery area. I just had inpt surg done, my poor hubby got there just in time to give me a kiss before they whisked me off at 10 am, then waited for hours to see if I'd make it to a room (I didn't get to one until 1615...by which time he was gone b/c he had to pick our son up from afterschool club). It would have been nice if he'd been able to peep in for a couple of minutes to see me, since the wait to get a room was so long, but I can so see the potential for abuse of this. As it was, I was in there high on dilaudid going in and out while I could hear the nurses talking about TWO patients I have cared for repeatedly on the floor...I know I made some inappropiate comments about how their families just needed to give up and let them go (both were chronically ill, demented, no quality of life who had PEGs placed that day...go figure).
With our son, the first time he had tubes placed he was nine months old and we had to wait till he woke up, which I think was a huge mistake. You could hear him screaming bloody murder, echoing down the halls. The poor nurse was trying to rock him and give him a pacifier to settle him down; he was breastfed and just wanted to comfort nurse. I think from a mom perspective it would have been better if I would have been the one to be there when he woke up initially, but again from a nurse perspective I can see where it could be troublesome.
When he had his second set of tubes done and adenoids out, we were able to be with him as soon as he came out of surgery. I think it helped that we were right there when he started vomiting up some blood and were able to reassure him.
Mama d, I know it is frustrating (from personal experience) to wait and not see family in the recovery room. We try to get family in as soon as we can, especially with kids. Sometimes the patient wakes (or doesn't wake) with issues. Family can either hinder or help a situation, but we don't know what we'll get and during a crisis, we don't have time to deal with an extra situation. People (and kids) can and do crash on arrival to PACU.
For example, recently I received a young ped patient with an oral airway. He was breathing fine and his O2 was good. After 10 minutes, he just stopped breathing and went blue. I had been listening to his breath sounds with my stethascope and happen to hear the respirations cease. We started bagging and the anesthesiologist came. There was a good outcome. The mother wondered what had taken so long. I, and the doctor explained there was a little incident (we down-played it), but the mother was so alarmed and panicked. I was glad she hadn't been there.
I work in a unit with 7 OR's and 2 minor rooms...we allow family in PhI only if the pt is a minor (under 18) or in special cases....(medical problem etc...). BUT even this causes problems. Last week a family member fainted while watching a toddler being cared for, was unresponsive for 2 minutes with a period of being pulseless--so a code was called. Because this was not our patient and the person showed a sinus arrhythmia on the monitor, she now needed a transfer to the ED.
This is becoming more common. Family members are vasovagaling and now we have more patients than we started with.....not good.
PACU'er....Yeah, from a nursing standpoint, I can totally understand the issues involved. The whole nurse/mom thing can make you feel like you've got multiple personality disorder sometimes when the points of view can be so different!
Just curious what folks are doing now on this issue? There is research to support "family centered" care. My place of work is a Pediatric PACU in a large Children's hospital. We only allow parents in Phase I when the Phase II is backed up and the child is awake and screaming for their parent. Also, the charge nurse has the decision on whether or not we can bring in the parent. There are expressed concerns among staff about confidentiality, the high acuity of the area being frightening, etc. Many of our patients have ET tubes in place when they roll in.
There is no consistency in enforcing any visitation policy - even from nurse to nurse.
this is something that is happening elsewhere - in my institution alone it happens. we dont allow friends/families inside our PACU for various reasons (some mentioned in this thread). but sometimes, for fear of being reported to the upper management (in cases of "high profile clients" or relative doctors) some nurses do allow.
however sometimes, the doctors are the one who allow relatives inside PACU, so once there are other relatives who wish to visit, they simply mention that others were allowed by the doctor. of course, by their perception doctors are of high ranking people compared to nurses. then the threats start when we dont allow (which actually happened to me!)
in special cases like pedia or with psych problems we do allow.
IMO, there should be no visitors allowed excpet special cases.
My unit is almost strictly pediatric, though--what do you guys think about that? Should we allow parents in Phase I Pacu on a regular basis? We have 1 to 1 nursing in this area, but the bed spaces are close and only curtains between.
Southern Fried RN
I'll just throw my $0.02 in here.
Phase 1, no visitors UNLESS the patient has been there for a good length of time (hours), bed placement is nowhere is site, 1 or 2 people for 5 minutes, and only if there isn't a fresh post-op or someone crashing. Yes, it is harsh and some patients don't like it. No food or drink, maybe a few ice chips if the patient's been out awhile and the curtain is pulled.
I used to work in an open heart recovery where people could wander back anytime and I HATED it. Nope, sorry, don't have time to tell you what all those tubes and numbers mean. I'm just worried about the numbers that say 1.5 and 69/40 right now!
Anyways, Phase 2 allows 2 visitors to stay, and they provide food/drinks. If Phase 1 is really backed up holding for beds then we put all those people in one area and curtain it off from the rest of PACU. One nurse is assigned to that area and we allow limited visitors.
Pediatric patients, we just try to get out ASAP. We only do peds ENT cases (T&A or tubes) so there isn't really any reasons to hold them very long to warrant the parents coming in.
I have to say that it is all in the way you do your teaching with the family. I know that according to ASPAN they are trying to encourage more family visitation in the PACU. I work in a hospital based ambulatory surgery department. Our post-op area is a combined PACU/post-op so we do allow family and are very comfortable with it. We make sure the patient is stable, good pain control, minimal nausea and requesting family. If the patient does not want family we don't get them but keep the family informed. We do get parents/family of ped patients as soon as patient is awake and stable. If I am to receive a patient I just inform my other patient(s) and family that I may be busy for a little while. We truly have not had major problems and our patients and family like being able to see each other.
In response to the nurse that had to resusitate a visitor, aren't we there to help people whether they are our patients or not?
The unit i work in is piloting a visitation for family times as follows: you pt has to have been there for an hour before a visit can happen. at 45 min past the hour, our secretary makes an announcement that 'visitation will start in 10 minutes'. if you pt can't have visitors for whatever reason (usually pain control, anxiety, hemodynamic/ airway issues), the RN lets the secretary know so that she can call back to the waiting area to hold visitors for that patient for that hour.
10 minutes later, a waiting room rn/tech escorts families to PACU. Our secretary makes a loudspeaker announcement that 'it is now visiting time in the pacu'. it is made ABUNDANTLY clear prior to visitation that it is a 10 minute visit ONLY, and that when it is time to go, they must go. at the end of 10 minutes, the rn/tech will collect all family, and head back to waiting area. only 2 family members are allowed at a time. if different family members want to come the next hour, great.
hourly visitation can be held for a variety of reasons for the entire unit, but mainly if there is an airway issue / code event. if that happens, then visiting resumes the next hour provided that everything has resolved or at least calmed down.
a couple observations: for us, this works for several reasons
1)we are NOT an 1 huge room pacu with just curtains. We are 3 sided bays (imagine a rectangle with bays all around, secretary desk in middle with pyxis). this would be a disaster in the previous pacu i worked in, as it was TINY and has no privacy.
2)our secretary and waiting room staff are very hardcore/ firm with visitation. you have to be unified and present a strong front! otherwise you end up with people pushing all the limits you can get
3)we are mainly adult population. rarely do we get peds, and there is 1 family member allowed to sit with a peds pt, mainly due to space. the rest may come visit during the hourly visits
this is still not perfect, but seems to appease the urge for family to see their loved one after surgery. i realize that we are better staffed then most, so this helps too!
Things that would be even more helpful:
-when the surgeons talk to the family they tell them that it may be another hour before they come to recovery! i HATE it when the MDs say 'oh, they'll be done soon', when in actuality they haven't taken down the drapes, or even extubated yet!
-there should be a screening for visitors such as "do you feel sick when u see blood or medical stuff?" i had a visitor pass out and hit her head on the sharps box while doing so, and then her family told me "oh, she faints at the sight of blood". Well, don't come visit then on the off chance that you MAY see some!
PostOpPrincess, BSN, RN
PACU Phase I - Visitors allowed ONLY if their family has been waiting for hours (for 5 minutes at the most) and NOTHING ELSE is going on. Otherwise, NO.
PACU PHASE II - Expected so that family can obtain instructions. Feeding? Only juice and crackers. They can go get food when they are discharged.
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