How do you triage in your PACU/ do breaks.

[emain86]

I'm a new RN at a PACU in a level 1 Trauma Center, but prior to this I worked as a medic in the PACU at a military hospital. We have a 14 bay recovery room ( there is another half but we don't have staff for it).

7 Nurses take patients, 2 nurses triage/relieve for breaks. Basically the OR calls nurse answers phone looks through the 9-12 page surgery schedule for the patient, writes down case # and procedure and hands it to nurse who is taking that patient.

Sometimes you end up with a nurse who has 2 patients the entire day because of a 7 hour bed delay. I'm thinking about a lined board where we put the patients last name and we have little magnets that say like transport, bed delay, same day, ICU. So that way when they are triaging they can try to even out the flow of the room a little better.

I'm also not used to getting breaks, in the service we just got a break when we could and scarfed down food as fast as possible... apparently it is a pretty big deal to get both their breaks in. 12 hour shift staff get one 45 minute break and one 30 minute break... which is obscene. Our two triage nurses relieve for break but I think if we had a board we could possibly triage it to where they just have nearby stations relieve each other for break.

I love my job and as crazy as it sounds. I plan on retiring from this job want to make it the best place to work as I can.

[meandragonbrett]

What state are you in? If you're in CA you have break nurses for a reason to maintain patient ratios. PACU can be a bit of a beast logistically when you have issues such as bed holds. Why have a board listing patients and what they are waiting on....do you not have somebody who functions as the charge nurse and coordinates all of that?

[emain86]

I live in Ohio. We do have a "charge nurse" and an additional nurse that works with her to relieve breaks. The problem I'm seeing is that they just write down on a sheet of paper whos turn it is to get a patient without really looking at whats in the room. They can't see everything and on top of that they have to cover breaks and answer phone and tell OR where patient's are going. Its hard to keep complete tabs on the entire room when relieving people for breaks.

Plus they usually aren't taking into account the type of patient you have. Half the time they can't even see. I just think it could help to organize things a little better. Like just because its your " turn " to get get a second patient doesn't mean that its best to give you another patient while you are in the process of getting your unit patient out. Also like today for instance one nurse literally had 2 patients for 6 hours due to bed delay. They could have easily had him relieve people for break while they took report on those patients and pretty much just watched them.

I'm just trying to see what other people do as I'm trying to come up with some kind of way to improve this process. I hate to be one of those people who jump in and try to change things, but something is not working with it and I'm the type of person who thinks having all the info right in front of you makes it easier to triage.

[SBPhilips]

We have a 14 bay recovery area, as well. We have a PACU 'log' that is kept on the computer as an excel spread sheet. Listed on there are the anticipated arrival time of a pt., name, surgeon, procedure, account number. We start our day with this. The charge nurse or unit secretary manages this as the day progresses. On there, we list which nurse gets which patient, into which bay, and what time the patient arrived. Once the patient arrives, we also list if they need a bed, or, if they've received an inpatient bed, which bed assignment it is. In addition, we have a white board with each nurses' name that gets checked when they are up next for a patient, in a rotation basis. We allow for variables for skipping a patient, such as a difficult patient, pediatric pt., etc. The log on the computer can be accessed by each nurse at their bay for a 'read only' purpose so they know what is going on. The charge or secretary knows who received which patient when, to help plan who gets the next patient. The computer spread sheet has really improved things for us compared to when we used to keep track of everything on many pieces of paper.

[SBPhilips]

Our unit is currently deducting hours from a nurse's scheduled work week if they are on call on the coming Saturday (or even a week night) in anticipation of the fact that they might get called in, to reduce potential overtime in the unit. There are, of course, times when the nurse is not called in and then they have not been able to reach their hours for the week. Is anyone working on a unit where this is being done? Does anyone have any recommendations as to how they are managing or avoiding overtime situations?

[emain86]

We have a 14 bay recovery area, as well. We have a PACU 'log' that is kept on the computer as an excel spread sheet. Listed on there are the anticipated arrival time of a pt., name, surgeon, procedure, account number. We start our day with this. The charge nurse or unit secretary manages this as the day progresses. On there, we list which nurse gets which patient, into which bay, and what time the patient arrived. Once the patient arrives, we also list if they need a bed, or, if they've received an inpatient bed, which bed assignment it is. In addition, we have a white board with each nurses' name that gets checked when they are up next for a patient, in a rotation basis. We allow for variables for skipping a patient, such as a difficult patient, pediatric pt., etc. The log on the computer can be accessed by each nurse at their bay for a 'read only' purpose so they know what is going on. The charge or secretary knows who received which patient when, to help plan who gets the next patient. The computer spread sheet has really improved things for us compared to when we used to keep track of everything on many pieces of paper.

Hmm a google drive type of spreadsheet could be handy. Maybe one that everyone can update on their own to add like bed delays/such. How did you make the log /spreadsheet available as a read only at each of the bays? I work with people who are very computer challenged but I just think these spreadsheets could help to improve the flow of patients.