I need an answer please

stevierae · Jul 16, 2004

i am a floor RN and have a question for all you OR nurses. Is it normal to not fully recover patients before sending them back up to the floor? I understand its the weekend or whatever..but to not have the pt recovered is just dangerous. I have ran into that TOOO many times..to the point where either the person coded or we had to Narcan them...please respond. This is frustrating.

This question is better directed to a PACU (Recovery Room)nurse--but, NO, it is not normal to send a patient to the floor without being fully recovered, either from general or spinal anesthesia, and the floor nurse can refuse to accept the patient until he or she is fully recovered.

Even if it is the weekend, a PACU nurse (in some institutions, 2 PACU nurses) come in to recover the patient. Each patient has very specific discharge criteria--that is, he may not be released to the floor until that discharge criteria is met.

The PACU nurse always calls report to the floor nurse who will be taking care of the patient. That report is expected to be accurate. If the PACU nurse says the patient is still a bit obtunded, or whatever, the floor nurse should refuse to accept him to her care until the appropriate discharge criteria (written on the PACU order sheet) is met.

What you are describing is indeed NOT the norm in any facility in which I have worked.

MelissaRN · Jul 16, 2004

In my experience we've had patients come up not fully recovered but two PACU nurses will come up and one will stay with the patient to ensure they don't need Narcan. Usually though they are pretty wide awake and alert.

sharann, BSN, RN · Jul 17, 2004

Are these patients being brought up unstable? They should not be(unless they were unstable before and are returning to a critical care area). We have criteria that are to be met prior to discharge from PACU (we use the Aldrete score) which the anesthesiologist determines (they say 8/10 is fine for d/c, or 5/10 is fine depending on the patients baseline) It is kinda like the Glasgow coma scale is used for LOC's. What unit do you work on and how often does this occur. Also are you sure that PACU is recovering these pts or are the OR nurses doing this?

carcha · Jul 18, 2004

Scary one this. I agree with a few posters, we too have criteria before we discharge post op patients. The exceptions being head injuries, young children , mentally challanged patients ect. However for just about everyone else one goes by how alert and co operative the patient is, vital signs, pain management, wound appearance, pulses, ect ect. I would never discharge a patient unless they were awake, comfortable, maintaining sats on room air ect ect. Any concern and the anaesthetist is called, I dont care what time it is. I am interested in the post about narcan though. The patient is sent back to the ward with 2 PACU nurses and one stays in case the patient "needs narcan", are u kidding me?. Are these patients still under general anaesthetic or what.

hospicemom · Jul 18, 2004

I work in the med surg area and yes it does happen more often then it should. since I have read what all of you have wrote I have stopped accepting pts who are not recovered fully. That has become the first question I ask when they call to give report......so I want to give a HUGE thank you to all who responded. Your advice has changed the way I practice medicine in this area and has proven to be successful. I have not gotten a pt who is not alert and oriented yet, since I wrote here. Thanks Again !!!!!!!!!!!

sharann, BSN, RN · Jul 19, 2004

Thats great Angie! I'm glad that things have improved for you(and your patients)

carcha · Jul 19, 2004

I feel good about posting on this site for the first time in ages Angie. Good luck.

hospicemom · Jul 19, 2004

I feel good about posting on this site for the first time in ages Angie. Good luck.

And I finally feel like I have somewhere to go for support.

nellie_nurse812 · Jul 20, 2004

You have every right to question this practice. We have specific guidelines for dc from pacu. So if our pts meet this then they are ready to go to the floor. This is not good standard of care....